At Triangle Ophthalmology, we accept the insurance plans listed. Patients are responsible for understanding their specific plan benefits. Therefore, if you have any questions in regards to your insurance plan, we ask that you contact your insurance company directly.
We do accept private pay (self-pay) for those individuals that do not have insurance or that have insurance that we are not in network with. Please feel free to contact us with any additional questions about insurance or private pay rates.
In-Network Medical Plans:
- Blue Cross/ Blue Shield
- Medicare (and most secondary insurance)
- Cigna
- Humana
- Aetna
In-Network Vision Plans:
- CEC Community Eye Care
- Superior
Understanding the difference between a “routine” eye exam and a “medical” eye exam?
Routine Vision Insurance
Vision Plans covers ROUTINE well-eye exams only (people with nearsightedness, farsightedness, and normal astigmatism ONLY). This includes the refraction to determine your eyeglass prescription and may also include a limited contact lens evaluation benefit. As part of your routine well-eye exam, our doctor examines your eyes for many conditions and diseases including glaucoma, dry eyes, cataracts, floaters, retinal diseases etc…
- glasses check
- well-eye exam
- +/- contacts check
If your routine well-eye exam reveals a medical condition or disease related to your eye that requires specific counseling, documentation, follow-up care or referral, or if the exam is related to a pre-existing medical condition such as cataracts, glaucoma, diabetes, dry eyes, etc., then your visit is NOT COVERED by your Vision Plan. For instance, if you come in for a routine well-eye exam simply because you are having difficulty seeing with your current glasses, but it is found that your reduced visual acuity is due to developing cataracts or dry eye, then your exam would be considered a medical exam and as such would be billed to your medical insurance. Unfortunately, the doctor cannot tell if medical eye conditions exist before you are thoroughly examined.
Medical Insurance
Medical insurance is used when the patient presents with eye-related symptoms such as redness, itching, discharge, discomfort, floaters, flashes, or double vision. Medical insurance is also used if the doctor detects medical problems such as cataracts, dry eyes, glaucoma, diabetes, or high blood pressure (among many others) during the course of the eye examination.
- diabetic exam
- any symptoms
- known eye disease
- identified eye disease
In both situations, your medical insurance would be billed and you would be responsible for your medical copay and deductibles (paid at the time of your exam). If a referral is required by your insurance plan in order to see a specialist, then you are responsible to obtain it.
Unfortunately, a comprehensive examination that is medical in nature does not include the refraction. Nearsightedness, farsightedness, astigmatism, and the need for reading glasses are not considered a medical diagnosis. If you would like to get a glasses or contact lens prescription at the time of your medical exam, you can elect to “self pay” for these services.
If you have both medical and vision insurance plans, our office will coordinate the benefits to minimize your out-of-pocket costs. You can still use your Vision Plan material benefits towards the purchase of eyeglass frames, lenses or contact lenses based on your specific plan’s allowances.
We realize that this can seem like a complicated process, but these are the rules set by your insurance company. Please provide our office your most complete and accurate information so that our office may answer questions to the best of our ability.