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Insurance
Health insurance can be very confusing and often frustrating, for both the patient and doctor! The confusion increases
when it comes to eye care due to the added variables of “refractions” and “vision coverage.” We want to help you
understand different types of insurance in hopes of lessening the confusion and frustration.
Refraction is the process of measuring your current glasses prescription and
determining the new prescription that gives
you the best vision obtainable. A refraction does not include any screening or examination and must be billed
separately according to Medicare and insurance guidelines. Medicare does not cover a refraction. Because Medicare
considers this a non-covered service, your supplemental insurance will also deny payment.
(Military: Tricare For Life will deny coverage and send it to Tricare Standard for payment. Tricare Standard will
recognize it as covered, but there is a $100.00 deductible per year. (Frustrating – YES, avoidable – NO.)
Routine vision plans cover a refraction and a complete eye examination.
This can be separate from your medical insurance plan or included within it. Some plans require pre-authorization
for the appointment while others do not. Your co-payment must be paid at the time of service per plan rules. Some
vision plans add an amount to use toward the purchase of glasses. Some plans also add an amount to use toward contact
lens evaluation and/or purchase. Some plans offer either glasses or contact lenses, but not always both. Please
contact your vision plan prior to your appointment and specifically ask:
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Do I need preauthorization for an eye examination
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How often is an examination covered (every 12 or 24 months)
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What is my co-payment amount
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Do you cover any amount toward glasses purchase (every 12 or 24 months)
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Do you cover any amount toward contact lenses (every 12 or 24 months)
Routine vision plans do not cover medical eye problems. If we find a medical eye
problem during your examination, you will need to return under your medical insurance plan for appropriate care.
Primary Medical Insurance covers medical eye complaints, eye diseases (cataracts,
glaucoma, macular degeneration, dry eyes, diabetic exams) and eye surgery. This is the same insurance you would use at
your regular doctor’s office or a visit to the emergency room. Many insurance plans, including Medicare, DO NOT cover
a refraction or a routine eye exam. Some insurance plans require a referral from your primary care doctor and most
require a co-payment which we must collect at your appointment time per plan rules. Most insurance companies also
have a deductible you must satisfy each calendar year before they will cover any expenses. For Medicare, the amount
is $100.00, which can be met at any medical doctor’s office.
Contact lens evaluation is for current contact lens wearers and involves checking
the contact lens parameters and how they move on your eye. The evaluation fee varies by the type of contact
lenses you wear.
Contact lens fitting is for patients who want to wear contact lenses. The fitting
fee varies by the type of contact lenses you need. A refraction and eye examination does not include an evaluation of
your contact lenses and your glasses prescription cannot be used for contact lenses.
Contact lens purchase is separate from both an evaluation and a fitting.
Cash pay refraction and screening eye examination is offered to patients without a
routine vision plan or coverage under their medical plan. The fee for the refraction and examination is $100.00,
with cash/check/credit card discount of 20% ($20.00) for a total cost of $80.00. The 20% discount is a direct savings
to you and can only be allowed if we receive payment in full prior to the examination and we do not bill any insurance.
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