Insurance Coverage

Medicaid (State) Medical Insurances

Medical Insurance:

• Aetna

• America’s PPO/HealthEZ

• Blue Cross Blue Shield

• Cigna Healthcare

• HealthPartners

• Hennepin Health (Effective 09/01/2024)

• Humana

• Medicaid or Minnesota Care

• Medica

• Medicare

• Surest

• UnitedHealthcare – Veteran’s Administration Community Care Network

• UnitedHealthcare

• UnitedHealthcare Community Plan (out-of-network for glasses)

• UMR

• UCare (Out-of-Network: Fairview Plans)

• TriCare

Vision Discount Plans:

• Out-of-Network for All Companies (EyeMed, VSP, Davis, Metlife, Spectera or UnitedHealthcare Vision)

What determines routine vs. medical?

Your reason or concern for the visit, as well as your results, will determine whether your insurance company will classify the exam as routine or medical. A routine eye exam is defined by insurance companies as a visit for the purpose of checking vision, screening for eye disease(s), and/or updating/renewing eyeglasses or contact lens prescriptions. Routine eye exams or wellness eye visits result in a final diagnosis such as nearsightedness (inability to see far away), farsightedness (near vision concerns) or astigmatism (blurry vision at distance/near).

VISION PLANS cover only routine vision care and are intended to determine a prescription for eyeglasses, to provide discounts on eyeglasses or contact lenses, and to screen the structures of the internal & external health of an eye in a healthy person without existing or known eye disease. Wellness eye visits do not qualify for the renewal or prescribing of oral/topical medications.

MEDICAL INSURANCE provides coverage when medical conditions (i.e., diabetes, hypertension etc.), eye conditions (infections, dry eyes, and cataracts) or an eye disease, such as glaucoma is present and requires diagnosis, management, regular follow-ups & treatment as well as communication with other healthcare providers (physician, advanced practice providers – nurse practitioner/physician assistant).

Auto Insurance:

If the reason for your medical eye visit or neuro-optometry evaluation is related to a motor vehicle accident, your visit must be billed to your auto-insurance. Whether the accident was your fault or not, auto-coverage policies in Minnesota have a rider known as personal injury protection (PIP). PIP is an allotment of funds to cover medical expenses in the event of an injury while operating your vehicle. Once your PIP coverage ($20,000, $30,000 or whatever the amount) is exhausted, your medical claims will be forwarded onto your medical insurance carrier. Your medical insurance carrier may have costs associated such as: a copay, co-insurance, and/or deductible amounts that will be billed to your patient account.

Disclaimer:

At Swoop Eye Care, we do our best to navigate each unique insurance carrier and each patient’s unique plan; however, it is the patient’s responsibility to understand his/her/their benefits.