ANNOYING QUESTIONS THAT INSURANCE OFTEN FAILS TO ANSWER

Here is some help with questions about  insurance.   We hope it helps resolve the confusion between  "Eye Exams"   and  "Medical Visits."

I came in for my yearly eye exam – shouldn’t it be billed to my "vision insurance"?   If you have any medical concern such as cataracts, blurry or dry eyes, symptoms describing a possible medical problem or any similar medical diagnosis,  then --> medical insurance must be billed.

Why do I have a $35 charge for a ‘refraction fee’? A refraction is a test generally used to determine how well a person sees. Refractions may be necessary for the optometric doctor to diagnose your eye condition. If you have a medical problem, your visit must be billed to your medical insurance and you may still need a refraction. Unfortunately, refractions are not covered by most insurances, such as Medicare, even if a patient has glaucoma, cataracts, etc.

How is refraction defined:  What is a refraction fee? A refraction is the test that is performed to determine your eyeglass prescription.  A refraction may be performed by either the doctor or a technician, and typically involves questioning along the lines of, “Is 1 better than 2?” Medicare and many other insurance plans consider a refraction to be routine medical care not covered under their medical coverage, so this amount is charged separately and is paid directly by the patient.  Medicare secondary insurance plans will also not pay the charge since it is not a Medicare-covered service, so the $35.00 fee is to be paid by the patient.

What is the difference between  Vision Insurance and Medical Insurance for an eye care visit?

Vision Insurance – (VSP,  Vision Resources), . ---This type of insurance covers routine vision care (i.e. regular eye exams for glasses and contacts) when no medical eye problem or related complaint specifically exists.

Medical Insurance – (Blue Cross/Blue Shield, Medicare, Aetna, etc.) This type of insurance provides benefits for the treatment of medical problems including medical eye problems. To obtain coverage under medical insurance, a symptom or complaint indicative of eye disease, eye injury, or a chronic medical condition is one of the reasons for your visit or the doctor.   

Although the examination that you receive may be the same or similar to previous visits, the reason for the exam and the doctor’s diagnosis dictate how we must bill our patients.

Why Do You Not Take My Plan?   We have not joined or we have dropped plans that do not, in our opinion, provide quality care.   If a plan pays a very low fee,  you will usually end up with low quality,  high volume care or some bait and switch game.  We will not be part of this.

Vision Plans we do not take:  EyeMed,  Cole Vision,  ECPA, Davis Vision    All these plans are low fee high volume in design. You will see plans like this at high volume chain stores like  Sears,  Perle and  LensCrafters.    If you are really curious as to how they survive on what appears to be a low fee,  call our office  and price a pair of  Varilux (brand) Lenses in 'UltraLight" plastic,  then Call LensCrafters and price  Varilux (brand) Lenses in their "Feather Weight"  plastic lenses.   If that doesn't blow you away,  then don't come to us!  (by the way... UltraLight is even a better thinner lens!)

Medical Plans we do not take -- We do not take medical plans that will encourage high volume low quality care:  Examples are HealthNet. and HIPP,  and there may be others.    

Why do I need a routine Eye Exam,  if I have recently been in for medical eye testing?    They are quite different examinations even though some of the screening tests may look similar or actually be the same.   Many of the tests in the screening room (pre-exam) are similar such as Reading The Eye Chart,   Blood Pressure,   Air Puff.     These tests are needed Each Time the doctor sees you and some are even required by medical law (standards) before the doctor can see you.  The two exams, Medical & Routine,   are quite different however. Medical exams are focused on resolving a clearly defined medical problem.  Routine exams (that include examinations for glasses or contact lenses)  are a broad scope of Preventive Testing. The aim here is to find things before they become a problem and do determine if you need  eyewear or a change in your eyewear.  In a "routine exam"