Your reason for being seen at the eye doctor and the results of your examination determine whether your insurance company will classify the exam as “routine” or “medical.”
What is a routine eye exam?
A routine eye exam is defined by insurance companies as an office visit for the purpose of checking vision, screening for eye disease, and/or updating eyeglass or contact lens prescriptions. Routine eye exams produce a final diagnosis, like nearsightedness, farsightedness or astigmatism.
Vision insurance plans provide coverage for routine exams, glasses and contact lenses, or at least provide some type of discounts on your doctor’s fees. A routine eye exam is billed to your vision insurance plan.
What is a medical eye exam?
A medical eye exam produces a diagnosis, like conjunctivitis, dry eye, glaucoma, macular degeneration or cataracts, to mention a few. Depending on your policy, your medical insurance may cover a medical exam, but not pay for the exam if it is a routine eye exam. Examinations for medical eye care, assessment of an eye complaint or to follow up on an existing medical condition are billed to your medical insurance plan.
Anything you discuss with your provider that cannot be classified as a part of a routine exam will be considered a problem oriented MEDICAL exam. DISEASE EVALUATION AND/OR TREATMENT IS NOT COVERED UNDER ROUTINE WELLNESS EXAMS. This will be your responsibility, but can be submitted under your medical plan which will incur other co-pays and/or charges
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