Important COVID-19 Update | Click Here to Learn More

Vision Plans & Insurance

Vision Plans & Insurance

self pay
self pay
self pay
Anthem
Avesis
Cigna
EyeMed
Humana
Medical Mutual
Medicare
superior vision
United Healthcare
self pay
VSP


​​​​​​​Please check with your plan provider to confirm coverage prior to your eye exam.


INSURANCE & VISION PLAN COVERAGE BEST PRACTICES

  • IMPORTANT - Check with your employer and/or provider: The vast majority of claims are processed successfully, however, your plan expects you to verify your coverage prior to seeking care. You are your own best advocate. Please check with your provider plan portal to confirm that your plan accepts assignment from us. Your employer benefits manager can help. Insurance companies and employers have many plans with many different coverages. Unfortunately, most large insurers have a few specialty plans we cannot accept. We will help in any way we can. Please call our office if you have any questions.
  • Out-of-Network Patients Can See Us: Check with your plan provider, they may provide decent coverage for out-of-network claims. Often, your ending out-of-pocket costs are comperable to in-network benefits. You will have to pay for your visit up front and submit your own claim, but we can provide the proper receipt and help with forms. Out-of-network patients may qualify for prompt pay discounts and/or use FSA funds. Use your benefits how you see fit.
  • Don't rush: Please note that if you schedule an appointment within 48 hours that we may not be able to attempt any automated verifiication. Manual verifiacation is often not possible due to long wait times with plan service departments. We provide pre-verification as a complementary service when possible, but are not able to verify all coverage. That is your responsibility per your agreement with your plan. Plans generally state that pre-verification is not a promise of coverage by them.
  • Provide us with your plan information and please call to check your pre-authorization status. When you provide us with your information via our electronic intake forms, we attempt to pre-verify your coverage prior to your visit via a sophisticated automated system so that we can update you when you arrive for your appointment. We are hopeful that the ability to pre-authorize will improve, but this is currently the best system. For a variety of reasons, pre-authorization can be difficult and we are not always able to match your information to an insurance system prior to your visit. Most failed matches are plans that block our system from their databases and small mismatches like address changes or an error entered on a form that can be corrected easily at the time of your visit. We do all we can to help, but your best source of information is your account portal. Plans can have very long customer service wait times for providers that can stretch to an hour per call and we are limited to how much we can reasonably do to help you verify your coverage manually. You are your own best advocate.
  • Know how your plan works: Not all plans will pre-authorize. Pre-authorization is not a guarentee of payment by the plan. Plan coverage can change from year to year. There are many plans and we estimate coverage based on what we are provided.
  • Claims are different: Claims systems are generally automated and we use a professional service to submit and follow up on claims on your behalf. We submit our usual and customary fees and your plan determines what you owe. Learn more about claims on the Patient Financial Responsibility page.
  • Please call our office if you have any questions. Insurance is very confusing and we are willing to help you navigate your plan.


FSA & HSA EYE CARE SPENDING OPTIONS

When it comes to using Flexible Spending Account (FSA) and Health Savings Account (HSA) dollars for eyecare, there are many eligible expenses you can choose from, including:
  • Prescription eyeglasses
  • Prescription sunglasses
  • Reading glasses, prescription, and non-prescription
  • Many contact lenses and contact lens care products
  • Eye exams and some procedures​​​​​​​

Before choosing where you will spend your FSA and HSA dollars, it is recommended that you check with your provider or your employer’s human resources department on exact coverage details. Some insurance providers may have restrictions on certain brands, types, and styles of contact lenses and other eyewear. If you have any hesitation or concerns, contact your provider for more information before making a purchase.​
​​​​​​​
Vision Insurance
Insurance can be overwhelming. Let us know if we can help. Please call our office and refer to your insurance provider's website or published lists. Visions plan that our Cincinnati Optometrists participate in may not be listed due to the variety of insurance plan name variations and affiliates. ​​​​​​​Madeira Optical Optometrists participate in plans from Vision Service Plan VSP, Vision Plus, Vision Benefits of America, United Health Care UHC, EyeMed, Aetna, Cigna, Medicare, Anthem Blue Cross Blue Shield, Medical Mutual of Ohio, Superior Vision, and others.

Our largest eye exam referrals are from Cincinnati Bell, Kroger, GE Aviation, Macy's, Proctor & Gamble (P&G), Cincinnati Children's Hospital Group, Christ Hospital, St. Elizabeth Healthcare, Convergys, Fifth Third Bank, Johnson & Johnson, The Archdiocese of Cincinnati, Mercy Health and the University of Cincinnati. Coverages will be based on your specific vision plan. Please contact your Optometrist or other vision providers. We will gladly help you navigate your plan specifics and verify coverage before your visit.

Insurance providers pay on behalf of responsible parties as third parties. Per your agreement with your plan, they state that the patient is always responsible for all balances. Please call us with any questions.
admin none 9:30 AM - 6:00 PM 9:30 AM - 6:00 PM 9:30 AM - 6:00 PM 9:30 AM - 6:00 PM 9:30 AM - 2:30 PM 9:30 AM - 2:30 PM Closed optometrist https://g.page/r/CanS9QoYcM1VEAg/review https://www.yelp.com/writeareview/biz/NzSMOn5GaoUgYml68FHPAw?return_url=%2Fbiz%2FNzSMOn5GaoUgYml68FHPAw&source=biz_details_war_button https://www.facebook.com/madeiraoptical/reviews/?ref=page_internal https://schedulewidget.revintake.com/d3b00c78eaf08ab09d5634f7d57e2055 https://s3.amazonaws.com/static.organiclead.com/Site-41ff0924-a137-4941-bd25-8cc8ad7a0c47/landingAssets/dryeyefavicon.ico 5134476034 https://s3.amazonaws.com/static.organiclead.com/Site-41ff0924-a137-4941-bd25-8cc8ad7a0c47/landingAssets/dry_eye_logo_1_.png