Routine Eye Exam vs. Medical Eye Coverage

Regular eye examinations are important to your overall eye health and vital in maintaining vision for your lifetime. In order to understand how the billing of your visit will be handled, it’s important that you be aware of your insurance benefits and how they apply to your appointment. Ultimately, it is your responsibility to know what your insurance policy will or will not cover. Be sure to check your policy to determine benefit coverage prior to your appointment.

For insurance purposes, eye examinations are divided into two categories and benefit coverage for each type of exam varies by insurance policy. You will be asked to verify the reason for your examination. This reason for your visit and your description of current eye conditions will help us to determine whether your clinical visit is defined as a “Routine/Well Vision Exam” or a “Medical Exam” and how your visit is coded and billed to your insurance.

Well Vision Exams

A well vision exam is performed for a patient who has no specific illness, symptoms, complaints, or injury that needs to be treated or diagnosed. The visit will be a comprehensive exam checking overall health of the eye, screening for potential indicators of eye disease and if applicable, supply a glasses or contact lens prescription. If your doctor finds anything abnormal during your well vision exam, further testing of a medical nature may be needed. We may ask that you come back for another visit to complete any testing recommended and further evaluate the medical condition. In this case, your initial visit will be billed as a well vision exam, and the follow up visit will be billed as a medical visit. Well vision exams do not qualify for prescribing medications.

Medical Exam

A medical eye exam is performed for a patient who is being evaluated or treated for a medical condition, symptom, complaint or injury. The visit will be a comprehensive examination for the diagnosis and treatment of disease or condition of the eye. It will evaluate the reasons for symptoms or complaints and assess any treatment needed. Some examples of disease or conditions evaluated in a medical eye exam include but are not limited to: cataracts, glaucoma, diabetic retinopathy, macular degeneration, dry eye, conjunctivitis, allergies, etc.