How do I use my private insurance for eye exams?

Depending on your selected plan, you may be eligible for insurance coverage when you visit the optometrist. Here at Willow Eye Clinic, we offer direct billing for most insurance companies.

It is recommended to double-check your vision coverage before arriving for your appointment. All insurance plans are different, but many offer coverage for eye exams and prescription glasses that renew every 12-24 months. This coverage may be combined or separate. There are a couple of different types of vision coverage relevant to your visit to Willow Eye Clinic:

• Typically, eye exam claims can only be submitted once per renewal cycle, and your coverage is capped at a certain monetary value and percentage. For example, one might have $100 of eye exam coverage that will pay out at 80%.

• Coverage for prescription glasses and contact lenses may be combined or separate, but claims can be submitted multiple times throughout the renewal cycle until the dollar amount runs out.

Some people are covered under more than one insurance plan – you may have a primary and a secondary insurance (for example, under a spouse’s name). We will always bill your primary insurance first. Certain insurance companies do not accept direct billing for secondary insurance plans, but we will provide you with the documents needed to submit secondary insurance claims yourself.

Children may also be covered under parental insurance. For children aged 19 and younger, we are legally required to bill OHIP before billing insurance. For this reason, please be sure to bring your child’s Ontario Health Card to their eye appointment. Like adults, children can have both primary and secondary insurance. The billing order is dependent on the parents’ birth month(s).

For more questions regarding private insurance, please feel free to contact us.