Routine eye care vs. Medical eye care

Medical Eye Exam

Eye exams for medical care are for a medical-related complaint or follow-up of an existing condition. These exams are billed to medical insurance. You may have an established medical condition that would necessitate your exam be considered a medical exam. The conditions include, but are not limited to:

  • Diabetes mellitus
  • Floaters and/or flashes of light
  • Glaucoma
  • High risk medication
  • Cataracts, post-cataract surgery
  • Eye muscles imbalance
  • Macular degeneration
  • Eye irritation
  • Dry eye
  • Other retinal issues
  • Foreign body
  • Eye injection

A refraction (glasses check) may be necessary during your medical eye exam. Medical insurance does not cover refraction.

Vision Plan & Routine Eye Exam

Most vision plans allow for 1 routine exam per year; they usually have an allowance for glasses and contacts and the fitting of contacts/glasses. Some medical insurance plans allow for 1 routine eye exam per year, and some cover the refraction and contact lens fitting. Vision plans do not cover medical treatment or follow-up. If a medical issue is found during your routine exam, a follow-up may be needed or, if urgent, the visit may be billed to your medical insurance.

If being seen for a medical reason, your exam will be billed to your medical insurance. Your Vision Plan (glasses exam) benefit can be used at a later date. You may also elect to pay the refraction fee and/or contact lens fitting fee out of pocket during your medical exam if you choose.

***If you have any questions regarding insurance coverage or benefits, it is the patient’s responsibility to contact your insurance company.***

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