Mommas of babes with glasses & frequent eye exams

SweetPeaKate · August 2013

Has anyone had any luck with vision insurance or finding ways to help cover or augment the cost of eye exams and lenses for your LOs. My DS is 20 months. got glass at 14 months and looks like we will be doing eye exams with dilation every 6 months for a little while. Most insurances I'm finding only cover one per year, which doesn't really help when you factor in the cost of needing new lenses every 6 months because his prescription changes.

The office is going to try submitting it to our regular insurance to see if they accept it as a medical diagnosis relating to prematurity (born at 30 weeks due to HELLP) but I don't think they approved it last time. Any advice or suggestions would be greatly appreciated. Thank you!!

meldoo2002 · August 2013

I haven't had any issues with my boys eye exams being covered. We go to a pediatric opthamologist who they saw in the NICU and have seen since. Joey ranges from 4-8 months between appointments and Nathan was going every 8-9 months, now he doesn't go back for a couple years. I just pay my copay. Sorry no suggestions because I really didn't have an issue.. maybe it's the opthamologist versus optometrist though... can you see if you went to someone different if that would help? We haven't needed glasses so it's just be exams at this point.

MaxandRuby · August 2013

DS2 (almost 4) has worn glasses since 10mos old and sees a pediatric ophthalmologist at this point every 6-9mos. He does not require his eyes being dilated that frequently though.

Insurance covers all of his eye exams but they do not cover glasses/lens. I don't know what insurance you have but mine is through the military and the kind I have is basically a HMO (we do not have separate vision insurance). I do have to get authorizations for the extra exams. In my experience with various kinds of employer insurance, they usually do not cover glasses/lenses. We pay OOP every time DS2 needs new lenses and/or frames. I keep the receipts and it gets tallied into medical expenses for tax purposes. We actually just ordered new lenses the other day after getting brand new lenses in January. I hate having to pay OOP and wish the glasses were covered but alas, they are not so OOP it is.

The only advice I really have is to check around to varying providers to see if they offer discounts or financial assistance. Where we get our glasses, they cover the yearly exam for myself and other son but do give us a discount on lenses and frames.

punky917 · August 2013

DS had ROP which eventually led to loss of vision in one eye. He had frequent eye visits to the ophthalmologist. He is 5 now and only has to go every 6 months. But I agree with pp, that eye exams (his has been EUAs-Exam Under Anesthesia) have always been covered with the ophthalmologist. However, his lenses have never been covered since it was under our vision plan which doesn't cover anything. He has had glasses since about 15 months and has had countless changes to his prescription just like your LO. Hope that helps! Good luck!

chicagobride_07 · August 2013

Agree with the others. Our pedi wanted LO to see a pediatric ophthalmologist a few times to rule out ROP and the exams with dilation have all been covered by our medical insurance like any other specialist visit.