The Medical Eye Exam

Routine and medical: two kinds of visit

Insurance draws a line that patients often do not see. A routine or vision exam is for checking vision and updating glasses or contacts in a healthy eye, and it is covered by vision plans. A medical exam addresses a medical problem: blurred vision from cataract, a red eye, floaters, dry eye, glaucoma monitoring, a diabetic screening, or a family history that warrants investigation. It is covered by medical insurance, with the usual copays and deductibles, and vision plans generally do not pay for it. The same visit cannot usually be billed as both.

What makes an exam medical

• A symptom: blur, pain, redness, floaters, flashes, double vision, headaches, dryness
• A known condition being monitored: glaucoma, cataract, macular degeneration, diabetic retinopathy, dry eye, keratoconus
• A systemic disease with eye effects: diabetes, high blood pressure, autoimmune disease, thyroid disease
• Medications that need eye monitoring, such as hydroxychloroquine or long-term steroids
• An injury or a foreign body
• A referral from another doctor for an eye problem

What the exam includes

Everything in a comprehensive exam that is relevant to the problem, plus the testing the problem requires: OCT of the macula or optic nerve, visual field testing, retinal photography, corneal imaging, tear film testing, or gonioscopy. The findings are documented as a diagnosis, a treatment plan is made, and follow-up is scheduled at the interval the condition needs. A report is sent to your referring or primary care doctor where appropriate.

If you need glasses too

A refraction for glasses can be done at a medical visit, but many medical plans do not cover the refraction itself, which may be billed separately. Our team will confirm your coverage when you book, so there are no surprises.