A common question we get at Tower Clock Eye Center is the difference between routine and medical care, especially how they are billed through insurance.
Routine eye care
Some medical insurance companies cover routine, or preventative, eye care. Patients should check with their insurance provider to see if this benefit is part of her or his plan.
Routine care is basic care that evaluates general eye health such as an exam for a prescription for eyeglasses or contacts, or to screen for eye disease. These exams usually detect for refractive error, such as nearsightedness, farsightedness or astigmatism. Routine eye exams also often measure eye pressure to detect for glaucoma and to screen for risk factors for other eye diseases.
It is important to note that these routine exams do not cover treatments for eye diseases.
Medical insurance is used for the treatment of medical eye conditions or disease including infections, glaucoma, cataracts and macular degeneration, among others. Insurance is billed when eye conditions are diagnosed. Subsequent follow-up care is also be billed to medical insurance.
Many eye diseases require additional testing. Diagnostic testing and exams that thoroughly examine the internal and external structures of the eye are billed to medical insurance. Copays and deductibles may apply.
Often, we do not know if the exam will turn into a medical eye exam until we discuss any symptoms you may be experiencing. If the type of exam changes during the appointment, we make our best effort to communicate this and how it may affect billing.
Vision coverage’s design is to determine a prescription for, or to help reduce the cost of glasses or contact lenses. Coverage can also evaluate the health of the eyes. Like routine eye care, vision insurance does not cover the evaluation and treatment of medical problems. If your doctor finds a medical issue during the exam it will be filed to your medical insurance provider.
If you have questions about how routine eye care differs from medical eye care, please call us at (920) 499-3102.
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