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Home » Billing FAQS » Is my exam routine or medical?

Is my exam routine or medical?

Some of our patients choose to purchase an insurance product (or their employer purchases it for them) that may entitle them to a low-cost routine eye exam each year as well as discounts or allowances on eyeglasses and/or contact lenses. These routine eye exams do not take the place of a medical exam, so we want patients to understand the difference between a routine eye exam and a medical eye exam.

A routine eye exam is intended to rule out eye disease and provide the patient with an eyeglass prescription if they request it. It is a ‘healthy eye exam.’ If any abnormalities are found during a routine exam, your doctor will schedule a return visit to discuss your medical condition and the recommended treatment plan. Medical tests will not be performed on the same day as a routine exam unless an urgent issue is detected. Routine eye exam services do not include the completion of forms, insurance paperwork or correspondence with other doctors. A routine eye exam does not include a contact lens exam or fitting services. These services can be provided for an additional cost.

A medical eye exam includes the diagnosis, treatment plan and/or follow up of medical issues, including cataracts, diabetes with complications, moderate to severe dry eyes, eye infections, eye pain or injuries, flashes or floaters, foreign bodies, glaucoma, lid infections and red or irritated eyes. A treatment plan for a medical exam may include discussions regarding additional testing, procedures or surgery. Correspondence with other medical professionals is included in the exam cost. The completion of other paperwork, except for information requested by or provided to attorneys, is also included in the cost of the exam.

Prior to your exam, you may be asked to complete a ‘Routine or Medical’ form so that we clearly understand the reason for your visit and which insurance company you want to be billed. If you have scheduled a routine eye exam and your doctor finds a medical condition, the doctor may give you the option of converting that day’s visit to a medical exam that is billed to your medical insurance plan. If the exam is not converted to a medical eye exam, then the medical problems will be addressed at a future exam. Regardless of whether your vision plan insurance or medical insurance is used for your eye exam, you can still purchase eyeglasses and/or contact lenses using your vision plan benefits.

It is crucial that you provide accurate billing information prior to your exam so that we can help you determine whether your exam will be covered by insurance. Our optometrists all participate in EyeMed and VSP, but our optometrists and ophthalmologists do not participate in most routine vision plans. If you are unsure which insurance plan will be covering your exam, it may be prudent to postpone your exam until you have accurate billing information.

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