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What's the Difference Between a Medical Eye Exam and a Vision Exam?

1. Vision Insurance vs. Medical Insurance At Price Eye Care, many of our patients have both vision insurance and medical insurance coverage for their eye care. We want to help explain the difference. Your eye care problem determines which Insurance Carrier we will need to file with for your eye care visit. Sometimes, there is no way to know prior to your examination which type of insurance our office will need to file for you. The following guidelines help us determine which plan is most appropriate. Vision Insurance will pay for your yearly eye care wellness examination where the results of your exam with vision insurance are used to correct vision problems (some examples are listed here): — nearsightedness — farsightedness — astigmatism — presbyopia Vision Insurance will not pay for your examination if the examination requires medical decision making and/or the treatment of a medical eye problem. Dr. Price may need to see you for a medical visit first or schedule an office visit in the near future to treat you for your medical problem. Contact Lens Patients: Your vision Insurance often requires patients to pay an additional fee called the contact lens fitting or evaluation fee if Dr. Price is going to write a new Rx for contact lenses. Please note in Indiana, your contact lens Rx is good for one year. Medical Insurance will be used if the reason for your visit is a medical problem (some examples are listed below). If we are not a provider for your plan, you would need to pay out of pocket for the visit.
  • itchy eyes
  • watery eyes
  • redness
  • flashes or floaters
  • foreign object in the eye
  • injury or abrasion to the eye
  • diabetic eye exam
  • cataract check
  • glaucoma check
  • macular degeneration
  • cobweb, curtain, or veil 
  • allergies affecting the eyes
  • headaches
  • blood in or around the eye
  • pain in or around the eye
  • swelling on the eye or eyelid
  • recent onset of double vision
  • high risk medication
  • itchy eyes
  • watery eyes
  • redness
  • flashes or floaters
  • foreign object in the eye
  • injury or abrasion to the eye
  • diabetic eye exam
  • cataract check
  • glaucoma check
  • macular degeneration
  • cobweb, curtain, or veil 
  • allergies affecting the eyes
  • headaches
  • blood in or around the eye
  • pain in or around the eye
  • swelling on the eye or eyelid
  • recent onset of double vision
  • high risk medication

Refraction: If a medical exam is performed, and if possible you would also like Dr. Price to write a new glasses Rx for you, a refraction will need to be performed. The refraction fee is not covered by your medical insurance.
Medical co-payments for a specialist visit will apply. If you have not met your deductible, additional exam fees will then be billed to you at a later date based on what your medical insurance determines is your required amount due.
The complexity of your medical condition and the level of medical decision making required to treat the problem are factors your Medical Carrier uses to determine your fee and your co-pay amount. Also, depending on your medical problem, certain Supplemental Tests may be necessary. The fee for these Tests is usually paid by your Insurance Carrier but often they will also require you to pay an additional co-pay amount. Medical Insurance Carriers have very specific guidelines regarding every aspect of your medical eye care testing and documentation. Our office did not make these rules, they were set forth in the contract by the medical insurance carriers.

What Does My Vision Plan Cover?

Usually, vision plans cover a thorough screening for eye diseases/disorders, and a refraction to determine your eyeglass prescription. Many vision plans also provide coverage or discounts for glasses and contact lenses.

What Does My Health Insurance Cover?

Medical eye exams are covered by your major medical insurance, subject to copays, coinsurance, and plan deductibles. Be sure to check with your insurance company to determine coverage. It is important to know that we are not able to bill both your vision insurance and medical insurance for an examination on the same day. Even if your eye exam is billed to your medical insurance, you may still use a vision plan to purchase eyeglasses or contacts.

Contact Lens Exams

Your corneas (the front of the eye) will be examined to ensure that they are healthy enough for wearing contact lenses. The next step will be to take careful measurements of your eye using a special instrument called a keratometer. Price Eye Care uses an automated keratometer that measures the curvature of the surface of your eye. These dimensions will then help Dr. Price to determine the shape and size of your lenses. In addition, a contact lens fitting also includes a test to evaluate the vision, centration, and comfort of the lens. Dr. Price will be looking at how well each contact lens works with your eyes. All of this information will help to ensure that the best contact lens brand and type is selected for you and your needs. Improper brands or solutions can often cause dry eye or allergy symptoms.

If you have worn contact lenses before, you will still need a contact lens fitting each time you would like a new contact lens prescription. The reason is your ocular health can deteriorate from wearing contact lenses. Improper use of contact lenses can lead to corneal scarring and in some cases blindness.

What Happens During A Contact Lens Fitting?

During your exam Dr. Price Kowaleski will talk to you about your visual needs. During your exam she will do a refraction to determine your glasses Rx which will then help to determine the contact lens Rx. She will examine the front health of your eyes and use careful measurements of your eye using an instrument called a keratometer. A contact lens fitting will also include tests to evaluate your visual acuity with the lens, as well as the lens movement, and centration, and comfort. All of this information will help to ensure that the best contact lens brand and type is selected for you and your needs. (read more)

Improper brands or solutions can often cause dry eye or allergy symptoms. In Indiana, the laws state that a contact lens prescription is good for up to 1 year. So even if you have worn contact lenses before, you will need an eye exam and contact lens fitting/evaluation each time you would like a new contact lens prescription. The reason is your ocular health can deteriorate from wearing contact lenses. Improper wear can then lead to corneal scarring and in some cases blindness. We want to do everything we can to prevent that from ever happening.

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