Below are the most Frequently asked Questions and Answers regarding Insurance and Vision Therapy. Please feel free to call and ask If you have questions that have not been answered.
We have many pages on our website, www.NJEyeSite.com that address: What is Vision Therapy and Neuro-Optometric Rehabilitation.
Q: How is this evaluation different than the one I had with my optometrist or another provider?
A: There are similarities and difference between what we provide and what other offices provide: Similar: comprehensive eye examination to determine:
- Eye health
- Sight evaluation for eyeglasses and contact lenses.
This includes visual acuity (eyesight) and refraction Different: in addition to the above, our comprehensive evaluation also includes evaluating the:
- Binocular system: (the use of the two eyes together),
- Saccades, Pursuits, Fixation, physical Focusing (coordinated eye movements that are needed for effective reading, for example)
- Visual Perception and Processing
- Integrating Vision with other senses; such as balance, touch, proprioception, body movement (kinesthesis)
We render Vision Therapy and Neuro Optometric Rehabilitation: helping people solve these problems so they no longer are an issue.
Q: What is the Functional Vision Evaluation?
A: This is a battery of tests that establishes a baseline of visual skills. We can then compare your skills before starting the therapy program to the improvements you have attained due to Vision Therapy.
Q: Will my Insurance Cover Vision Therapy or Vision Rehabilitation?
A: This is the most frequently asked question. Everyone would like medical insurance to coverall services. Vision Therapy and Vision Rehabilitation addresses Visual Problems. Vision therapy addresses problems that Eyeglasses and Contact Lenses can’t treat.
In many cases, Vision Therapy and Neuro Optometric Rehabilitation is the only available and effective treatment option for these conditions. Treatment may be covered under major medical insurance however, some insurance companies and managed care plans may deny or place limits on coverage for Vision Therapy services as a cost saving measure. You have the ability to decide what services you want to receive to address the problems you have, irrespective of medical insurance. It’s important to understand that although medical insurance companies typically do not cover these services, it does not mean that you reduce the need for obtaining treatment. While Vision Therapy is not inexpensive, it can be seen as an investment in yourself or your child’s future.
Q: Why would my medical insurance not coverage for Vision Therapy? After all, this is affecting me / my child?
A: Medical insurance deals with medical problems The medical insurance company, and your specific policy within that medical insurance has certain limitations. Medical insurance companies determine what services they cover and create the rules of what they will or won’t cover. Medical insurance works with a definition of medical necessity. These are: disease, injury, illness. If it does not fall within their criteria, they do not cover the service. For example, all medical insurances do not cover for dental. Rarely will they cover for an elective procedure like LASIK or a facelift.
Q: What will they cover?
A: That depends on:
- Your diagnosis
- The specific details of your insurance plan
- The procedure code(s) used throughout the course of therapy
Q: But I spoke with the Medical Insurance representative and they said that therapy is covered.
A: Medical Insurance representatives are instructed to tell their clients what they want to hear. In reality through years of experience, once we submit the codes, it is rare for Medical Insurance to cover and pay for those services. In those rare cases when they do, it is only a small part (about 20%) of what is done in the therapy session. They often site the code below and its explanation:(92065) Orthoptic and/or Pleoptic training, with continuing medical direction and evaluation
Orthoptics (92065) is NOT Vision Therapy. It does not even mention the term Vision Therapy. It does not define what is done in Vision Therapy. Orthoptics is eye muscle based. Vision Therapy is brain based. The brain receives visual input and interprets that. The brain then controls where the eyes move.
When medical insurance companies tell patients one thing but ultimately do not meet that verbal description and do not compensate for services rendered, it gives the false impression that we are less competent. The fact of the matter is a Medical Insurance will cover only a very limited number or diagnoses.
Q: Are there any other codes that might be covered?
A: Medical insurance routinely rejects other codes when we have submitted them in the past.
Q: But if your office would code this correctly, I know they would cover these services
A: We have many years of experience rendering Vision Therapy and we also have many years with insurance companies and expertise in coding. The fact of the matter is that the medical insurance companies make the decision regarding what they will cover, which procedure codes they will cover for and which diagnostic codes meet their requirements to obtain reimbursement.
Q: What are the financial obligations in those rare cases that Medical insurance covers a small portion of Vision Therapy?
A: When Vision Therapy is covered by insurance, it is common to have a co-pay (usually your regular medical copay) or co-insurance (if that is part of your plan) for each session. Just likeany other form of medical treatment, Vision Therapy services may apply to your annual medical deductible; if you have not fulfilled your deductible there may be additional fees beyond your co-pay/co-insurance.
Q: Are there any medical insurances that do cover Vision Therapy?
A: Some do cover a small portion of therapy, but again, that is dependent on the problem that you have (diagnosis) and what your medical insurance covers.
Q: Will my Vision Plan cover these services?
A: Vision Plans cover for an Eye Examination once every one or two years, depending on the particular plan. They may cover or give a discount toward eyeglasses or contact lenses. Vision Plans do not cover Vision Therapy or Vision Rehabilitation.
Q: If my medical insurance covers anything, what can I expect?
A: Medical insurance company limits sessions to one 30-minute session per day. Patients who have medical insurance are responsible for the following fees:
- Co-pay or co-insurance
- Visual Perception and Processing session.
- The second 30-minute Therapy session.