This is one of the most confusing topics for patients and for good reason! As optometrists, we sometimes take vision insurance and sometimes take medical insurance. In a few cases, a portion can be billed to each.
Vision insurance covers a “routine” comprehensive eye examination. In this exam, we check for, but do not find medical problems. The determination of the glasses prescription is always included in this type of exam. Most vision plans do not cover 100% of expenses. You may have a co-pay or deductible. In some cases, vision insurance plans pay for a portion of your materials (eyeglasses or contact lenses). Vision insurance does not usually cover a contact lens evaluation fee.
Medical insurance pays for an eye care visit that is medical in nature. The following are some examples of medical visits: a red or inflamed eye, acute loss of vision, foreign body sensation, floaters and/or flashes of light, dry eye, diabetes, glaucoma, cataracts, and post-surgical office visits.
A comprehensive medical exam does not include the determination of the glasses prescription. Medical insurance plans will deny this portion of the exam. In these cases, a supplemental vision plan may pick up the cost. Oftentimes, it is the patient’s responsibility. You may also have a co-pay or deductible with medical insurance.
How do I know which type of visit I will have?
- If you are healthy with no known eye or health problems and you are wanting an updated glasses or contact lens prescription, we will likely bill your vision insurance.
- If you have a pre-existing eye condition or medical condition that may affect your eyes, we will likely bill your medical insurance.
- If you are coming to our office due to a medical concern (such as one listed above), we will always bill your medical insurance.
- **We always check for medical problems no matter what type of eye exam. For this reason, we occasionally find a medical problem the patient is unaware of. In this circumstance, we bill for a medical exam, not a routine exam. Only medical insurance will cover this type of visit.