Two Eye Appointments
October 11, 2017 8:04 AM   Subscribe

I have an eye exam scheduled with an ophthalmologist in two weeks. My health coverage covers eye exams and is through my husband's employer. I just learned that I have another appointment at Pearle Vision in three weeks. I also have EyeMed coverage through my own employer. Is there any reason I should keep the second appointment?

I understand how having the same type of coverage from two different companies works, with my own being primary and my spousal coverage being secondary. Is it different in this case because one is medical and one is vision care? I have no medical coverage through my employer by my own choice. I am leaning towards cancelling the Pearle appointment, but is there something I have not thought about?

I've used Pearle for several years and last year was not a good experience, not horrible but just not good. I am nearsighted and have astigmatism. They gave me an unusable copy of my prescription (after purchasing new glasses) and a brush off about the quality of my previous pair that was only a year old. I know that EyeMed and Pearle are both part of Luxxotica, so this year I resolved to find a different doctor and just order glasses from Zenni if I need a new pair. I explored the EyeMed website and the only doctors they cover are optometrists at various glasses stores. The ophthalmologist I am seeing is not listed on their website.
posted by soelo to Health & Fitness (8 answers total)
I would just go to the ophthalmologist appointment. Check with your health insurance to make sure it's covered as an eye exam, though. Ophthalmologists are usually considered specialists and insurance coverage can vary.
posted by wearyaswater at 8:14 AM on October 11 [3 favorites]

You do not need your eyes measured twice in one week. Attend the ophthalmologist appointment and they will be able to prescribe corrective lenses if you need them. You can then request a copy of the prescription to take to your preferred optometry shop or to an online store.

I would make one caveat against Zenni and other bottom-dollar online eyewear shops; the quality of the lenses can be acceptable but the frames themselves are often very poor quality. Any problems that require lens adjustment are effectively money lost. In my experience they can be good-enough for glasses I use at home (where I don't have to care how I look in them) but not so great in public or at the office. Some of the better (but still cheap by U.S. standards) online shops can get you frames whose finishes won't be chipping and tarnishing within a year.

Look for a good independent optometrist unaffiliated with Luxottica; they can usually set you up with frames from companies not owned by Luxottica, many of which are of excellent quality and lower-cost. And although independent shops usually can't accept EyeMed insurance, the prices for lenses can also be on par or cheaper than your out-of-pocket expenses at a Luxottica store with EyeMed coverage.
posted by Subaru drwxrwxrwx at 8:31 AM on October 11 [1 favorite]

Whoops I meant to say, "Look for a good independent optician."
posted by Subaru drwxrwxrwx at 8:42 AM on October 11 [1 favorite]

You're going to have some issues with the insurers. Technically, your vision insurance comes first, and they apparently don't cover ophthalmologists (which is pretty typical). You need to double check with your medical insurance (through your husband?) that they cover ophthalmologists as a medical service, and not vision, or, if they cover ophthalmologists at all, the one you have the appointment with is in-network.

Honestly, it's rare that any insurance covers ophthalmologists for simple eye exams. You would usually need to have an actual injury or illness of the eye for insurance to cover an ophthalmologist. My gut says you'll have to make due with Pearl.
posted by Thorzdad at 9:31 AM on October 11

Contradictory evidence to Thorzdad: I have EyeMed and my benefits include a yearly exam from an ophthalmologist (NEVER see an optometrist to diagnose eye health!). My EyeMed also provides a yearly allowance for frames or contacts.

If the doctor you want to see is not in their plan, I personally would switch to one that is.
posted by JoeZydeco at 9:42 AM on October 11 [1 favorite]

I think it depends on why you are seeing the ophthalmologist and the optometrist. I see both, occasionally in a short window if things line up that way. My ophthalmologist is monitoring a medical condition; I see her multiple times per year. My optometrist is just doing a contact lens fitting. Both are covered by Kaiser for me, and I also have additional vision insurance which covers my contacts.
posted by ktkt at 9:56 AM on October 11

My mistake - the first appointment is with an Optometrist and not an Ophthalmologist. They are located at my medical clinic and were on the list when I selected "Standard Eye Exam".
posted by soelo at 10:03 AM on October 11

If I get the ophthalmologist to give me a glasses prescription, my medical insurance will not cover the cost of the appointment! They say that it has to be covered by my eye plan. I have to avoid getting the lens prescription so that my health insurance will pay for everything else. This made economic sense for me even when I had no eye plan for my glasses prescription.

Of course my eye plan doesn't do much to cover the far more intensive exam that I go to my retina specialist ophthalmologist for.

So I've found it to be very important to see the optometrist for my glasses/contact lens prescription and the ophthalmologist for all other important eye health issues. Of course I let the optometrist do his usual little eye health check, too, but his checkup is pretty cursory compared to what the ophthalmologist does.

Ideally my optometrist appointments should be staggered from my ophthalmologist appointments, so that the optometrist can see if there's anything serious that may have come up since my ophthalmologist appointment. When I was seeing the ophthalmologist once a year, I made sure to see the optometrist six months later.
posted by artistic verisimilitude at 2:19 PM on October 11

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