When verifying coverage with your insurance provider, please understand there is a difference between medical insurance plans and routine vision plans. Northwest Eye DOES NOT accept vision plans. If you schedule a routine eye exam with us, and you have a vision plan, you will be responsible for paying for the appointment. If you have a medical insurance plan, we may be able to bill your medical insurance plan depending on the nature of the visit, since Northwest Eye is considered a specialty medical practice.
Be Eye Wise and know that even if you have invested in vision coverage, we will bill charges to your insurance company, as most carriers will reduce your allowable amount, even if you don’t technically have vision as a covered benefit under your insurance plan.
What is the difference between a routine eye exam and a medical eye exam?
Please review the following links and continue reading to better understand the difference between routine and medical eye care.
A comprehensive eye exam can be performed by either an ophthalmologist or an optometrist. It may include an ophthalmic assistant or ophthalmic technician completing the following portions of the exam:
- A health and medication history
- A vision history
- A refraction or visual acuity test
During the appointment, the doctor may determine if the problems you are experiencing are normal age-related changes to your vision, or are disease-related. He or she may order additional testing, refer you to another doctor or specialist, or recommend treatment.
An Eye Exam completed by the ophthalmologist or an optometrist includes:
- Examination of the external parts of your eyes, including the whites of your eyes, the iris, pupil, eyelids and eyelashes.
- A dilated internal eye exam allows the doctor to observe the retina and optic nerve.
- They may test the fluid pressure within your eyes to check for signs of glaucoma.
If the doctor’s diagnosis is medical, such as cataracts or conjunctivitis, it will be billed as a Medical Eye Exam. If the diagnosis is related to normal age-related changes in your vision, such as nearsightedness or astigmatism, it will be billed as a Routine Eye Exam.
Health Insurance vs. Vision Insurance: What’s the Difference?
Understanding which insurance applies to your eye care visit can feel confusing. That’s why we created this short video to explain the difference between health insurance iyo vision insurance, and when each one is used.
Both health and vision insurance play an important role in keeping your eyes healthy and your vision clear:
- Health insurance generally covers medical eye exams and treatments related to eye health — such as glaucoma, cataracts, or eye injuries.
- Vision insurance helps with how you see day-to-day. It often covers routine eye exams, prescription glasses, contact lenses, and other vision services.
- Some plans (like Medicare) may cover certain medical services but not routine refraction tests for glasses prescriptions.
- Even if adult vision benefits aren’t included, most health plans provide children’s vision services.
To make the most of your benefits, please:
- Bring both your health insurance card and, if you have one, your vision insurance card to your appointment.
- Provide a printed list of all current medications.
- Ask our friendly staff any questions — we’re here to help.
