MEDICAL EYE CARE

Medical Eye Care

The eyes are called the “windows to the soul,” but did you know they are also the windows to the body? Eyes are the only place in the body a doctor can directly view your nerves and blood vessels, so a retina exam is a fantastic way to monitor some chronic systemic diseases such as diabetes, hypertension, high cholesterol, and sleep apnea, to name just a few. We also monitor the retina for toxicity when a patient is on certain high-risk medications.

Did you know the eyes can suffer from chronic diseases of their own? Eye diseases like glaucoma, macular degeneration, keratoconus and many more require ongoing monitoring and treatment. Check out our technology section for more details about how we can help.

Medical Eye Care vs Routine Eye Care

At Nora Eye Care, we are experts in both routine refractive eye care and medical eye care. Sometimes we are able to care for both types of problems during the same exam, and sometimes we cannot. This can cause confusion with how visits are scheduled or billed to insurance. Insurance plans often dictate what can or cannot be done on the same visit.

Medical eye care is any eye problem that cannot be completely fixed by glasses or contact lenses. Below are some common medical diagnoses in eye care:

• Cataract
• Glaucoma
• Dry Eye Syndrome
• Allergic conjunctivitis
• Infectious conjunctivitis
• Diabetic retinopathy
• Hypertensive retinopathy
• Cranial nerve palsies
• Keratoconus
• Age-Related Macular Degeneration

Routine/refractive eye care is any eye problem that can be completely solved by glasses or contact lenses. Below are some common routine diagnoses:

• Myopia (near-sightedness)
• Hyperopia (far-sightedness)
• Astigmatism
• Presbyopia

 

Will my visit be billed to my MEDICAL INSURANCE (Medicare, United Healthcare, Anthem BCBS, Cigna, etc.) or my VISION PLAN (VSP, EyeMed, Blue View Vision, etc.) ?

 

SHORT EXPLANATION:

Medical Insurance will be used for eye health visits. No coverage for glasses, contacts (except medically necessary contacts for diseased eyes) or other similar materials are provided by most medical health plans.

Vision Plans are not truly insurance. They are discount plans that cover routine exams for glasses, contacts and inspection of the internal and external eye health in a healthy person without eye disease. Vision plans have coverage for glasses and contact lenses.

 

LONG EXPLANATION:

One of the most challenging billing issues for an eye doctor office is to determine whether your visit is for a medical reason (diabetes, cataract, glaucoma, eye pain, etc.) or a wellness vision exam to determine your prescription for glasses, contact lenses and screen the health of your eyes to make sure you do not have an eye problem or disease you may not be aware of yet. Sometimes it is appropriate to schedule separate visits to accommodate both your routine eye care needs (glasses, contacts) and medical eye needs (glaucoma follow up, eye emergencies like injury or red eye, etc.) on different days. As a general rule of thumb, please note medical plans do not cover materials (glasses or contacts) but some may have an annual reimbursement direct to patient. It is the patient’s responsibility to know whether they have this benefit and file directly with the medical plan for reimbursement. We will assist with appropriate receipts for submission.

Our goal is to bill appropriately based on the reason for visit. If you call us with an eye problem or sudden change or loss in vision OR another doctor asked you to see us for an exam because you are diabetic or put on medications that can risk your eye health, we will cater the exam to medical eye care and bill your medical insurance the same way any other specialist health care provider would. The patient is responsible for obtaining referrals, copays, deductibles and coinsurance. Rarely, a routine visit must be converted to medical if an incidental and urgent eye problem is discovered during your vision exam (such as very high eye pressure that needs immediate testing and treatment to prevent irreversible vision loss). If you have a vision plan, it is your responsibility to inform our staff at the time of scheduling the appointment so that we may assist you in understanding your benefits.

Vision plans are not eye insurance and do not cover medically necessary eye testing. Vision plans assist in discounted fees for contact lenses and glasses. Some plans are better than others. We will help you maximize your savings. In order to do this, you must know your plan and present it ahead of being seen for your exam. Medicare does not pay for eyeglasses or contact lenses. Medicare patients will be responsible for their refraction fee (if necessary) and their annual deductible (if not met at another doctor’s office already for the calendar year).