Due to insurance reasons, there are two main types of eye exams: Medical Eye Exams and Routine Vision Exams. An optometrist or ophthalmologist can perform both types of exams:
The “classic eye exam” is where the doctor determines your eyeglass prescription by doing a refraction (the 1 or 2 test). This type of exam deals with determining the refractive error of your eyes and correcting it to improve your vision. Some examples of refractive errors are myopia (nearsightedness) and hyperopia (farsightedness). Routine vision exams are NOT covered by your medical insurance as an eyeglass prescription to correct your vision is not considered a medical necessity. Routine vision exams are covered by vision plans and may include an eye health screening but do not deal with any medical problems you may be having with your eyes and do not qualify for prescribing medications to treat any eye conditions.
A medical eye exam differs from a routine vision exam in that it is an exam where we are treating you for a problem you may be having such as a red or painful eye. We may also be evaluating medical conditions such as diabetic retinopathy, glaucoma, macular degeneration, cataracts, dry eye, conjunctivitis and retinal detachments just to name a few. A medical eye exam deals with issues that cannot be fixed with eyeglasses and therefore a refraction to determine your eyeglass prescription is not included in a medical eye exam nor will your medical insurance pay for a refraction to determine your eyeglass prescription. A medical eye exam is often a comprehensive exam that includes dilation of your eyes and possibly additional testing to monitor any eye conditions you may have.
Unfortunately, both your vision benefits and medical insurance cannot be used on the same day. If you are having a problem with your eyes, we will use your medical insurance whereas if you just need your glasses updated, we will use your vision benefits.
Additionally, if the doctor uncovers a medical condition with your eyes during a routine vision exam, they may ask you to come back another day and use your medical insurance for additional evaluation, management and testing if need be. If the medical condition is more serious, they may ask you to use your medical insurance first and come back to check your glasses and use your vision benefits.
Vision Plans such as VSP, EyeMed and more are accepted at our Boardman and East Liverpool locations. At this time our other locations do not participate in vision plans and only accept medical insurance.