• Doug Cook

Eye Medical versus Vision Visits to the Eye Doctor

An office visit with an eye care professional is simple and not complicated for most people with healthy eyes.

When disease is present, the patient discovers limitations if they use a third party to help pay such as a vision care plan or a health care plan.

Eye Medical versus Vision Exams

The separation of the above heading is one created by third party payers.

Health care plans almost never cover refractive conditions, testing for glasses or eyewear.  We have to separate those tests out of the visit or the patient just pays out of pocket and gets tested if desired.

Likewise, vision care plans do not cover eye medical conditions (e.g. glaucoma, cataracts, red eyes, allergies, infections, retinal diseases, etc) so testing may be limited to screening style tests for disease which would not be covered if something is detected and more tests are ordered.

Rules set by others affects what is covered

A visit may have some items not covered because of arbitrary rules set by others.

If a patient happens to have both health care and vision care coverage they are forced to choose one to use for the visit.  Most plans would not allow a provider to bill both – the patient has to decide which to use.

So a person with glaucoma with 3 or 4 visits a year would use their health insurance for each visit as his reason for being there is to manage a medical condition affecting the eye.  If the patient needs glasses and wants to use his vision care plan, a separate visit would need be set up to use his vision plan.  Their rules prevents doing both on one visit if they want to have something paid.

If a person using a vision care plan has an eye disease suspected or diagnosed, a separate visit would be needed to run those tests ordered by the doctor to use their health care plan.

The regular cash patient has the best benefits. Since no third party is present to pay the bill, we can do whatever that patient desires.

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