It is often difficult for patients to determine which insurance is to be used for an eye exam. Many people have both medical insurance which covers medical eye exams and vision plans which cover routine eye exams. Yet, they each have their specific uses.
Remember, anything not "routine" is a medical eye exam and payable by medicare, Medicaid, and commercial insurance. Since diabetes is the leading cause of visual disability and blindness in people under 65, all diabetics are recommended to get a yearly eye exam to detect diabetic eye disease.
You have even been told by your primary care doctor or medical insurance company to get an eye exam if you are diabetic. A diabetic eye exam is not the same eye exam as one covered under a vision plan. It is a more thorough exam, involves diagnostics testing, requires a report be sent to your PCP or endocrinologist and your medical insurance requires we use specific codes when billing to describe the state of your eye health.
Vision Plans allow for one "routine" eye exam per year. Routine vision exams generally are used when the reason for an eye exam is to update glasses or contact lenses or for a yearly check up with no significant complaints of eye problems.
We recommend a yearly eye and vision exam for all people. Check yearly, see clearly.
Blue Cross Blue Shield NC
A yearly comprehensive eye exam always includes a thorough eye health exam and vision evaluation. Checking vision is just one important part of a full eye exam. Knowing how well you can see is an important part of knowing how healthy the eye is. Conversely, just because you have 20/20 vision, doesn't mean you have healthy eyes. Many eye diseases, like glaucoma, do not affect our visual acuity until significant damage has been done.
Below is an image of an eye with advanced glaucoma. This patient was asymptomatic and it discovered on a "routine" eye exam in our office.
Dr. Paul W. Nienaber, OD Optometrist (336) 969-5514
Medical Insurance covers eye examinations for the evaluation and treatment of eye disease, injuries, signs or symptoms related to an eye disease. Examples of medical eye exams are comprehensive eye exams for diabetics, flashes or floaters, eye pain, ocular allergies, eye infections, loss of vision, monitoring for high risk medications (plaquenil, ethambutanol, etc)
Vision Service Plan
Community Eye Care
Blue Cross Blue Shield