Understanding vision insurance can feel overwhelming — especially when you’re not sure what your plan covers or whether your visit will be considered “vision” or “medical.” At Project Eyecare Optometry, we walk patients through this every day, and our goal is to make it clear, transparent, and stress-free.
Below is everything you need to know before your appointment, including the plans we accept, how to check your benefits, and what happens if you don’t have insurance at all.
What’s the Difference Between Vision and Medical Insurance?
The first thing many patients ask is:
“Do I use my medical insurance or my vision insurance?”
Here’s the simplest explanation:
Vision Insurance (Routine Care)
Covers:
- Routine eye exams
- Glasses prescriptions
- Contact lens prescriptions
- Allowances toward frames and lenses
Medical Insurance (Eye Problems or Emergencies)
Covers visits related to:
- Red or irritated eyes
- Floaters or flashes
- Sudden vision changes
- Eye pain
- Diabetes or high blood pressure eye checks
Project Eyecare Optometry is not in network with medical insurance, which means all medical visits are self-pay unless your vision plan includes a medical benefit (only some VSP plans do).
Vision Insurance Plans We Accept
We accept the following PPO vision plans:
- VSP
- EyeMed
- Davis Vision
- Spectera
For seniors:
Some Medicare supplement plans (like Scan or UnitedHealthcare vision riders) may include EyeMed or Spectera coverage, and these are accepted here.
We do not accept:
- Medi-Cal
- CalOptima
Our team explains this clearly and kindly:
“We only accept PPO vision plans such as VSP, EyeMed, Spectera, and Davis. We do not accept Medi-Cal or CalOptima.”
What If You’re Not Sure What Coverage You Have?
Many patients call unsure about their plan — and that’s completely normal. Here’s what we recommend:
1. Contact your medical insurance provider
Vision coverage often lives under your medical plan.
2. Check your member portal
Most portals list “vision benefits” under supplemental coverage.
3. Call your HR department
Especially helpful if your insurance is employer-provided.
4. Call us and we’ll guide you
We can help you understand:
- What information to look for
- Whether your plan is in network
- What to ask your insurance provider
However, the patient is ultimately responsible for knowing their coverage — and we’ll help you navigate from there.
Do We Accept Out-of-Network Patients?
Yes — even if we don’t take your insurance, we can still see you.
We provide:
- A detailed, itemized invoice (superbill)
- Includes all diagnosis codes
- Allows you to submit a claim for potential reimbursement
Patients love this option because it gives them the freedom to choose us even if their plan is different.
Transparent Pricing If You’re Self-Pay
If we look up your benefits and find you’re not covered, we’ll always discuss pricing before your exam.
Eye Exam Pricing (as of November 2025):
- $180 — comprehensive eye exam (glasses Rx + eye health check)
- $39 — retinal imaging
- $219 total for a complete visit
Contact lens fittings
Additional fee depending on lens type:
- Spherical
- Toric (astigmatism)
- Multifocal
- Monovision
We also offer CareCredit, which our team can help you apply for in office.
Payment is due in full at the time of service.
Common Insurance Surprises Patients Don’t Expect
Our front desk team sees these misunderstandings often:
1. “My medical insurance should cover this visit.”
Not for routine eye exams — and we are not contracted with medical insurance.
2. “My vision plan covers emergencies, right?”
No. Medical visits use medical insurance.
VSP is the only plan that sometimes includes a medical benefit.
3. “I don’t feel any symptoms, so I must not need an exam.”
Eye health problems can exist without symptoms. Exams check vision and eye health, which are two separate things.
What Happens During a Medical Eye Visit?
If you come in for:
- Red or irritated eyes
- Floaters or flashes
- Sudden blurry vision
- Pain or sensitivity
- Diabetes-related concerns
- This is billed as a medical visit.
Pricing (self-pay):
- $169 for new patients
- $121 for established patients
We’ll explain the reason clearly and help you decide if you should see us or an ophthalmologist — though most urgent care centers end up referring patients right back to an optometrist.
Ready to Schedule Your Visit?
Whether you’re using insurance or paying out of pocket, our team will help you understand your options clearly and confidently.
Book your eye exam at Project Eyecare Optometry today.
Experience care that puts you first.