Routine vs Medical Eye Exams

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 diseases, and/or updating eyeglass or contact lens prescriptions. A routine eye exam is billed to your vision insurance plan. By law, Medicare does not pay for routine eye exams.

Medical Eye Exam

A medical eye exam may produce a diagnosis such as conjunctivitis, dry eye syndrome, glaucoma or cataracts to mention a few. Additionally a medical eye exam will determine if certain systemic diseases in particular diabetes have affected the ocular health. Depending on your policy, your medical insurance may cover a medical exam, but not pay for the exam if it is considered routine in nature. 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.

Refraction Fee

A refraction is part of an office visit that determines our eyeglass prescription. Vision insurance policies generally cover both the routine eye exam and refraction. Medical insurance does not cover the cost of the refraction. If a refraction is performed during a medical eye exam the patient will be responsible for the $40 refraction fee.

***Insurance coverage does not necessarily mean payment. Many health plans have copayments and deductibles that must be met before your insurance will pay any amount towards your bill.