Routine or Vision Eye Examination:
A “routine eye exam” takes place when you come in for an eye examination without any known medical eye problem. Your eyes are examined and assessed for possible correction due to nearsightedness, farsightedness, or astigmatism and a look at the overall eye health is performed, checking for any potential indicators of eye disease. Correction needs may be determined or an update of your current eyeglasses may occur. These exams are treated as routine and billed to your routine benefit or vision plan. If the doctor discovers a medical eye condition or disease during that routine vision exam, the doctor will inform you that your visit is now a medical exam and the exam will be billed to your medical insurance.
Medical Eye Examination:
A “medical eye examination” is the examination, treatment, and management of an eye condition or disease such as cataracts, glaucoma, diabetic retinopathy, macular degeneration, and many other potentially sight-threatening diseases or injuries. These exams are treated like any other medical exam and billed to your medical insurance.
The way your eye exam is submitted to your insurance and to which insurance plan it is submitted will depend not only upon what you tell the doctor, but also what the doctor finds upon examination. Diagnosis of eye disorders is initially based on the symptoms that a person is experiencing, the appearance of the eyes, and results of an examination. A new symptom such as double vision or flashing lights also warrants a medical eye exam billed to medical insurance. It is important to know that certain eye diseases do not have symptoms.
The Refraction is the part of the eye exam that determines the prescription for eyeglasses. It also plays a key role in identifying medical problems; therefore, it is important to note that routine and medical exams at Country Hills Eye Center contain a refraction. This is typically not an insurance-covered part of the exam, and will be your responsibility to pay.
Please remember, there are vision plans that do not cover medical exams and medical plans that do not cover routine eye care. Be sure to check with your insurance company to determine your coverage as they vary by insurance and employer. It is also important to remember to inform us of your insurance plan payment restrictions prior to your examination.
Please understand Country Hills Eye Center cannot be held responsible for knowing every patient’s insurance coverage.