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Medical Release Form Internal

Medical Release Form

Optomap Form

Patient Information

Dry Eye Questionaire


There are two types of health insurance that will help pay for your eye care services and optical products. You may have both types. InVision Eye Health accepts most insurance plans in both categories: 1) Vision plans (such as VSP, EyeMed and others) and 2) Medical insurance (such as Blue Cross/Blue Shield, Medicare and others).

  • Vision plans only cover routine vision wellness exams, along with eyeglasses and contact lenses. Vision plans do not cover medical eye care (the diagnosis, management or treatment of eye health problems).
  • Medical insurance must be used for medical eye care.
  • If you have both types of insurance plans it may be necessary for us to bill some services to one plan and some services to the other. We will follow a procedure called coordination of benefits to do this properly and to minimize your out-of-pocket expense.
  • If some fees are not paid by your insurance, we will bill you for them, such as deductibles, co-pays or non-covered services as allowed by the insurance contract.

Please provide your insurance cards to our staff member so we can make a copy. We need to have your medical insurance card or Medicare card on file in case we should need it in the future for billing your insurance.


This list may not be all inclusive, so if you do not see your plan listed here, please give us a call and we would be happy to assist you. We are always available to answer any questions regarding your benefits. WE NO LONGER ACCEPT SELECT HEALTH.

• AARP Medicare Complete – Optum Medical Network
• Aetna
• Altius
• Avesis Vision
• Blue Cross Blue Shield
• Cigna
• Davis Vision
• Educators
• Eyemed
• Great West
• Humana
• Humana Vision
• IBEW/Western Utilities
• March Vision Care
• Medical Eye Services
• Medicare
• Medicaid *select plans accepted, please call our office for more information
• Molina Commercial Plans
• Spectera – Optum Health Vision UHC Vision *exam and contact lens benefits only
• Superior Vision
• Tricare
• United Health Care
• Utah Idaho Teamsters
• Vision Benefits of America
• Vision Service Plan (VSP)

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