Posted on 08 Jun 2019
austin eye care


Vision Therapy is a treatment that’s used for various eye conditions. It’s an effective treatment for a wide variety of conditions that are provided at Austin eye care. However, this treatment may not be covered by some insurance plans. If you feel your plan has not evaluated your claim for coverage, here are some steps you can take for requesting a review.


  1. Review Your Explanation of Benefits


The first step is to review your Explanation of Benefits from your health insurance provider for pediatric eye care. This can help you determine if there is a statement about the exclusion or inclusion coverage for Orthoptics or Vision Therapy. Some of those plans explicitly state they don’t provide coverage for these services.


Other plans may provide coverage for Vision Therapy for dyslexia, learning disabilities, and more. There are certain treatments for educational problems and learning disabilities that are not provided in the major medical insurance coverage. This doesn’t often include coverage for Vision Therapy, which is the treatment of the diagnosed problem.


  1. Ask for a Written Statement


If you’re still unsure, ask for a written statement. This can provide you with a clear reason as to why the coverage was denied or limited. If the statement says that the coverage or plan does not consider Vision Therapy as medically necessary, or won’t be effective in treating the problem, then ask for additional documentation to support that claim.


Many clinical reports and research studies have proven the effectiveness of Orthoptics and Vision Therapy. But your insurance provider may not have looked into these studies.


  1. Inquire the Medical Consultant


Some health insurance plans may claim that their medical consultant was the one who decided that the services should not be covered by an Austin vision center. You can ask the qualifications of that consultant, especially when it comes to their designation. The appropriateness of some treatments made by reviewed by a medical peer who is a doctor with training or knowledge in a certain area of care.


If an optometrist did not review the claim for Vision Therapy who will also provide these services, then a full medical peer review was not made. Two examples of medical peer reviews include the College of Optometrists in Vision Development (COVD) and the Fellows of COVD (FCOVD). Both of these groups are Board Certified in Vision Development and Therapy.


Request that your claim is reviewed by a Fellow of the College of Optometrists in Vision Development or by the Peer Review Committee of the College if you want a true peer review for Vision Therapy.


  1. Provide Supplying Documentation


Sometimes claims can be denied due to their insurance provider or medical consultant claiming there was a lack of evidence to support the effectiveness of Vision Therapy. Provide additional documentation can result in approval of your coverage.


It’s important to consider that while your insurance company may not pay for these services shouldn’t mean you shouldn’t seek Vision Therapy. Ask your doctor at Austin eye care about payment options that can help you or your family in receiving care.