Wolstan & Goldberg Eye Associates is currently contracted with Medicare, the Torrance Health Independent Physicians Association (THIPA) HMO plan, and approximately 600 different types of private medical and vision insurance plans. There are 2 types of insurance that can be used for eye care, and they can get very confusing.
- Vision Insurances (VSP or MESC) can be used if you are in need of a prescription for glasses or contact lenses, or you have noticed that your vision is not what it used to be and you want to see if glasses or contact lenses will help.
- Medical Insurances (Medicare, Anthem, HealthNet, etc.) cover things like infection or injury to the eye, or problems like cataracts, glaucoma, or retinal damage. They cover services that are deemed necessary by the insurance to maintain the health of the eye.
“What will my insurance cover?”
The short answer to this question is that your insurance will cover whatever is designated in your specific plan, and in cases of medical insurance, whatever the insurance deems or agrees is “medically necessary”. That term, “medically necessary” is where confusion sets in. Cataract surgery is generally covered because there is no other non-surgical way to correct a cataract. However, if someone chooses to have their cataract surgery performed with one of the advanced lens implants or with the laser, those options are not covered. As long as a patient is able to wear glasses, whether or not the patient likes them or is comfortable with them, it is not necessary to perform surgery with a specialized lens implant or with the laser. Another popular procedure that is usually NOT covered by insurance is Blepharoplasty, or eye lid lift. Medicare is very strict about when or IF they will cover a lid surgery. The surgeon has to be able to prove to the insurance’s satisfaction that a patient’s eye lid is significantly interfering with the patient’s vision.
One of the main priorities of our practice is that our patients get the care they need, and that the insurance is being utilized in the patient’s best interest. Our staff would be happy to make an inquiry to see if we are able to work with your insurance, or to clarify what might or might not be covered under your plan.
At the end of the day, if a patient needs care and either has no insurance or the insurance will not cover the care that is recommended, we offer financing through CareCredit. Please consult our “Financing” page for more information.