Why This Is Important To Know
If you are seen by your Doctor of Optometry and:
- There is no coverage under your plan contract, or
- Your coverage has run out because you have exceeded the yearly limit of your plan, or
- Your Doctor of Optometry’s fees for a procedure exceed the amount your plan allows, or
- Your coverage has expired and you will be responsible for payment of the treatment.
Eye Examination fees and coverage
Exam costs vary for adults over 19 who have MSP coverage. Extra testing may be required during your exam. Most extra testing (if required) is covered by MSP. Fees will be discussed before performing any testing that is not fully covered. Children’s exams (under 19) are covered by MSP, for children registered with MSP.
Patients who are not registered with MSP or do not have a BC CareCard are subject to full private clinic fees. We are unable to bill other provincial healthcare plans. Contact lens exam fees are an additional charge
Regarding BC Medical Services Plan Coverage for eye examinations: BC seniors who are 65 or more years of age have partial coverage for most eye examinations through the BC Medical Services Plan (BC MSP). In most cases, children through age 18 have full coverage for preventive eye examinations through BC Medical (MSP). Regardless of age, almost all residents of BC are eligible for partial BC MSP coverage if an eye or general health problem or medical reason is detected during the examination, but this cannot be confirmed prior to assessment. Unfortunately, BC MSP does not cover preventive eye care for most adults 19-64 years of age.
Patients are required to pay, on the day of service, for any portion of their examination fees which are not covered by BC MSP. We will bill BC MSP directly for any services for which you are eligible, if you have a current BC Health Care Card or BC Services Card. We are able to bill directly for most examinations covered by RCMP, Canadian Forces members and Department of Veterans Affairs.
We welcome individuals with BC Social Services (Ministry of Human Resources), First Nations
Health Authority (Status card) and Department of Veteran Affairs (Canada) coverage to schedule
appointments. We will assist you in obtaining approval for coverage of your eye examination
and/or eyewear.
However, please be aware that most organizations have strict
guidelines regarding the timeline for examinations and replacement of glasses.
We are able to direct bill some extended health companies online. If the company you use is not one of the few that we can bill directly, we will provide you with receipt of payment so that you can apply for reimbursement according to your coverage. You the patient are responsible for any, and all, parts of the treatment fee that is not covered by your insurance plan or BC Medical Services Plan.
Your plan’s Policy number and ID number card must be brought to your appointment, we must be notified of your coverage prior to checkout, and we must know if you have any secondary coverage or if your visit is WCB or accident related.
Please ask our staff about this for more information if you have any questions.
Extended Medical Billing
Contrary to popular belief our staff does not know which optical procedures or products are covered under your extended healthcare plan, and which are not. Your extended healthcare plan is a contract that exists solely between you and your insurance company. You, the patient, are responsible for educating yourself about such things as:
- Examinations, glasses or other products that are covered by your plan
- To what extent or percentage of the actual cost they are covered
- Annual maximums, procedure maximums within your plan
If you do not already have information that explains your benefits, you may want to ask your employer how your particular plan operates. Extended Insurance carriers consider the details of your plan to be a private matter since the Privacy Act was introduced in 2004, and will not provide information about your plan to a Doctor of Optometry or Optometric staff.