It is important to remember that it is ultimately the patient’s responsibility to know the detail of their insurance and any applicable co-pays and/or deductibles. However, our office will do its best to help you determine what your plan covers.
A medical eye examination has nothing to do with neither the procedures that are performed during your visit nor the type of licensed eye care professional who performs your exam. A medical eye examination is determined by your chief complaint or reason for the visit and ultimately your diagnosis.
An example of a medical chief complaint is a complaint of light sensitivity and a watery discharge from your eyes. One possible medical diagnosis for this would be conjunctivitis (commonly called pink eye) thus requiring medical treatment with an antibiotic.
The reason for determining if a visit is a routine “visual” examination or a “medical” eye examination is that health insurance (e.g., Blue Cross/Blue Shield, UnitedHealthCare, etc.) may cover a medical diagnosis but not a vision diagnosis such as near sightedness or astigmatism.
A visual diagnosis may be covered by a major medical health plan's supplemental vision insurance plan (e.g., VSP, EyeMed, Humana). This means that even if you do not have vision insurance, depending upon your diagnosis and reason for visit, your visit may still be covered by your major medical insurance.