Health and Vision Insurance
We accept most major insurance plans including:
- Blue Cross Blue Shield
- Tufts Health Plan
- Harvard Pilgrim Health Care
- Fallon Community Healthcare
- Mass Health
We will bill your insurance for your eye exam, but co-payments and payments for services not covered by insurance are expected at the time of your visit. Patients with a high deductible who are anticipating surgery may be required to pay a portion of their deductible in advance of the surgery. We accept major credit cards, including VISA, MasterCard and Discover Card.
Insurance Coverage for Eye Exams
Most insurance plans cover an eye exam for a specific medical problem, but not all insurances cover “routine” eye care, i.e., meaning you have to come in for an eye examination without any medical eye problem and there are no symptoms except for a change in your vision that can be corrected with eyeglasses or contact lenses.
Some insurance plans cover “routine” eye exams, but limit the frequency to every 12 or 24 months. Some medical insurance plans “carve out” their routine eye care to vision plans, such as EyeMed or VSP. Vision plans often limit their coverage for a “routine” eye care to one examination every 12 or 24 months.
While we try to ensure exams are covered by your insurance, patients should contact their insurance if they are unsure of what will be covered.
Referrals from your Primary Care Doctor
If you are covered by a managed care plan (e.g., HMO) you will need to obtain a referral from your primary care physician before your exam. Obtaining a referral as a requirement of your insurance plan does not guarantee coverage for a “routine” eye exam unless you are eligible for this type of coverage. With the exception of an urgent medical visit (when it is not possible to obtain a referral prior to your exam), your appointment will be rescheduled to a later date when a referral is available.
Medicare, as a primary insurance, does not require referrals but some supplemental or replacement plans do.