As an eye doctor in network with SoonerCare Insurance in Broken Arrow, I have to be familiar with all the rules or guidelines that apply. I will discuss some of those rules in this article. Now, please understand that SoonerCare could change those rules tomorrow, but here is information about SoonerCare in the current environment for Tulsa, Broken Arrow, and the surrounding areas.
SoonerCare Guidelines
SoonerCare’s purpose and goal is to make sure no one goes without their needed vision correction due to their financial situation. Eye examinations with SoonerCare are covered for individuals under the age of 20. SoonerCare also covers basic glasses, again, for those under 20 years old. If you are over the age of 20, then SoonerCare will only cover the examination for medical reasons such as allergies, dry eyes, headaches, diabetes, or other eye conditions.
Does SoonerCare Pregnancy Cover Eye Exams?
If you are pregnant SoonerCare will cover the eye exam if you have an eye medical condition. Those conditions could be dry eyes, cataracts, watery eyes, glaucoma, headaches, or any other eye related medical condition. SoonerCare will not cover glasses over the age of 20 regardless of if you are pregnant or not.
What Does SoonerCare Cover for Kids?
SoonerCare covers a yearly examination and any requested follow-ups by your Eye Doctor or Optometrist. SoonerCare will also cover a pair of glasses. This includes both the lenses and the frames. The lenses are to be polycarbonate material. The frames are expected to last the patient 1 year, but if broken SoonerCare will cover an additional frame within that year. One Vision has a large selection of SoonerCare-eligible glasses. Our SoonerCare eyeglasses come in a wide variety of colors and styles.
What Does SoonerCare Cover for Adults?
When it comes to adults, SoonerCare will cover an eye examination for a medical reason. In other words, SoonerCare will cover the examination if you have eye allergies, dry eyes, glaucoma, diabetes, cataracts, or any other eye disease. Currently, it doesn’t help with glasses for anyone over 20 years old.
Does Medicaid Cover Vision Therapy?
Sadly Medicaid does not cover vision therapy. Years ago SoonerCare did cover vision therapy, but those guidelines got changed and it no longer covers vision therapy. I am hopeful that one day they will change that guideline back and start allowing vision therapy treatments.
Does SoonerCare Cover Contact Lenses?
SoonerCare views contact lenses as a convenience and therefore it does not cover them. Thankfully, contact lenses are not nearly as expensive as they were in years passed, so even though SoonerCare does not cover contact lenses you or your child may be able to afford contact lenses.
Tulsa Eye Doctors in Network with SoonerCare
Also, most of the Eye Doctors in Tulsa and Broken Arrow accept SoonerCare. After all, with over 70% of Tulsa kids enrolled in the program, it makes sense that SoonerCare would be the first vision insurance most Eye Doctors would apply to get in network with, and therefore be able to take more patients.
Will SoonerCare Cover Replacement Glasses?
Next, Soonercare will cover replacement glasses under certain circumstances. Here are the guidelines from the Oklahoma Health Care Authority:
“Eye glasses, lenses and frames, are covered for children. Prior Authorization is required for additional eye glasses for children beyond 2 pairs in a 12 month period. It should be unusual for a child’s vision to change so frequently that greater than two pairs of eye glasses are needed within a 12 month timeframe. However, if this should occur, the documentation should clearly demonstrate changes in the member’s vision necessitating the new prescription. PA will provide if the services are reasonable and medically necessary.”
Here is a list of indications for additional eye glasses:
- Change in Vision:
- Documentation should indicate a change in correction of 0.5 diopters or greater in either sphere or cylinder power in either eye since last examination; OR
- A shift in axis of greater than 10 degrees in either eye since last examination; OR
- A change in the member’s head size warranting a new pair of eyeglasses; OR
- The member has an allergic reaction to the eyeglasses materials; OR
- A comprehensive or intermediate vision examination shows that a change in eyeglasses is medically necessary.
2. Irreparable Lenses/or Frames
- Documentation should indicate the nature of the incident resulting in irreparable damage, including how and when the lenses and/or frames were damaged; AND
- A statement indicating why the lenses and/or frames cannot be repaired.
3. Lost or Stolen Eye Glasses
- Documentation should include a signed statement from the parent/caregiver attesting to the loss of the eye glasses and that reasonable attempts were made to locate the lost or stolen eye glasses and failed.
Helpful Links
Next, here are some links to help you get started with Soonercare. If you find yourself with more questions, feel free to call us at 918-286-2020. As an Amazon associate I earn a commission on qualifying purchases.
Soonercare Benefits Information
Soonercare Eligibility Guidelines
Summary of Eye Doctor in Network with SoonerCare
Lastly, One Vision is proud to be a practice in network with SoonerCare. Our Eye Doctors became Eye Doctors to help people. As an Optometrist office in network with SoonerCare, we can do just that. Also, if you want to learn more about SoonerCare, you can visit their website here. Lastly, if you want to compare SoonerCare insurance to other insurances commonly used with Eye Doctors, check out this insurance review to weigh your options. Thanks for reading, and we hope to see you (and get you seeing) soon!
-Doctor Hernandez
