Seeking A Clearer Vision
"One of the challenges we face as a profession is that we are constantly juggling" vision plans and medical coverage plans, said Mark Swan, who is an optometrist. "We're always trying to help our patients understand that 'your vision plan will cover this, but we need your medical plan coverage for that.'"
It is particularly important today because a vision plan benefit for employees is often "one of the first things that get cut when a company tries to trim cost," said Swan. A result is that sometimes people may not seek care for their eyes when they should, because they think it will not be covered by insurance. Sometimes they are right and sometimes they are wrong.
Vision plans typically cover regular eye exams, glasses and contact lenses. Medical plan coverage generally doesn't cover routine vision exams or prescription lenses, but does cover eye exams in certain cases.
"There are some gray areas," said Swan. "It depends on the medical insurance plan. It could go either way."
If you suffered an eye injury or experienced a sudden radical change in vision, a visit to the eye doctor — either an optometrist or an ophthalmologist — is generally covered by health insurance. But if you are having blurry vision and the visit reveals you just need glasses or your prescription has changed, that exam probably is not covered by health insurance.
The “probably" is because insurance plans — even from the same carrier — can vary from one employer to the next, according to Swan. Insurance plan "gray areas" are the bane of eye care professionals. In some cases, the doctor can't know for sure before the exam takes place if it will be covered or not.
"That's one of the hardest things we have to deal with as a profession," said Swan. "A patient comes in to have an evaluation, and I say, 'Sorry, it's just a prescription. You have to pay out-of-pocket.' They don't like that."
Vision professionals maintain that an employer-sponsored vision plan benefit can pay for itself, and they cite research that indicates improved vision can reduce worker errors in production and help reduce accidents that are the result of poor vision.
One key thing that employees and their benefits plan administrators need to know about medical insurance, according to Swan, is that it does cover dilated retina eye exams for people with diabetes.
"Diabetes is considered high risk" for potential blindness, said Swan. "If you have not had a dilated retina exam in a year or more, and you have been diagnosed with diabetes, your medical insurance should pay for that exam."
The same is true for African-Americans and Hispanics age 55 or over. Those individuals are automatically classified as being at risk of glaucoma, and a glaucoma screening exam is covered by medical insurance.
Swan, 44, is inclined to educate people. Since 1999, he has been a full-time faculty member of the Michigan College of Optometry at Ferris State University. Swan received his undergrad degree from FSU, and then returned for four more years for his doctorate in optometry. In practice for a few years, he found that he really enjoyed working with children, which led him to attend the University of California at Berkeley Graduate School of Education where he received a master's degree in reading disabilities.
At Ferris, Swan teaches courses related to vision problems in children and specializes in problems that impair a child's learning abilities. Many schools provide a basic vision screening test to children just starting school, but only a thorough eye exam can reveal some of the subtle problems, he said. A child with an undetected vision problem isn't able to keep up on an academic level with his or her peers. "Only about 14 percent of all children have had an eye examination before they start school," Swan noted.
In addition to his classroom work at Ferris, Swan supervises the school’s working clinics staffed by student optometrists.
He also serves as a consultant for the Michigan Commission on Law Enforcement Standards and the Michigan Department of Community Health Vision Screening Program. He has lectured nationally and internationally, and he serves as an editorial reviewer for the Journal of Optometric Education, Review of Optometry and the Michigan Optometrist.
A native of Roscommon, Mich., Swan also works a half-day each week at Rockford Vision Services. He likes to maintain a hands-on routine in the everyday world of private practice, to help him relate better to his students who will soon enter private practice.
Swan also puts in time each week at Saint Mary’s Health Care’s Center for Diabetes and Endocrinology in Grand Rapids. There he provides vision exams for the center's patients, "thousands of whom have diabetes," he noted.
"As in all health care matters, African-Americans and Hispanics are an underserved part of our population. They have many more (medical) complications because they typically don't get as good care as the Caucasian population. They are more at risk," he said.
Swan was elected president of the Michigan Optometric Association in July; his term will last one year.
Ferris State University seems to be a powerhouse in leadership among the optometry profession. While Swan is the president of the state organization, the president of the American Optometric Association is the dean of the FSU optometry program, Kevin Alexander. In addition, an FSU optometry student is vice president of the American Optometric Student Association. HQX