You ran an article recently stating it was illegal for an eye-care provider to charge for a prescription/refraction portion of an eye exam. This in turn has confused your readers and our patients.
Please note there are two different types of eye exams and multiple insurance plans. The two types of eye evaluations are “routine,” covering refraction issues (myopia, astigmatism, presbyopia); this exam type generally is for a glasses or contact lens prescription. And then there are medical eye exams covering items such as cataract, glaucoma or diabetes. Under a “medical eye exam,” the refraction is not a covered portion of the eye exam. For example, if a patient is coming in for a glaucoma evaluation and that patient informs us he or she wants a new prescription for glasses, in this scenario in order to create a prescription we have to refract the patient. At this point there is a separate charge as the exam has two components: the comprehensive medical eye exam component covering glaucoma and a noncovered component, “the refraction.” Both exam components are legitimately billable to insurance and patient, but the noncovered refraction fee is collected at the time of service.
Louis Pennow, Boise