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Vision Eye Exams vs. Medical Eye Exams

  • Regular eye examinations are important to maintain your vision for your lifetime. It is important that you be aware of your insurance benefits and how they apply to your visit. We have prepared this sheet to help you understand how your visit is submitted to your health insurance or vision savings plan for today’s visit. Please be aware that not every medical insurance has a vision savings plan.

    Benefits may vary based upon the reason for your visit. Your description of your eye condition will help us to determine whether your visit to our office is defined as “Routine” or “Medical”. Your symptoms and eye examination will determine how your visit is coded and billed to your insurance.

    Routine Eye Examination : A “routine eye exam” takes place when you come for an eye examination without any medical eye problem and there are no symptoms except for visual changes that can be correct by eyeglasses or contact lenses. The doctor will screen your eyes for disease and other medical problems, and if no medical diagnosis is found, your glasses and contact lenses prescriptions may be updated.

    Medical Eye Examination : Your visit will be coded as a “medical eye examination” whenever you are being evaluated or treated for a medical condition or symptom that you inform our office about or a condition that the doctor finds during the examination. Examples that will necessitate your visit being submitted as a medical exam include but may not be limited to:

    • Headache
    • Dry or Red Eyes
    • Floaters and/or flashing lights
    • Cataracts
    • “Lazy Eye”
    • Contact Lens Intolerance
    • Diabetes mellitus
    • Allergies
    • Glaucoma
    • Eye muscle imbalance
    • Macular Degeneration
    • High risk medications that is used to treat certain illnesses
  • If your visit is determined to fall under that category of “medical eye examination”, your visit will be billed to your medical insurance instead of your vision savings plan and will be subject to co-pays, deductibles and/or co-insurance according to your plan. You will then have the option to pay out of packet for your refraction (glasses prescription) or schedule a return appointment, using your applicable vision savings plan.

    In summary, how your eye exam will be submitted to your insurance carrier will not only depend on what you tell the doctor, but also what the doctor finds upon examination. Remember there are vision savings plans that do not cover medical exams and medical plans that do not cover routine eye care.

    In summary, how your eye exam will be submitted to your insurance carrier will not only depend on what you tell the doctor, but also what the doctor finds upon examination. Remember there are vision savings plans that do not cover medical exams and medical plans that do not cover routine eye care.

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