Insurance

We provide both medical and routine exams at Elkin Eye Care. These terms are very different for the services they cover and it is important to understand those differences.

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Medical insurance (such as Medicare or BCBS) is used for medical eye exams. When a medical diagnosis or condition is present (such as cataracts, diabetes, dry eyes, allergies, etc), it is necessary to file a claim for your visit with your major medical insurance carrier. It typically does not cover the costs for a refraction (required to get an updated glasses prescription), glasses or contact lenses.

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Vision plans (such as VSP & Community Eye Care) only cover routine vision wellness exams, along with giving discounts on eyeglasses and contact lenses.  A routine eye exam is defined by insurance companies as an office visit for the purpose of checking vision, screening for eye disease, and/or updating eyeglass or contact lens prescriptions. Routine eye exams are filed for people with healthy eyes but need glasses for nearsightedness, farsightedness or astigmatism. ​Standard vision plans do not cover medical eye care (the diagnosis, management or treatment of eye health problems). 

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Contact lenses are considered a separate part of an eye exam. A separate fee for contact lens exams is customary in all eye care practices. Vision plans may have benefits for discounted contact lens exam fees. If you have a medical condition but wear contact lenses and have benefits through a routine vision plan, your contact lens exam can be filed through the in-network routine carrier and exam through the medical carrier.

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We understand that the difference between “routine” and “medical” eye examinations can be confusing and we’ll gladly answer any questions you may have. It’s important to remember that “routine” or “medical” has nothing to do with the steps involved in an eye exam. It is ultimately up to the doctor to determine if your exam is considered routine or medical.

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Keep these things in mind: 

• Having insurance doesn’t guarantee your carrier will pay for your exam. Many health plans have copayments and/or deductibles that must be met before your insurance will pay any amount towards your bill.

• Check with your insurance carrier prior to your office visit to make sure you have medical and vision benefits (and what they are)