Vision therapy is an in-office and at-home program used to address vision problems such as amblyopia (lazy eye), crossed eyes (strabismus), double vision, eye teaming and visual processing issues.
Children struggling in school, having trouble focusing or reading, or being diagnosed with ADHD/ADD could benefit from Vision Therapy. Adults experiencing headaches, eye strain or “fuzzy” vision could also reap its rewards.
In-Network Providers
Vision therapy providers are typically covered by multiple medical insurance carriers. When booking sessions, always inquire before booking them; if a provider is out-of-network it may be possible to appeal directly to your insurer; additionally there may be payment plans available that help cover some of the costs.
Most major medical insurance plans cover vision therapy as part of their coverage, although not necessarily as an “eye care” benefit. Some plans do limit or exclude such services to save costs; it would be wise to check with your agent or workplace HR department to determine what types of vision therapy are covered by your particular policy.
Vision therapy can be used to treat conditions ranging from eye strain and blurriness, double vision, and lazy eye (amblyopia). Anyone having trouble keeping their hands steady when writing or inverting letters while reading or doing homework could benefit from vision therapy; children who struggle in school due to visual performance issues could also benefit greatly from vision therapy treatments.
To ensure coverage, it’s important to speak to both your primary care doctor and optometrist and seek a referral to an appropriately-trained vision therapist. Furthermore, contact your insurance company directly and find out their specific preauthorization requirements – for instance some require sending in detailed care plans with progress notes from your therapist before authorizing coverage for services provided by that provider. Furthermore, having your therapist become acquainted with any codes used by insurance providers can ensure accurate billing.
The American Optometric Association offers an invaluable coding document for vision therapy that every therapist should be familiar with. It covers many details regarding insurance and vision therapy, with prewritten letters to send to your insurers if necessary – it’s a must read!
Prescriptions
As is widely acknowledged, vision therapy is a proven and effective treatment for numerous visual conditions. Unfortunately, however, vision therapy may not always be covered by insurance, or offered as a benefit by insurers at all. While optometrists have often successfully advocated for coverage through advocacy efforts with insurers or directly lobbying insurers themselves for coverage, ultimately this decision rests solely with your specific diagnosis and policy provider.
As a good starting point, contact your insurance provider and inquire whether vision therapy coverage exists. If so, great! If not, start investigating why and begin the journey toward understanding why. Often it comes down to cost or understanding issues.
Finding insurance to cover vision therapy may seem impossible, but there are ways around this obstacle. Patients may consider using medical financing programs like Care Credit to help cover the expenses. Others take advantage of flexible spending accounts or health savings accounts as a means to cover these expenses.
Another option for appealing a decision from your insurance provider is appealing it directly. Each insurer may have unique paper requirements, so be sure to contact them and determine exactly what’s necessary. It might also help if either the patient themselves or their parent writes a letter outlining why vision therapy would benefit their case and could change it entirely.
Caleb first approached us due to difficulties focusing at school and keeping his place while reading, as well as difficulties with transferring words from paper to hands, and math calculations. Since beginning vision therapy he now enjoys school activities more and has even shown more enthusiasm towards sports due to improved performance.
As an eye care provider, adding vision therapy into your workup is an effective way of both helping patients and increasing profits. To do so successfully, be in-network with top providers, provide proper referrals for accurate diagnosis, and give patients confidence that their insurance will cover it. If you need assistance getting coverage for vision therapy for your patients contact Nebraska Visual Integration Center now!
Out-of-Pocket Costs
Your insurance can help to lower out-of-pocket expenses. Unfortunately, some companies are reluctant to cover vision therapy due to its high costs; perhaps this is an attempt to keep premiums down by limiting benefits; fortunately there are ways around this if this becomes an issue for you.
As one option, your provider can submit the bill directly to your insurance company; this way, the insurance company will only pay out once your deductible has been met. Care Credit offers another method for spreading out payments over time rather than all at once.
Consider whether your employer offers flexible spending health care accounts (pre-tax accounts that allow users to cover various medical costs). If so, money could be put in this account in order to cover vision therapy sessions.
If your vision therapy coverage has been denied by an insurance provider, get a written statement outlining why this decision has been made and appeal it. This will give you a better idea of their reasoning behind their decision and allow you to present an argument in favor of coverage.
One common reason given for denying vision therapy is lack of approval by their medical consultant. Unfortunately, this is unfair as many clinical and research studies support its efficacy. You could try finding out the publications the insurer or insurance company reviewed when making their decision.
Remember, insurance companies are in business to make money. They do this by charging premiums from healthy people to cover costs associated with those who become sick or injured; this allows them to provide medical benefits of various kinds – it would not serve them well if they refused coverage for services like vision therapy which have proven their efficacy against various disorders.
Insurance Policy
Vision therapy is a clinically-proven and cost-effective solution to vision issues; however, insurance policies don’t always cover its services. There are ways you can get vision therapy covered under your policy though.
Start by reviewing your insurance policy and reaching out to your provider directly for coverage confirmation. If vision therapy is not covered, inquire why, and consider filing an appeal against them.
Insurance companies may classify vision therapy as an educational treatment rather than medical one, as they perceive it more like tutoring for visual skills rather than necessary treatment of an eye issue. When this occurs, it can be useful to consult both your family doctor and eye doctor about providing documentation demonstrating why vision therapy is needed for your diagnosis.
Referrals from your family doctor or an optometrist can be an excellent way to ensure that vision therapy treatment will be covered by insurance. If you’re having trouble, reaching out to an ophthalmologist may also help provide support in getting coverage approved.
If your vision therapy claim has been denied by an insurer or subjected to restrictions, or severe limits have been placed upon it, you have every right to appeal their decision. When filing an appeal it is essential that all relevant documents and information is included to make a compelling argument as to why vision therapy is medically necessary for you and why its services must be made available immediately.
When filing an appeal, it is also vital that you receive a written statement outlining exactly why coverage has been denied or severely limited. This will enable you to assess if an arbitrary decision was made by the insurance provider, or there is evidence suggesting they did not take your diagnosis and treatment plan into consideration.
If your vision therapy treatment has been approved, using a flexible spending account or health savings account as payment may be more affordable than paying out of pocket and may help provide access to necessary treatments.
