A routine eye exam is defined by insurance companies as an office visit for the purpose of checking vision, screening for eye disease, and/or updating eyeglass or contact lens prescriptions. Routine eye exams produce a final diagnosis, like nearsightedness, farsightedness or astigmatism.
Vision insurance plans provide coverage for routine exams, glasses and contact lenses, or at least provide some type of discounts on your doctor’s fees. A routine eye exam is billed to your vision insurance plan. Medicare does not pay for routine vision exams.
A medical eye exam produces a diagnosis, like conjunctivitis, dry eye, glaucoma or cataracts, to mention a few. Your medical insurance covers medically necessary eye exams. However, medical coverage does not customarily cover routine eye exams. 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 plan.
A refraction is the test that is performed to determine your glasses prescription. If you have a complaint of “blurry vision,” this test will be performed. Medicare and many other medical insurance plans consider a refraction to be not medically necessary and therefore it is considered a non covered service. This amount is charged separately and is paid directly by the patient.
Routine eye exams are not covered by Medicare, including eye refractions. However, Medicare may cover treatment, diagnostic and preventive testing of diseases such as glaucoma, diabetes and macular degeneration. You are responsible for the remaining 20% of Medicare-approved amounts unless you have a Medigap policy that helps pay your co-pay, co-insurance and deductible.
If you have had cataract surgery Medicare Part B covers one pair of corrective lenses (either one pair of prescription eyeglasses or contact lenses). Certain frames may be considered upgrades, and you are responsible for any additional costs for upgraded eyeglasses.
Please contact our billing department at (904) 595-5121 to see if special arrangements can be made.
Please bring your insurance card(s), picture ID, and a list of current medications. If you are a new patient, please bring your completed patient paperwork to your appointment.
A comprehensive eye exam which includes dilation may take 1-2 hours. If your eyesight requires multiple tests or if you have a more complex problem, the exam may run longer or require subsequent visits. If you are not having your eyes dilated, your exam may only take 45-60 minutes, however, this is dependent on the reason for your visit.
Dilation can last up to 6 hours and will cause light sensitivity and blurry vision. While most people feel comfortable enough to drive with a pair of sunglasses, some people prefer to have a friend or family member drive them. If you have never had your eyes dilated before (and therefore don’t know if you will feel comfortable), we recommend that you bring a driver or arrange for someone to pick you up after your exam.