Insurance Coverage for Vision Therapy

Insurance coverage for vision therapy for many people ranks up among taxes and inflation as one of the most frustrating things in the world right now. I currently chair the insurance committee of COVD (College of Optometrists in Vision Development - disregard the word “college” as it is an old word to describe an association - is the largest international body of doctors and therapists who practice vision therapy). In this position, I am painfully aware of the issues that patients and doctors face when it comes to billing medical insurance for vision therapy.

I can tell you that as it stands right now, providers have no good options when it comes to billing vision therapy to medical insurance companies. For this reason, most providers of vision therapy are out-of network with insurance plans. One of the main reasons behind this is that insurance plans place significant restrictions on vision therapy services. Many are very restrictive on the diagnoses and how many sessions of vision therapy are covered. Other plans restrict when vision therapy can begin based on certain conditions being met.

The biggest kicker is that even when insurance plans do cover vision therapy, they most often only contribute a very small portion of the total cost of vision therapy.

So what can you do if vision therapy has been recommended and the provider does not accept your insurance. Here are some tips:

1. Understand that vision therapy conditions almost always are medical conditions and fall under your medical insurance benefits and not your vision insurance benefits

2. Most providers who are out-of-network will provide you with documentation so that you can submit the claim to your insurance company

3. You can fight for insurance coverage and this document put together by a vision therapy provider can give you some help.

4. Most offices offer payment plans

5. If you are unable to afford the treatment you or your child needs, we may be able to help. You are welcome to apply for financial assistance through our organization by filling out this scholarship application.

About the author: Benjamin C. Winters is a founder and current President of the Foundation for Vision Therapy Awareness. Dr. Winters is board-certified in vision development and vision therapy. In 2010, he started the Washington Vision Therapy Center in Yakima, Washington. He has since helped start 2 more vision therapy clinics in Washington State. He acts now as a consultant to vision therapy clinics around the country. His advocacy for children and adults that struggle with vision therapy conditions has included over 100 lectures in colleges, professional groups, parent groups, and schools. He has participated in screenings to almost 1000 children in the Yakima area.