Some insurance do require a referral from your primary care office or a prior authorization to be presented in order for services to be covered. These requirements should be explained in your coverage handbook, on the insurance carrier’s website or by calling the customer service number on the card. It is the patient’s responsibility to […]
Occasionally. Some vision insurance plans will cover a refraction (see above) on the same date as an office visit for a medical condition (with the medical insurance covering the office visit). It is the patient’s responsibility to determine whether their vision insurance plan allows the refraction to be billed separately on the same date as […]
No. If the reason for the visit was for a routine vision examination, the visit cannot be billed to medical insurance per federally accepted billing guidelines. Therefore either: the vision insurance is billed (if the patient has vision insurance and the doctors are participating providers in their vision insurance plan) or, the patient is responsible […]
This depends on the reason for the visit. Examinations for medical care, evaluation of an eye complaint or to follow an existing medical condition are billed to the patient’s medical insurance plan. Examinations for the purpose of checking vision, screening for disease, or updating eyeglasses or contact lenses are billed to the patient’s vision insurance […]
A refraction is the part of the office visit that determines the eyeglass prescription. Many times this involves the comparison question “which choice is clearer, choice one or choice two?” as different lens combinations are presented to the patient. Medicare does not consider a refraction to be a “medically necessary” service, and therefore Medicare will […]
Medicare does not pay for routine vision exams or refractions. Medicare beneficiaries may choose to have a routine or annual eye examinations performed, but the patient is responsible for full payment for these examinations on the day of service. Some Medicare beneficiaries may have “vision benefits” that cover routine eye examinations through their secondary or […]
Insurance companies define a “routine” or “annual” vision examination as an office visit for the purpose of checking vision, screening for disease, and/or updating eyeglass or contact lens prescriptions.
The difference between routine vision examinations and medical eye examinations can be confusing and difficult to understand. There are, however, important differences between these two types of examinations and these differences determine how the office visit will be billed. Please read additional questions below.
Yes, as of June 2012 we are accepting Community Eye Care Plans. Please speak with our staff at your next appointment with any additional questions.
Any abnormal phenomena or changes in your vision can indicate a variety of possible problems. The key to preserving vision in the face of most eye diseases is early treatment. Thus it is important to consult an eye doctor if you notice anything unusual or any change in your vision. It could be a serious […]