Spend your flex dollars with us for professional services or eyewear purchases!
Spend your flex dollars with us for professional services or eyewear purchases!
What’s the Difference Between a Wellness Eye Exam and a Medical Eye Exam?
On the surface, a wellness eye exam and a medical eye exam may sound like they accomplish the same purpose. However, these exams identify different potential eye problems. It is essential to determine the type of exam needed, as this may affect your plan coverage.
What is a wellness eye exam?
You are probably more familiar with a wellness eye exam, as it involves the classic eye exam. A wellness exam provides an overall evaluation of your eye health and is preventative, meaning no other medical conditions are found or addressed.
During a wellness eye exam, the doctor uses refraction to determine the best prescription for glasses. A wellness eye exam does not include a contact lens exam or fitting services; however, these additional services can be provided during your wellness or medical eye exam upon request.
Typically, the diagnosis from a wellness eye exam includes myopia (nearsightedness), hyperopia (farsightedness), presbyopia, or astigmatism. These routine exams are not considered medical exams because these vision conditions are not considered “medically harmful.”
What is a medical eye exam?
A comprehensive medical eye exam is designed specifically to look for conditions and diseases that result in poor eye health. When our doctors conduct a medical eye exam, they are evaluating problems that cannot be corrected by glasses or contact lenses.
While refraction may be a component of a medical eye exam, it is used as an additional diagnostic tool to help identify changes in overall eye health.
A medical eye exam includes a medical diagnosis, treatment plan, possible medication prescriptions, and/or follow-up for medical issues such as cataracts, diabetes, glaucoma, and more. A treatment plan may also include discussions regarding additional testing, procedures, or surgery, as well as necessary communication with other medical professionals.
Medical eye exam diagnoses may include, but are not limited to, glaucoma, conjunctivitis, cataracts, diabetes, dry eyes, eye infections, injuries, flashes or floaters, foreign bodies, lid infections, red or irritated eyes, and many others.
Examples
Taking care of your eyes is just as important as taking care of any other part of your body. We use our eyes every day to see the world around us, yet we often take them for granted until something goes wrong. This is why eye health is so important, and our doctors at Spectrum Eye Center play a vital role in helping you maintain and improve your vision.
Please contact us today to schedule an appointment with Dr. Athans, Dr. Keel, or Dr. Poindexter.
💡 Tip: Provide your vision plan details or medical plan details before your appointment so we can confirm your coverage!
Book Your Eye Exam Today! Your eye health matters! Schedule an appointment with our expert doctors today. 📞 Call Spectrum Eye Center: 910.692.3937
At Spectrum Eye Center, we want our patients to receive the best eye care possible. This includes making sure our patients are informed regarding insurance and plan benefits.
Typically, there are two types of plans that may help cover some costs of your eye exam:
1) Vision plans for wellness eye exams
2) Medical plans for medical eye exams
Wellness vs. Medical Eye Exams
Patients are often unsure of the difference between wellness and medical eye exams. While the purpose of each exam is different, both may include similar components such as refraction, pupil dilation, intra-ocular pressure testing, and an internal eye health examination.
Vision Plans & Medical Insurance
Some patients choose to purchase a vision plan (or receive one through an employer), which may include a wellness eye exam every year or two, as well as discounts or allowances on eyeglasses and/or contact lenses. In addition, most patients also have medical insurance, which can cover medical conditions of the eye.
Understanding Coverage
Determining whether you need a wellness or medical eye exam, and whether your plan will cover it, can sometimes be confusing. Coverage depends on your insurance provider and your specific policy. Some plans cover medical exams but not wellness exams, while others do the opposite. While it is ultimately the patient’s responsibility to understand their coverage, our team is always happy to help answer questions. If you need assistance determining what your plan covers, please contact our office.
Insurance Participation & Billing
Providing accurate insurance information prior to your exam is essential so we can help determine coverage. Our doctors participate in many vision plans, such as VSP and Community Eye Care, as well as many medical plans, including Medicare, BCBS, and others. If you are unsure which plan applies to your visit, we can help guide you. Our goal is to help you maximize your benefits and discounts, saving you time and money.
Scheduling & Exam Changes
When scheduling your appointment, we may ask about your eye health history to determine whether a wellness or medical exam is appropriate. This helps ensure the correct plan is billed. If you schedule a wellness eye exam and a medical condition is discovered during the visit, your doctor may convert that day’s exam to a medical exam and bill your medical insurance. If the exam is not converted, a second appointment may be scheduled to address the medical concern, and our office can file your medical insurance for that visit.
Eyeglasses & Contact Lenses
Regardless of whether your exam is billed as a wellness or medical visit, you may still request our doctors to perform an exam for an eyeglasses prescription or contact lens prescription. These services may or may not be included in your plan benefit structure but we can help you determine your benefits for these services and for eyeglasses or contact lenses, as applicable.
Our office accepts many vision and medical plans. Each plan is different, so please contact your individual plan prior to your appointment to verify coverage on your eye health examination, as well as your eyeglass benefit/discount or contact lens benefit/discount. We will be happy to assist you in determining your plan coverages.
Vision Plans – Covers a wellness eye examination, but not usually a medical eye examination
• VSP
• COMMUNITY EYE CARE
Medical Plans – Covers a medical eye examination, but not usually a wellness eye examination
• MEDICARE
• BCBS
• AETNA
• HUMANA
• UNITED HEALTH CARE
• MEDCOST
• VETERANS AFFAIRS
· TRICARE SELECT – Out of network, but we will file on patient’s behalf
At Spectrum Eye Center, we are here to make it easy. One advantage of purchasing eyewear from our office, is that you have the doctor and the optical together on your side, helping you through any transition. With every prescription eyewear purchase, you will receive excellent warranties at no additional cost and no additional co-pay.
If you are not happy with your eye frame purchase from Spectrum, you have 30 days to exchange the undamaged eye frames with another one of equal or lesser value (no refund on price difference). If you choose a more expensive eye frame, simply pay the difference.
What are we treating (what is myopia)?
Myopia, or nearsightedness, is an eye disease that causes poor long-distance vision. In myopic
eyes, the eyeball is either longer than normal, or the cornea is too curved, or both. This causes
images to be blurry.
What are the signs and symptoms of myopia that I should look for?
Myopia is often first detected during childhood & is commonly diagnosed between the early school years through the teens. A child with myopia may:
Some kids may stop paying attention in class, with associated decline in their academic performance. Then, later, it is determined that they’re myopic and can’t see the board.
Why did my child get myopia?
Evidence shows that myopia, or at least the tendency to develop myopia, may be hereditary. If one or both parents are nearsighted, there is an increased chance their children will be nearsighted. There is a 25-33% chance that a child will develop myopia if one parent is myopic. That number jumps to 50% if both are myopic.
Environmental factors also play a role in developing myopia. They include activities like time
spent doing close work on a computer or tablet or reading while not spending enough time
outside.
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