Optometry Insurance Coverage Details | MSP 2023 Update
Be Aware Of Your Options: Optometry insurance coverage can be complicated and often overwhelming. Stay updated on the 2023 MSP coverage guidelines and let us, at Real Eyes Optometry, help you understand how to use your insurance.
MSP covers one full examination per year for children up to 18 years of age and partially covers individuals over 65 years of age.
Optometry insurance coverage does not provide reimbursement for individuals aged 19 to 64 unless they have a medical issue that falls within the MSP guidelines.
Real Eyes Optometry can directly bill your insurance provider. All you need to bring to your appointment is your Picture ID and Insurance Card. You can also email us a copy ahead of time to make the process more efficient.
Please note that we are not able to determine how much coverage a patient has. We recommend that you call your insurance provider to determine coverage amounts before your appointment.
The following is a list of insurance coverage providers our office can directly bill:
Pacific Blue Cross
Green Shield Canada
SSQ Financial Group
Sun Life Financial
Great West Life
Manulife Financial – Standard Life
Desjardins Insurance
Chamber of Commerce Group Insurance
CINUP
Cowan Insurance
First Canadian Insurance
Group HEALTH
Group Source
Industrial Alliance
Johnson Inc.
Johnston Group Inc.
Manion
Maximum Benefit
Optometry Insurance Coverage: Medically Required Eye Examinations
An eye examination is an insured benefit if medically required. In general, medically required examinations that are considered under optometry insurance coverage include the following:
- Ocular disease, trauma or injury
- Systemic diseases associated with significant ocular risk (e.g. diabetes)
- Medications associated with significant ocular risk
Optometry Insurance Coverage on Eye Examination Benefits
Copy from the BC MSP Guidelines:
Routine eye examinations are not an MSP benefit for individuals aged 19 to 64 years. Medically required eye examinations continue to be a benefit for all MSP beneficiaries. We are providing the following information to clarify the changes to the eye examination benefits and to provide more detail on when a referral is required.
According to Optometry Insurance Coverage with MSP, an eye examination is an insured benefit if medically required. The diagnoses which meet the MSP definition of medically required are listed by ICD9 code, and are payable at the frequency indicated on the website. In general, the criteria for medically required Optometry Insurance Coverage includes:
- ocular disease, trauma or injury
- systemic diseases associated with significant ocular risk (e.g. diabetes)
- medications associated with significant ocular risk
Formal referrals to ophthalmologists or direct requests to optometrists for an eye examination on behalf of patients are appropriate only if, in the practitioner’s judgement, and based on clinical evidence, there is a medical necessity for the examination.
Refractive change (needing glasses or contact lenses) with no other pathology does not meet the MSP medically required criteria for payment. These patients should contact their optometrist directly to request an eye exam and they should also be advised that payment for the eye examination would be their responsibility.
MSP will be monitoring billings and conducting audits of referrals to assess compliance with the criteria defining medically required services.
Now that you understand your Optometry Insurance Coverage, you’re ready to go.
If you have any questions, feel free to contact us.
