Why do you need to see an eye doctor? What are the results of your examination? These two questions are critical because your answers to them will help determine whether your insurance company will classify your eye exam as “routine” or “medical.”
The difference between vision insurance and medical insurance is not well understood by many people. From the viewpoint of insurance companies, what makes an eye exam routine is if it involves an office visit to check one’s vision, screen for eye disease and/or update a prescription for visual aids or accessories. Routine eye exams produce a final diagnosis, like nearsightedness, farsightedness or astigmatism.
To put things simply, vision insurance plans will provide coverage for routine eye checkups, the cost of calculating your updated prescriptions and a health wellness screening. Vision plans often also provide discounts or allowances towards eyeglass frames, lenses or contacts, and will shoulder or provide some type of discount on your doctor’s fees. A routine eye exam is billed to your vision insurance plan which, by law, Medicare will not pay for.
Routine eye exams can address issues such as astigmatism, nearsightedness or farsightedness. Your doctor, typically an optometrist in Newington, VA, will also check you for conditions and diseases such as:
Diabetic or hypertensive eye diseases
Retinal holes or tears
Considered as well-eye exams, they often help in exposing a medical condition or disease related to your eye.
Other issues with the eye, however, including allergies, dryness or infections, are no longer covered by routine vision exams. Nor are any treatments for headaches, cataracts, macular degeneration or glaucoma covered. Patients on high-risk medications or who need diabetic check-ups likewise have to look elsewhere to get medical insurance to cover these other conditions and more.
In other words, while medical insurance may not pay for a routine eye exam; it will pay for the assessment of an eye complaint or to follow up on an existing medical condition. An eye exam that produces a diagnosis, such as dry eye, conjunctivitis, glaucoma or cataracts, is considered medical.
Medical Insurance covers a range of eye-related medical problems, which include:
Itchy, dry eyes
Complications from diabetes or high blood pressure
The bottom line is that vision and medical insurance are NOT one and the same thing.
Barring concerns about terminology that may or may not qualify you for different types of insurance, it can’t be denied that keeping your eyes healthy is important. It’s also important that you regularly have an eye exam.
But how can you know when you and your family members should have your eyes examined, and what, specifically, should your eye exam cover? These questions are critical, because having your eyes checked by an eye doctor in Lorton, VA, at the right time can help ensure that your vision will last you a lifetime.
Lots of people with vision problems avoid visiting an eye doctor because they mistakenly believe that without vision insurance, they may be required to shell out money they can ill-afford for a doctor’s consultation.
What’s wrong with this kind of thinking is that the fear of shouldering a huge medical bill can keep you from verifying if your symptoms are a result of an underlying medical problem. Sadly, many people miss a valuable opportunity to visit a Lorton, VA, optometrist to have a consult, not knowing that their medical insurance would have covered the expense.
Without a doubt, we all value our eyesight. That’s why regular eye care is something that we should all be concerned with. Caring for the eyes involves early screening for vision problems and being consistent about keeping up with check-ups as well as following prescribed eye care practices.
When to Screen for Vision Problems
Childhood screening. From birth through teenage years, the eyes are still developing and, like the rest of the body, are undergoing quick changes. Specific childhood eye screening guidelines developed by the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus have been developed to help ensure that children get screened at the right times and, if necessary, recommended for a complete eye exam.
Adult baseline eye exams. Adults should have a complete eye examination at age 40, according to the American Academy of Ophthalmology. It is at around this time that early signs of disease or changes in vision typically appear. Finding eye diseases early is essential to early treatment, which can help preserve your vision. Adults should see an eye doctor earlier than age 40 if they have eye disease or are at risk for diabetes, high blood pressure or have a family history of eye disease.
The risk for eye disease increases with age, which makes it important to closely follow scheduled check-ups and follow any additional advice your eye doctor gives you as you get older.
Eye exams for seniors. When you turn 65, make sure that you have your eyes checked every one to two years. You’ll need to pay close attention to age-related eye issues like cataracts, diabetic retinopathy, age-related macular degeneration and glaucoma.
What to Expect During an Eye Exam
Getting a comprehensive eye exam — one that can pinpoint underlying medical conditions — will usually take anywhere from 45 to 90 minutes, sometimes even more. Besides your doctor, a staff assistant may be present to assist or take you through some of the steps, including:
Taking your medical history. To start, your eye doctor will ask you to complete a health history form, which will provide an overview of your general health. Expect to be asked about your family’s medical history as well as your specific medical conditions. Also, note any medications you take. You could be asked about whether you wear corrective lenses, or if there are specific activities you engage in for which you may require specialized vision care or eyewear.
Conducting a pre-exam consult. Your doctor will review your health history and discuss with you any vision problems you may be having. He or she will discuss any medical conditions and specific visual needs, then measure your visual acuity.
Visual acuity test. This involves reading an eye chart with one eye covered to determine how well you see at various distances. This test will evaluate whether or not you have 20/20 vision. If you need corrective lenses, you may need to read an eye chart through a phoropter. This is a device that contains different lenses to help determine the most suitable vision prescription for you.
A Dilation procedure lets the doctor get a better view of the structures inside the eye when an abnormality is suspected. Special eye drops will be placed in your eyes so the inner structures of your eyes can be examined. Your pupils’ response to light will be checked by shining a bright beam of light into your eye. Pupils will usually get smaller; if they widen or fail to respond, that could point to an underlying problem.
Perimetry or visual field test. This test checks for blind spots in your peripheral vision. These blind spots can indicate that glaucoma is developing; it can also be used to identify potential brain damage from a stroke or tumor.
Eye pressure test. A test with a non-contact tonometer is done to measure the pressure of your eye and assess your risk of developing glaucoma. Untreated glaucoma can result in permanent damage of the optic nerve and visual field loss. Identified early, glaucoma can be effectively treated. The test may involve a quick puff of air against your eyeball while you are staring at a light source. It is quick and painless.
A cover test is an ocular motility test that evaluates eye movement. You stare at a portion of an eye chart and alternately cover each of your eyes with a small paddle. This checks to ensure that your eyes are aligned and your eye muscles are working correctly. Done both for close-up and distance vision, it helps determine the presence of strabismus, which can cause amblyopia (lazy eye), poor depth perception and binocular vision problems.
A binocular slit-lamp examination looks at the front part of your eye. A slit-lamp microscope will light up the front part of the eye, including the eyelids, cornea, iris and lens to check for cataracts, scars or scratches on your cornea. This magnified view of the eye structures allows the doctor to check for signs of a wide range of potential eye diseases and conditions.
Refraction Test. This is the test that most people associate with an eye exam. Dilating eye drops will be applied to your eye to dilate, or widen, your pupil. Your retina and optic nerve can then be examined for signs of damage from disease. Starting with the base prescription determined through retinoscopy, the doctor uses a refraction test to determine your precise prescription.
Your optometrist or ophthalmologist may suggest further tests, such as specialized imaging techniques that are crucial to the detection of problems in the back of the eye, on the eye’s surface or inside the eye to diagnose diseases early.
Comprehensive eye exams provide important information about the health of your eyes. Always get a complete eye examination as part of your commitment to your overall health.