How to Use Your Health and Vision Insurance in Santa Monica

Navigating insurance can be confusing, especially when it comes to eye care. At OptiHealth Optometry in Santa Monica, we want to make the process as simple as possible. While we are out of network for all vision insurance providers and most health insurance plans (except Medicare), you can still use your benefits for eye exams and treatments at our office. Here’s how:

Using Vision Insurance at Our Office

Although we are out of network for all vision insurance plans, many patients can still use their benefits in the following ways:

• Out-of-Network Reimbursement – Most vision insurance plans allow you to submit a claim for reimbursement after your exam. We will provide an itemized receipt with the necessary codes so you can submit it to your insurance. Alternatively, we can also help you submit your claim.

• Flexible Spending Accounts (FSA) & Health Savings Accounts (HSA) – These accounts can be used for eye exams, contact lenses, dry eye treatments, and prescription eyewear.

• Competitive Pricing – We strive to offer high-quality, personalized care at fair prices, making our services a great value even without in-network coverage.

Using Medical Insurance at Our Office

We are in network with Medicare and out of network for all other medical insurance plans, but you can still use your benefits for medical eye care. Here’s how:

• Medicare Patients – If you have Medicare, we will bill your exam directly for medically necessary visits related to conditions such as dry eye, glaucoma, diabetes, and more. You will be responsible for any deductibles or co-pays.

• Out-of-Network Medical Insurance – If you have a non-Medicare health insurance plan, you may be eligible for reimbursement for medically necessary visits. We will provide a superbill that you can submit to your insurer.

• Cash Pay & HSA/FSA – Many patients choose to pay out of pocket and use their HSA or FSA for medical eye exams and treatments.

Common Questions

What’s the difference between a vision and medical eye exam?
A vision exam focuses on glasses and contact lens prescriptions and is typically covered by vision insurance. A medical eye exam addresses eye diseases or conditions (like dry eye, infections, or diabetes-related issues) and is billed through medical insurance.

Can I still come to your office if I have VSP, EyeMed, or another vision plan?
Yes! You can still receive an exam at our office. Since we are out of network, you will pay for your visit upfront, and we’ll provide documentation to help you get reimbursed by your insurance provider.

What if I need an advanced dry eye treatment?
Medicare and most medical insurance plans do not cover advanced dry eye treatments (such as IPL or RF therapy). However, you can use HSA/FSA funds to pay for these services.

Why Choose OptiHealth Optometry?

At OptiHealth Optometry, we focus on high-quality, personalized care rather than rushing patients through the insurance system. Our goal is to provide thorough eye health evaluations, advanced dry eye treatments, and customized solutions for your vision needs.

If you have any questions about using your insurance, feel free to call our office. We’re happy to guide you through the process and help you maximize your benefits!