Junctioneyecenter.com
Medical Eye Exams VS Routine Vision ExamWith constant changes to how insurance works we are trying to be as transparent as possible with how your visit is billed. We are hoping this explanation will help eliminate any confusion about your visit today.How your eye exam will be submitted to your insurance will depend not only upon what you tell the doctor, but also what the doctor finds upon examination. Remember there are vision plans that do not cover medical exams, and there are medical plans that do not cover routine eye care. If you have further questions please ask one of our staff members. It is our goal to make understanding your insurance as easy as possible.Routine Vision Care:A routine vision exam or “wellness exam” takes place when you have an eye examination without a medical eye/systemic problem. Under a routine exam there will be no symptoms except for visual changes that can be corrected with glasses or contact lenses. The doctor will screen your eyes for disease and find no medical problems. Glasses and contact lens prescriptions may be updated. If you have previously been diagnosed with a chronic medical eye or systemic condition you are not eligible for a routine eye examination.Regardless of whether you have a medical reason for the eye health portion of your visit, if a refraction (glasses RX check) is preformed insurance companies considers the refraction to be routine and processes the charge accordingly.Medical Eye Examination:A visit will be billed as a medical eye examination whenever a patient is being evaluated, followed, or treated for a medical condition or symptom. The condition or symptoms can be elicited by the patient during evaluation of the patient’s history or found during the examination by the doctor. Examples that necessitate billing to medical insurance include but are not limited to:Diabetes, Dry Eye, Glaucoma, Glaucoma Suspect, Narrow Angles, Choroidal Nevus, Macular Degeneration, Vitreous Floater, Cataracts, Eye Irritation, Eye Itching, Contact Lens Intolerance, Lattice Degeneration, Amblyopia (Lazy Eye), High Myopia.Vision Service Plan:If your vision plan is VSP, we need to be aware of this prior to your examination in order to obtain a billing authorization from them. VSP covers only Routine Eye Examinations. If you report symptoms during your visit related to an eye problem, disease, or injury, or if the doctor determines that your eye health exam falls under the category of a medical eye examination, your visit will be billed to your medical insurance first and then to your vision plan. When billing to medical insurance, you are subject to, and responsible for payment of co-pays/co-insurance and deductibles in accordance with the terms of your medical plan. If your VSP insurance allows, we will then do a “coordination of benefits”, some VSP plans do not allow coordination of benefits.Eyemed Vision Plan:Eyemed Vision Insurance does not allow us to do “coordination of benefits”. If you are seen for a medical reason, we are only allowed to bill your health insurance per Eyemed Vision Insurance._______________________________________________________________________________ Date: _________________Printed Patient NameSIGNATURE OF PATIENT OR GUARDIAN ................
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