What determines routine vs. medical?

Your reason or concern for the visit, as well as your results will determine whether your insurance company will classify the exam as routine or medical. A routine eye exam is defined by insurance companies as a visit for the purpose of checking vision, screening for an eye disease(s) and/or updating/renewing eyeglass or contact lens prescriptions. Routine eye exams or wellness eye visits result in a final diagnosis such as: nearsightedness (inability to see far away), farsightedness (near vision concerns) or astigmatism (blurry vision at distance/near).

VISION PLANS cover only routine vision care and are intended to determine a prescription for eyeglasses, to provide discounts on eyeglasses or contact lenses, and to screen the structures of the internal & external health of an eye in a healthy person without existing or known eye disease. Wellness eye visits do not qualify for the renewal or prescribing of oral/topical medications.

MEDICAL INSURANCE provides coverage when medical conditions (i.e., diabetes, hypertension etc.), eye conditions (infections, dry eyes, and cataracts) or an eye disease, such as glaucoma is present and requires diagnosis, management, regular follow-ups & treatment as well as communication with other healthcare providers (physician, advanced practice providers – nurse practitioner/physician assistant).

It is important to note that many patients have coverage under both medical insurance and vision plans. At Wallerich Eye Care, we do our best to navigate each unique plan; however, it is ultimately the patient’s responsibility to understand his or her benefits.

We accept the following payment methods:

• • Cash
  • Visa, MasterCard, Discover, American Express
  • Flexible Spending Plans
  • Health Savings Accounts (HSA)