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Insurance coverage for eye exams varies. Some plans only cover routine, well eye exams. Other plans will not pay for your exam unless you have a medical eye condition or disease. Some plans require a referral from your primary care physician. Be sure to check your policy(s) to determine your coverage prior to your appointment.
For insurance purposes, eye examinations are divided into two categories:
These are routine or "Well Vision" exams for people who have no eye disease or symptoms of disease. Your eyes will be examined for any needed correction (glasses or contact lenses) or any potential indicators of eye disease. If your doctor finds anything abnormal during your vision exam, further testing of a medical nature may be needed at another visit. In that case, your medical insurance would be billed.
Vision exams do not qualify for prescribing medications.
Diabetic eye exams cannot be billed to insurance under vision coverage.
This is a medically necessary comprehensive examination for the diagnosis and treatment of diseases and conditions of the eye performed by an eye physician. This exam evaluates the reasons for the symptoms and assesses any treatment needed. Some conditions evaluated with medical eye exams include allergies, cataracts, glaucoma, diabetic retinopathy, macular degeneration and many other eye diseases and conditions.
Most patients will have a refraction done during both types of exam.
Refraction is a diagnostic test used to determine your “best corrected vision”.
For some medical conditions Refraction is needed even when eyeglasses are not prescribed. The majority of insurance companies do not cover this procedure.
If your insurance does not cover your refraction, you will be asked to pay the fee.
Click the image below to open a downloadable and printable PDF of this pamphlet about medical insurance and vision plans or call our friendly staff at 423-581-2020 with any questions about your coverage.