When most people think of an eye exam, they're thinking about whether or not they will need to update a prescription for glasses and/or contact lenses. Most people don't think of it as a medical exam. We offer many services that evaluate and treat many different conditions related to your eyes. There are many different terms referring to eye exams that can sometimes be confusing. When it comes to your eye care, you need to know what you need and what you're getting.
Routine vs. Medical
Ultimately, what determines whether your visit is classified as "routine" or "medical" depends on two things: the reason for your visit, and the results at the end of your visit.
Routine Eye Exams
Routine eye exams are important to maintain your vision throughout your lifetime. The purpose of a routine exam is to check your vision, evaluate the overall health of the eye, and update prescriptions for glasses and/or contact lenses. It will also check your color vision, depth perception, and eye muscle balance. This exam diagnoses conditions such as nearsightedness, farsightedness, or astigmatism.
This type of exam would be billed to your vision insurance if applicable, or you if you are self‐pay.
Medical Eye Exams/Office Visits
The eyes act as a window through which we can see other things happening inside the body. Many times, diseases such as hypertension, diabetes, tumors, various auto‐immune diseases, and more can show up in the eyes and lead to a diagnosis of a disease. In addition, the eyes themselves have the potential to develop their own diseases. Many eye conditions may not present with symptoms, so yearly exams are important to maintain the overall health of the eye.
The medical exam differs from the routine exam in that with a medical exam, we are evaluating or treating you for a medical condition. Some of these conditions include Glaucoma, diabetic eye disease, macular degeneration, eye infections, cataracts, retinal disease, and any other eye conditions that are not treated by wearing glasses or contact lenses. These conditions are not considered "routine" and therefore are not included in a routine evaluation.
Exams for medical eye care, assessment of an eye complaint, or to follow up on an existing condition are billed to your medical insurance plan. A refraction (vision check) is not included in this exam and typically not paid by medical insurance.
Which exam do you need? What if you need both?
Due to the difference in nature and length of the types of exams, you most likely will not be able to have both exams in the same visit. Additionally, most vision and medical insurance plans will not allow a routine and medical exam on the same date of service.
Will my insurance pay for it?
The ins and outs of insurance can be very confusing. It is to your benefit to be aware of both your vision and medical coverage, and any deductibles or co-pays that may apply. We will always do our best to determine ahead of time what kind of eye exam you are receiving and who it's being billed to. When you schedule an appointment with us, our staff will verify the reason for your visit, collect all applicable insurance information, and verify your benefits and your cost for the visit prior to you being seen.