Routine Eye Exams Vs. Medical Eye Exam

Many patients have a Routine Eye Exam benefit as part of their health insurance or with a separate vision plan. When you have medical coverage and routine coverage, which plan should be billed for your visit? Actually, your insurance company says it depends upon the reason you are here today.

Your Medical Benefit is billed if you are here for medical care, much the same was as when you visit a cardiologist for an evaluation or follow up to a heart condition. Medical care would address items such as:

evaluation of an ocular disease you have been diagnosed with, e.g., glaucoma, cataract or retinal disease; or

a complaint such as red eyes, tearing, burning, floaters, flashes of light; or

to follow an existing condition, such as diabetes, plaquenil medication for autoimmune disease; or

if you are scheduled for ancillary testing such as visual field, OCT, etc.

Your Routine Vision benefit is billed if you are here if:

you would like a “healthy” eye exam, much the same as a “routine physical” or

you would like your eyeglass prescription updated

These definitions are based on the guidelines of your insurance company and vision plans and Nashua Eye Associates is contractually obligated to follow them. Every effort is made to submit claims correctly so that:

We are in compliance with our contracted insurance carriers and vision plans

You do not receive unexpected medical bills for uncovered services

This is usually a straight-forward issue once you understand the insurance carriers’ definitions, but please do not hesitate to ask your Nashua Eye Associates doctor if you have questions.