Routine vs. Medical Eye Exams – What’s the Difference?

Insurance companies usually categorize visits to your eye doctor as either “routine” or “medical.” But understanding the difference between the two can get a little confusing.

A routine eye exam is defined by insurance companies as “an office visit to check vision, screen for eye disease, and/or update eyeglass or contact lens prescriptions.” Routine eye exams produce a final diagnosis – like nearsightedness, farsightedness or astigmatism.

Routine eye exams are billed to your vision insurance plan. Vision insurance plans provide coverage for routine eye exams, glasses and contact lenses, and some type of discounts on your eye doctor’s fees. This type of insurance also covers the cost of a refraction. A refraction is the part of an office visit that determines your eyeglass prescription. It involved questions like, “which is clearer – option a or option b” as different lens combinations are shown to you. 

A medical eye exam produces a diagnosis, like conjunctivitis (pink eye), glaucoma, cataracts, or dry eye to mention a few. Examinations for medical eye care, assessment of an eye complaint or follow up to an existing medical condition are all billed to your medical insurance plan. 

At Illinois Eye Center, we understand how confusing the difference between routine and medical eye exams can be. It’s important to remember that the difference has nothing to do with the steps involved in eye exam or the type of doctor who performs the exam. A “routine” eye exam has components like a “medical” eye exam. And seeing an ophthalmologist (MD), doesn’t classify as being medical either. 

You should check with your insurance carrier prior to your office visit to make sure you have vision benefits (and what they are), to confirm that our eye doctors are classified as providers in your plan, and to determine if refractions are covered under your plan. 

For more information and to schedule your eye exam, give Illinois Eye Center a call at (309) 243-2400.

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All Other Offices Closed

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