Routine vs. Medical Eye Exam?

Many patients have both VISION AND MEDICAL insurance. They are very different in terms of the services they cover and it's important for our patients to understand these differences. Vision coverage is a discount plan mainly designed to determine a prescription for and give discounts for glasses/contact lenses. Vision coverage is NOT designed to deal with complex medical conditions or medical diagnoses of the eye. Vision coverage does allow for screening of medical conditions. However, if a medical eye condition is determined to be the cause of the exam complaint, Medical insurance has to be filed and NOT vision coverage for these exam services related to that medical eye condition. For example, if a medical condition (such as diabetes, cataracts, dry eyes, floaters, infections, etc.) is present and is supported by the patient complaint, it is necessary to file the visit with your medical carrier (BCBS, UHC, Aetna, etc.) thus, the co-pays for that medical insurance will apply as well as any deductibles. This includes chronic conditions such as diabetes meaning your vision insurance will not cover your exam but can still be used to purchase glasses and contact lenses.

INSURANCE CARRIERS SET THESE RULES AND OUR OFFICE IS OBLIGATED TO FOLLOW THEM. 

In most cases, there is no way to know before the exam which type of insurance our office will be able to file for you. We do make every effort to be on every major carrier for your convenience and will file those claims for you if able. If we do not take your medical insurance, we will provide an itemized receipt, at your request, so that you may file with your carrier for reimbursement.