Is My Eye Exam Covered Under My Insurance?

Knowing which insurance plan to use can be confusing, but it does not have to be. Essentially, vision insurance only covers routine eye exams, annual eye health exams, or exams for glasses and/or contact prescriptions and does not cover anything considered medical. On the other hand, medical insurance only covers exams in which a patient is diagnosed with a medical condition or diagnosis and does not cover anything considered routine. Medical insurance does not cover the refraction portion of your exam.

· I’m only here for a new glasses and/or contact lens prescription. Which insurance should I use? VISION

· I’m only here for a routine eye exam and have absolutely no complaints about my eyes. Which insurance should I use? VISION

· I’m here because I was diagnosed with cataracts by another doctor but want a second opinion. Which insurance should

I use? MEDICAL

· I was referred by my primary care physician for an eye exam due to a medication I’m taking that affects my eyes. Which insurance should I use? MEDICAL

· I was previously diagnosed with macular degeneration, diabetes, dry eye, or another ocular disorder. Which exam should I have? MEDICAL

· I’m here because my vision seems to be getting worse and I’ve never worn glasses before. Which insurance

should I use? IT DEPENDS. If the cause for your decreased vision is treated with glasses and contacts, you will be using your vision insurance. If the cause for your decreased vision is treated with drops or surgery, you will be using your medical insurance.

· I just had a complete exam a few months ago, but I’ve noticed a recent change in my vision. Which insurance

should I use? IT DEPENDS. If the cause for your decreased vision is treated with glasses and contacts, you will be using your vision insurance. If the cause for your decreased vision is treated with drops or surgery, you will be using your medical insurance.

Vision insurance covers a routine comprehensive eye exam annually. This examination checks for but does not cover treatment of eye disease. The refraction (determination of the eye’s prescription) is included, and since there are no medical problems, there is no discussion of problems or follow-up needed when using Vision Insurance. Depending on your coverage for your vision plan, you may have benefits for materials such as glasses and contacts. Ask your optician for details regarding your plan benefits.

MEDICAL PLAN

Medical insurance is health insurance that covers evaluations for medical conditions. Medical insurance does not cover routine eye exams or refractions. This includes testing and treatment. Medical evaluations may incur additional cost based on the doctor’s findings.

We accept most major medical insurance plans. Please contact your insurance carrier to verify benefits and coverage. Payment of benefits are subject to all terms, conditions, and exclusions of the member’s policy at the time of service.

Eye health is complex and circumstances may vary. The information above is a general guideline. Each insurance is different and we recommend checking with your insurance provider on which option is best for your immediate needs.

Is it possible to switch my visit from a vision/

routine-only visit to a medical visit? Yes. Both you and your provider will make the determination on which insurance covers the nature of your visit.

I only have vision insurance, but I’d like to discuss a medical eye condition that I’ve been diagnosed with. Will my vision insurance cover this visit?

No. Vision insurance covers complete eye exams but does not cover visits in which patients discuss medical treatment plans.

I’d like to have diagnostic testing done to rule out an eye condition as recommended by my eye doctor. Will my vision insurance cover these costs?

No. Diagnostic testing is considered medical in nature. You will have to return for another visit to have the medical issues addressed.

I only have medical insurance and would like to use it to cover my follow up visit for my chronic eye condition. I also need a new glasses prescription. Will my medical insurance pay for my visit and my

glasses prescription? The medical insurance will cover the medical visit but will not cover the cost of the refraction (test used to determine glasses prescription). You will have to pay the refraction fee at the time of your visit.