Did you know that the term EYE EXAM can mean multiple things?
There are three terms that are commonly confused when someone asks for an eye exam. Those are:
Vision exam, Medical exam, and Refraction
What is a vision exam?
A VISION exam (sometimes referred to "routine") is an exam that assess the basic overall health of your vision. It will consist of a vision test on the eye chart, a REFRACTION (you know..."number 1, or number 2?"), and basic eye health screening exam at the slit lamp. It may or may not include dilation, depending on the preference of your eye care provider. It often results in a prescription for glasses or contacts but typically does not address medical conditions such as cataracts or dry eyes.
The costs of a routine vision exam, as well as material goods such as glasses and contacts, are often supplemented by VISION INSURANCE, but most medical insurances will not cover these services. (In other words, medical insurance will not cover the test required to obtain your prescription for glasses or contacts, i.e. the REFRACTION). Vision Insurance typically DOES NOT COVER the diagnosis and treatment of medical eye disorders such as dry eyes, macular degeneration, glaucoma, or cataracts. To address these issues you will need a MEDICAL EYE EXAM.
What is a medical eye exam?
A medical eye exam is a comprehensive yet often targeted eye exam. This includes evaluation and treatment of medical conditions from anything like dry eyes, cataracts, macular degeneration, or glaucoma, to other concerns like the use of high risk medications such as plaquenil. Those are only a few examples of what is covered by most medical insurances.
Did you know that "BLURRED VISION" can often be considered a medical diagnosis that is covered under your MEDICAL insurance plan? The vast majority of patients do not need vision coverage in their medical plans to assess and treat these conditions. Yearly medical eye exams are often comprehensive and included in medical benefits. Dilation, photography, visual fields, and other types of testing are often COVERED portions of the MEDICAL eye exam. In most cases, a REFRACTION is not a covered benefit of medical insurance plans.
What is a REFRACTION?
A refraction is what most people think of when the hear the term Eye Exam. It is the test that is required in order to obtain a prescription for glasses. Most people know this as the anxiety provoking portion of an eye exam. This is performed by placing a series of lenses in front of a patient while they are asked to choose between "number 1 and number 2".
Here's a secret to help you relax: if you can't decide between "1" or "2", that usually means we're in the right place!
The REFRACTION is often part of the medical eye exam and is usually not a covered benefit during the medical eye exam. However, most doctors will agree to perform a REFRACTION with the medical eye exam for a small fee that typically varies from office to office.
I have vision insurance and medical insurance. Can I have my vision insurance pay for the refraction and my medical insurance pay for the medical eye exam.
Uhgg...unfortunately no. Medical and Vision insurers prevent patients from utilizing both insurance plans on the same visit. (A notable exception to this is that material goods covered by vision insurance, such as glasses and contacts, MAY be purchased on the same day as your MEDICAL eye exam)
Believe us, this is just as frustrating for the doctor as it is for the patient, and is a frequent source of confusion in the general public. As mentioned above, most doctors will heavily discount the "refraction" to patients when obtained as part of a medical eye exam.
the term "eye exam" is a generic term that can mean any or all of the above exams. When you make your appointment, it is best to state what your needs are using the above terms, rather than asking for "just an eye exam". If you are unsure, please feel free to call and mention your current eye complaints to our staff and they can help you decide which type of exam is best for you.
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