Below are the insurance plans in which we participate.  Click plan name for link to plan details.

The patient is responsible for knowing their coverage PRIOR  to examination or delivery of services.  Contact our office if you need assistance for clarification of details regarding your insurance.  If you do not present your insurance card prior to being seen, the visit is considered a PRIVATE PAY situation.

Coverage and/or payment is not guaranteed by your insurance company.  Insurance is a contract between the patient and the insurance company.  We will be glad to submit forms for you.  See Statement of Financial Policy for details.

VISION PLANS usually have a 12 or 24 month waiting period between benefits.  CALL TO VERIFY DATE OF LAST EXAM if your plan has limitations.  

MAJOR MEDICAL PLANS - usually have no limitation on frequency of visit.  Visits must be of medical nature.  Initial visit must be for evaluation of patient's complaint of symptoms, or referral by patient's physician, for coverage to be effective.  Subsequent visits for further testing/diagnosis/treatment of established problems are usually covered, unless specifically not covered by pre-existing clause in your insurance contract.

PLAN	MAJOR MEDICAL or VISION CARE  Plan	COMMENTS & FOOTNOTES   *See footnotes section below this table.
MEDICARE Plans
MEDICARE  (Regular Medicare)	Major Medical	"Regular Medicare" only.  Covers anyone over age 65, or those under 65 with DISABILITY SSI coverage.   No coverage for ROUTINE EYE EXAM or eyeglasses.   COVERS examination for Evaluation and Treatment of eye disease. Call our office for clarification.   We do NOT participate in Medicare United Healthcare HMO plan.
Anthem Senior Advantage	Major Medical	Ohio Medicare +Choice
RAILROAD Medicare	Major Medical	Same as Medicare.
Federal & State Plans Vision Care Plans & Major Medical Plans
TRICARE  Heartland Region (Champus)	Major Medical	Military health plan.
OHIO MEDICAID & Healthy Start   CARESOURCE GATEWAY UNISON	Major Medical & Vision Care	Read the TOP of your Medicaid card.  "OHIO MEDICAID", eligible for examination, frame, and lenses once per 365 days under age 18 and over age 60.  Age 19 to age 59: once every 2 years. "DISABILITY ASSISTANCE" card has no coverage in our office. GATEWAY and UNISON - Davis Vision for Routine Vision Exam and Eyeglasses GATEWAY and UNISON - You MUST have a referral from your primary care doctor for MEDICAL EYE CARE [Evaluation and Treatment if Eye Disease].  Call our office first if you have any questions.
Ohio Worker's Comp	Major Medical	CURRENTLY NON-PAR.  APPLICATION PENDING.  Coverage in case of occupational injury.  Requires FIRST REPORT OF INJURY form at time of visit.
MAJOR MEDICAL Plans  (also see listings by insurance carrier): Major Medical Insurance covers the following situations:  The patient comes into the office, presenting a medical complaint, or presents for evaluation of suspected eye disease, or the Doctor has established the presence of eye disease, and is following the course of the treatment plan.
AETNA  -  US HEALTHCARE	Major Medical & Vision Care
MEDICAL MUTUAL	Major Medical & Vision Care	Call to verify coverage on your plan.
HIGHMARK		Call to verify coverage on your plan.
ANTHEM Plans
Anthem BLUE VISION	Vision Care
Anthem BLUE ACCESS (PPO)	Major Medical	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R P
Blue Preferred Primary (HMO)	Major Medical	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R M
Blue Priority	Major Medical	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R M
Blue Preferred Primary Plus (POS)	Major Medical	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R G
Blue Senior	Major Medical	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R R
Anthem Senior Advantage	Major Medical	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R A Also known as Ohio Medicare + Choice.
Anthem Blue TRADITIONAL	Major Medical & Vision Care	Participating Provider for IDENTIFICATION NUMBER beginning with this prefix:  Y R T
VISION CARE Plans Coverage for Routine Vision Care, in the absence of eye disease, where there are no symptomatic complaints presented by the patient, and the patient does not have an established diagnosis of eye disease.
VISION SERVICE PLAN VSP	Vision Care
COLE VISION PLANS	Vision Care	WCI Steel only. Other Cole Plans:  Non-Par. Out-of-Network Coverage for GM employees for Exam (partial reimbursement). See EYEMED below.
VISION PLUS	Vision Care	Application Pending
EyeMed	Vision Care	Formerly Cole Vision
Davis Vision	Vision Care	Plan for General Motors, Gateway Medicaid HMO, Unison Medicaid HMO, others. [4]

    F O O T N O T E S:

[ 1 ]  No coverage for ROUTINE eye examinations.  

[ 2 ]  No coverage for eyeglasses or cosmetic contact lenses.

[ 3 ]  Covers examination for purposes of Evaluation and Treatment of Eye Disease, where patient presents with symptoms or complaint.  Also covers subsequent office visits for continuing care of established diagnosis of eye disease, or further evaluation of suspected eye disease.  

[ 4 ] May require PRIOR AUTHORIZATION from your primary care physician BEFORE you are seen at our office.

[ 5 ]

[ 6 ]

[ 7 ]

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