Insurance & pricing: the simple version
Most people want two things:
- Clarity on what they’ll pay
- No surprises about what’s optional vs recommended
This page explains the common patterns — and how to make a good decision even if your benefits don’t line up perfectly.
Do I need to wait until my benefits reset?
Many vision plans reset every 1–2 years. That’s common.
You should consider booking before the reset if you have:
- new or worsening blur
- headaches or eye strain that is getting worse
- flashes/floaters or sudden changes
- eye pain/redness/light sensitivity
- diabetes, high blood pressure, or other health conditions that can affect the eyes
If you’re unsure, call and describe what you’re noticing.
Direct billing vs reimbursement
Two typical scenarios:
- Direct billing: the clinic submits to the insurer (when supported)
- Reimbursement: you pay, then submit the receipt
Either way, you should leave with clear documentation and a receipt suitable for claims.
OHIP: what it usually means (and what it doesn’t)
OHIP coverage is based on eligibility rules (age and medical criteria). Many adults are not covered for routine eye exams.
If OHIP covers part of an exam, there may still be services that are not covered by OHIP or your plan.
For the Spadina-specific version of this topic, see:
“Recommended” vs “optional” — what to ask
If you want a no-pressure experience, ask this directly:
- What’s medically recommended today?
- What’s optional, and what does it help with?
- What will it cost, and what might insurance cover?
A good clinic will answer clearly.
Related pages
Want to confirm coverage or pricing?
If you tell us your plan name (or bring your card), we can help you understand what’s likely covered and what isn’t.
Prefer to talk first? Call or text us at 416-703-2797.
Last reviewed: February 4, 2026