Eye Exams
Medical Eye Exams
A medical eye exam addresses a specific eye condition, symptom or disease rather than routine vision correction. It is typically billed to medical insurance rather than a vision plan, because it is treating a medical problem.
The distinction between a routine and a medical eye exam confuses almost everybody, and it matters mainly for billing. A routine exam checks vision and screens for problems in someone with no complaint. A medical exam investigates or manages a specific condition.
If you attend because you need new glasses, that is routine. If you attend because your eye is red and painful, because you have diabetes needing retinal monitoring, or because glaucoma is being managed, that is medical. Vision plans typically cover the former. Medical insurance typically covers the latter.
The practical consequence worth knowing is that a routine visit can turn into a medical one when something is found, and that changes how it is billed. The office explains that at the time rather than leaving it as a surprise on a statement.
What to expect
- Symptom focused assessment
- Testing is directed at the presenting problem rather than following the routine sequence.
- Diagnostic imaging as indicated
- OCT, retinal imaging, visual fields or topography depending on the condition.
- Treatment at the visit
- Where medication is indicated, it is prescribed at the appointment.
- Follow up scheduling
- Medical conditions need monitoring rather than annual review.
Questions and answers
Which insurance does this go through?
Medical eye care is usually billed to medical insurance, not to your vision plan. Bring both cards and the office sorts out which applies.
What counts as medical?
Eye infections, injuries, dry eye, glaucoma, diabetic monitoring, macular degeneration, floaters and flashes, and any specific symptom or condition.
Can one visit be both?
It can, and the office explains how it is being billed at the time. A routine visit that uncovers a problem may generate both a routine and a medical component.
Do I need a referral?
Most patients do not need a referral to see an optometrist, though some insurance plans require one. Check with your plan.
Talk to someone about medical eye exams
Appointments are scheduled two per hour, so there is time to answer questions properly. Call (480) 706-3937 or request a time online.