What is the difference between medical insurance and vision insurance and why do I need both?
Medical (or health) insurance is the regular insurance you use when going to the doctor. It covers you when you are sick, need surgery or a procedure and some preventative care such as your yearly checkup.
Vision insurance covers “routine” eyecare. This refers to your yearly eye exam for glasses or contacts when no other medical diagnosis is present. The doctor will check the health of your eyes at this exam, but if your eyes are healthy it is considered a routine visit. When there is another diagnosis or condition present which would affect the health of your eyes, it is considered a medical visit. Some examples of these conditions are diabetes, glaucoma or cataracts. Sometimes if you are taking certain medications, our doctors will need to monitor your eyes for negative side effects and report back to your primary care provider. These visits are also considered medical and can be filed with your health insurance.
I don’t have any medical conditions which affect my eyes- why do you need my medical insurance information?
Sometimes you may visit us for a reason other than your yearly eye exam. You may injure your eye or have an infection or be experiencing dry or allergic eyes. These visits are medical in nature and your medical insurance will likely help cover them. We put your medical insurance information in our system so if you ever need to use it for the visit, it’s ready to go.
FYI: some tests will not be covered by medical or vision insurance at all. Things such as retinal imaging, contact lens evaluations or refractions may require out of pocket copays. We will always inform you when that is the case.
How does insurance work regarding contact lenses or eyeglasses?
Medical insurance will not pay for glasses or contact lenses except in extremely rare cases.
Routine vision insurance will help you to pay for part or all of these items depending on your plan. Most plans will allow one pair of glasses OR contact lenses within a one year period. Some plans will provide coverage for glasses or contacts just every other year. Some plans will provide spectacle lenses or contact lens coverage every year but frames only every other year. We are happy to look up your coverage and explain the details to you. There will likely be copays on your glasses or contacts and any options added to glasses such as progressive lenses, anti-reflective coatings or transitions will have charges that are specified by your plan. Our staff is very well educated in all the various plans and will strive to help you maximize your available benefits. We will also file all in network benefits on your behalf.
My plan covers medically necessary contact lenses. I need my contacts to see- why aren’t they covered under this?
Some plans will cover contacts which are necessary medically and is a great benefit for those who qualify. However, the requirements for medically necessary coverage are very strict and specific and most will not qualify. The truth is, qualifying is not necessarily a “good” thing. Medically necessary contact lenses are non-elective contact lenses prescribed when certain medical conditions hinder vision correction through regular eyeglasses and contact lenses. With some medical conditions, patients are unable to achieve a specified level of visual acuity or performance through regular eyeglasses.
Such medical conditions include:
Aphakia – the removal or absence of the lens of the eye(s) due to surgery, injury, or abnormality.
Anisometrophia – a refractive condition where the eyes have unequal focus or optical power
Keratoconus – an eye disease that causes structural damage to the eye’s cornea, changing from the normal, round shape to a bulging, cone shape.
I have cataracts and need surgery. Which insurance will help pay for that?
Cataract surgery will fall under your medical insurance benefits. There is usually some out of pocket cost associated with this procedure as well.
What about Lasik?
Lasik surgery is considered cosmetic and will not likely be covered. However, some vision insurance plans offer a pre-arranged discounted fee with some providers.
Can I use my Health Savings Account (HSA) or my Flexible Spending Account (FSA) to pay for my eyecare?
Absolutely! All eye exams – routine and medical qualify for HSA and FSA and you can also use those cards to pay for your glasses and contact lenses. We are happy to provide you with detailed receipts to turn in as well.
Hopefully, this clears up some of the questions surrounding insurance coverage and eyecare. And, our staff is always available to help with your concerns and happy to answer any additional questions you may have!
If you are over the age of 60, there’s a very good chance that you will develop cataracts within the next 20 years or so.
A cataract is the result of the natural lens inside of your eye becoming cloudy. It’s caused by the proteins in the lens breaking down- most commonly related to age- and it leads to progressively worsening vision. The only way to permanently cure a cataract is with surgery but it can take many years before a cataract reaches the point where it needs to be surgically removed. Until that time, it is important to have regular eye exams to allow your optometrist to monitor the progression of your cataract, manage your symptoms and to make sure you have the best vision possible. Your optometrist will adjust your contact lens or eyeglass prescription as needed and will also perform visual acuity test and other tests to gauge increased sensitivity to light and glare as well as deterioration in your color vision and visual contrast.
Time for Surgery:
At some point, updating your prescription may no longer work to give you the vision you need, and your optometrist will determine that it’s time for surgery. The doctor will then recommend an ophthalmologist to perform the surgery. At Koetting Eye center, our doctors work closely with most surgeons in the area and will comanage your care. This means that we are in constant communication with the ophthalmologist and that we will perform the follow-up care to your surgery in our office and report all findings back to them.
Once you have been referred to the surgeon, you will make an initial appointment with them for consultation. At this point, they will discuss the options for the artificial lenses to be implanted in your eye to replace your natural lenses. If you are a contact lens wearer, you may be asked to stop wearing your contacts for a certain period of time before you return for your pre-operative exam with the surgeon.
At the pre-operative exam they will determine the prescription and measurements of the lens to be implanted. This new lens will also correct your vision so that depending upon the type of lens chosen, once the surgery is completed you may only need glasses for reading or perhaps you may not need glasses at all!
Once you have had this exam, you will be given a date for the surgery on your first eye. If you have cataracts in both eyes you’ll likely get two separate surgeries a few weeks apart. This gives the first eye a chance to heal.
Surgery Day:
You will probably be asked not to eat or drink for 12 hours before the surgery.
You will be awake during the surgery but your eye will be numb so you will not feel any pain. You will likely have an IV and be given medication to help you relax.
Surgery typically takes less than an hour, and you will not need to stay overnight, but you will need someone to drive you home. Most people will notice that their vision is already improving immediately after the surgery but it will take about 8 weeks to heal completely and you will be given a regimen of eyedrops to use in the weeks following the procedure. It is important to use the drops as directed in order to heal properly, prevent infection and achieve the best possible result.
The Next Day and Beyond:
When our doctors comanage your care, you will see us the day after your surgery for the follow up visit. You will also return for follow up one week later and again one month after the initial surgery date. Once it’s clear that the first eye is healing as expected, you should be given an appointment to begin the process on the second eye if needed.
A Few Helpful Details:
Since the procedure is surgical, the doctor visits and the surgery itself will be filed under your medical insurance, but there is typically some out of pocket cost involved.
As you are waiting for the first eye to heal, that lens will be removed from your glasses so you can still see with both eyes – or if you wear contacts, you can continue to wear a contact lens in the non-surgical eye in order to see properly.
Once the natural lens in your eye is replaced with the artificial lens, you will never get another cataract. However, sometimes several years after your surgery the capsule or tissue in your eye which holds the lens in place can become cloudy or wrinkled causing blurred vision. This is sometimes called a “secondary cataract” or “scar tissue”. This is resolved by a simple procedure with a YAG laser (called a YAG capsulotomy) which will make your vision clear once again.
The Good News:
Cataract surgery is a very safe and low risk surgery. It is quick and painless and it will help you to see again. Most patients report that cataract surgery is the best surgery they have ever had and that they wish they could have done it sooner. Rest assured that at Koetting Eye Center, our doctors are highly skilled and have extensive experience in treating cataracts. We work with the top surgeons in the area and we will make every effort to ensure that you achieve the very best vision possible after your surgery. Contact us today to schedule an exam and cataract screening and see clearly again!
This time of year, we find ourselves with shorter days, longer nights and lots of gloomy weather conditions to contend with. For those of us without perfect eyesight, it can be difficult to navigate safely in the dark. Deep shadows and glare from oncoming headlights can make it hard to notice upcoming curves and obstacles. Additionally, the older we get, the worse our night vision tends to become.
A few of the more common causes include:
Changing prescription – After the age of 40 we experience more frequent changes to our prescription. The lens of the eye loses flexibility and its ability to bring near objects into focus decreases. There can also be increases in astigmatism as we age. The muscles which regulate the size of our pupils also get weaker leading to reduced pupil response to poor lighting. When we are younger, our pupils get larger in dim light allowing more light to enter giving us better vision, but as we get older the muscles which regulate the size of our pupils get weaker leading to reduced pupillary response to poor lighting. Our pupils actually look smaller which can cause halos around light and decreased vision in low light conditions.
Cataracts - Another age-related issue that can influence night vision is the development and worsening of cataracts. As we age, the natural lenses inside our eyes become cloudy. This can make low light conditions and glare more challenging. Eventually the cataracts can be resolved by surgery to have the cloudy lens replaced with a clear, artificial lens.
With age we also gradually lose some of the rods (or photoreceptors) in our eyes which help us to distinguish between light and dark.
If you are experiencing any of these symptoms: cloudy, dim, or blurry vision, halos around lights or increased glare or eye fatigue, call to schedule an eye exam. Usually, a pair of driving glasses with an updated prescription and Anti- glare lenses will help a great deal to mitigate these difficulties.
It is also important to be sure to keep your windshield and headlights clean, try to be sure you are well rested before getting on the road, and always remember to eat plenty of eye healthy foods.
If you find yourself struggling to drive at night, don’t despair. We are here to help. Schedule your exam and bring us your questions and concerns. We are happy to help you discover the cause and find the best solution for all of your vision related issues.
2023 will bring a few changes to Koetting Eye Center. We have a lot of exciting things in store- new technologies, new products and probably some new faces. As a cutting-edge eyecare practice, we are constantly on the lookout for better ways to serve our patients and we are very proud of this fact.
We now have a Digital Retinal Imaging system in both of our locations. This non-invasive test uses a laser to allow our doctors to see almost the entirety of the back of the eyes without dilation. The purpose of the test is early detection and diagnosis of various diseases and better monitoring of eye health. In short, it makes us even better doctors.
The biggest change we will be implementing this year is to our office hours. A great deal of consideration went into this decision and it is not one made lightly. We realize that some of you will be inconvenienced by the discontinuation of Saturdays, but we hope that you will be able to find the time for your yearly eye exam on a weekday going forward.
We truly want the best for all of our patients and our staff. We feel it’s important that our staff have time off each week to spend with their families and take a couple of days to regroup and recharge for the busy week ahead. We are adding many appointment slots to our schedules both in Brentwood and Ellisville to compensate for the lost half day each week, and we feel confident that there will be plenty of times available for you to find something that will fit your schedule. We also have some innovations on the horizon to help with getting your glasses and contacts to you once ordered.
All in all, we feel the schedule changes are the right move for the future of Koetting. We are grateful for your trust and for the opportunity to continue to serve all of your eyecare needs.
Masks can obstruct vision and decrease peripheral vision, and an eye patch decreases depth perception. Be sure to wear a mask that allows you to see clearly all around or use face paint instead.
If you are going to use face paint or Halloween makeup, remember that fragrance, preservatives, metallic pigments and dyes can be extremely irritating to skin and eyes. Test for allergies on a small area before using on your face or around your eyes- and don’t ever use glitter around the eyes as it can cause corneal scratches and eyelid infections.
Please remember to remove all Halloween makeup before sending kids to bed, and use a safe, gentle makeup remover for use around the eyes.
Pointy accessories such as wands and swords can be dangerous in dark or crowded spaces. Try to keep the accessories short and flexible- foam accessories are much safer than hard plastic or metal.
Glowsticks and flashlights are a must for safe trick or treating, and kids under 12 should be accompanied by a responsible adult with a flashlight and fully charged cell phone.
Always look both ways when crossing the street and obey traffic laws. Use corners to cross and never cross between parked cars or dart into the street. Stay on the sidewalk if possible.
Only trick or treat at houses with the porch light on.
Drivers should be extra vigilant on Halloween. Slow down and turn on headlights before dusk just to be safe.
Make sure your home is safe for trick or treaters. Bring pets inside and inspect your walkways to be sure they are free from obstructions that could trip someone or cause them to slip and fall. Be sure walkways are well lit, and do not have any open flames where a trick or treater could brush past with their costume- flashlights or battery-operated candles are much safer alternatives to light your jack-o-lanterns.
Never eat your candy until you get home and inspect it in the light with the help of an adult.
We at Koetting Eye Center wish everyone a safe and Happy Halloween!
