Insurance Plans We Accept in Aiea

At Omphroy Eye Care, we participate with numerous insurance plans to make quality eye care accessible to as many patients as possible. Below is a list of insurance plans we currently accept. Because insurance coverage details can vary significantly even within the same plan, we recommend contacting your insurance company directly to confirm your specific benefits, copays, and coverage details before your visit.

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Understanding Your Vision and Medical Insurance Coverage

It’s important to understand that eye care often involves two distinct types of insurance coverage: vision insurance and medical insurance. Vision insurance typically covers routine eye exams, glasses, and contact lenses. Medical insurance covers diagnosis and treatment of eye diseases and conditions, such as glaucoma, cataracts, diabetic eye disease, and other medical eye conditions.

Depending on the reason for your visit, your appointment may be billed under your vision plan, medical plan, or a combination of both. For example, if you’re visiting for a routine comprehensive eye exam with no underlying medical concerns, this is typically billed to vision insurance. If you’re being evaluated or treated for an eye disease or medical condition, this is typically billed to medical insurance.

How to Verify Your Coverage

Before your appointment, we recommend taking the following steps to understand your coverage:

  • Contact your insurance company directly to confirm your specific plan benefits
  • Ask about your copay, deductible, and coverage limits for eye exams and treatments
  • Confirm whether Omphroy Eye Care and Dr. Omphroy are in-network providers for your specific plan
  • Ask about any pre-authorization requirements for specialized testing or procedures
  • Understand the difference between your vision and medical insurance benefits if you have both

Our office staff is happy to help verify basic insurance information, but because insurance plans have many variables and exceptions, your insurance company can provide the most accurate and complete information about your specific coverage.

What If My Insurance Isn’t Listed?

If you don’t see your insurance plan listed above, please call our office at (808) 487-7700. Insurance networks and partnerships change periodically, and we may participate with additional plans not reflected here. Our staff can verify whether we accept your specific plan.

Self-Pay and Payment Options

If you don’t have insurance or prefer to pay out-of-pocket, we’re happy to discuss self-pay options for your eye care needs. Please contact our office to discuss pricing for exams, treatments, and procedures.

Questions About Your Coverage?

Insurance can be confusing, especially when eye care involves both vision and medical benefits. If you have questions about your coverage, copays, or what’s included in your specific plan, please call Omphroy Eye Care at (808) 487-7700. We’re here to help make the insurance process as smooth as possible so you can focus on your eye health.

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Insurance FAQs

What’s the difference between vision insurance and medical insurance for eye care?

Vision insurance typically covers routine eye exams, glasses, and contacts when there’s no underlying medical condition. Medical insurance covers diagnosis and treatment of eye diseases like glaucoma, cataracts, or diabetic eye disease. Depending on the reason for your visit, one or both types of coverage may apply.

Do you accept Medicare?

Please call our office at (808) 487-7700 to confirm current Medicare participation and coverage details for your specific situation.

How do I know if my visit will be billed to vision or medical insurance?

This depends on the reason for your visit and what’s discovered during your exam. Routine exams without medical findings are typically billed to vision insurance. If Dr. Omphroy diagnoses or treats an eye disease, that portion of your visit may be billed to medical insurance. Our staff can help clarify billing for your specific situation.

What should I do if my insurance requires a referral?

If your insurance plan requires a referral from your primary care physician to see a specialist like Dr. Omphroy, please obtain this referral before your appointment to ensure your visit is properly covered.

Can I use both vision and medical insurance during the same visit?

Yes, in some cases both types of insurance may be used during a single visit if you have both routine vision needs and a medical eye condition being addressed. Our billing staff can help coordinate this for you.

What if I need a procedure not covered by my insurance?

If a recommended procedure isn’t covered by your insurance, our staff will discuss the costs with you in advance and explore any available payment options. We believe in transparency about costs before you commit to any treatment.

How can I find out my copay before my appointment?

Contact your insurance company directly using the number on your insurance card. They can provide the most accurate information about your specific copay, deductible, and coverage for eye care visits.