![]() ![]() If it’s a non-covered service and the patient must pay out of pocket for it … all the better!” What can patients do?Ĭharging separately for refraction is increasingly becoming a standard practice among eye doctors. As one provider stated candidly in a trade journal targeted at eye doctors, “efraction is a service that is valuable and people will pay for it. Īnother reason doctors charge separately for refraction is that the practice is profitable. If caught by the insurance company, the doctor could be asked to pay back to the insurer the cost of all the unbilled refraction fees. But Medicare and other insurance companies technically prohibit this practice: A doctor who fails to charge a refraction fee may be accused of overcharging for the exam to cover the cost of the refraction. Some eye doctors choose not to charge separately for refraction, meaning patients only have to pay for the co-payment on the eye exam, and receive no additional bill. But because Medicare and most private health insurers do not cover refraction, an eye doctor who performs this service during the exam often will issue two separate bills: one for the eye exam and one for the refraction. , Under Medicare, these exams include testing for glaucoma, macular degeneration and diabetic retinopathy.Įye doctors have found that they can make more money by billing Medicare or other health insurers for an eye exam to test for disease than relying on reimbursements from vision insurance, which tend to be lower than health insurance payments. Medicare and other health insurers do, however, cover eye exams to test for eye disease. Most private health insurance companies have followed Medicare’s example, forcing patients to either pay these expenses out of pocket or buy vision insurance. Under the Medicare statute, doctor’s office coverage under Medicare Part B is not supposed to cover eyeglasses or refractions. ![]() The answer to these questions comes in part from a somewhat arbitrary distinction that health insurance companies draw: keeping eyes healthy versus improving vision through use of glasses or contacts. Why would an essential service be so widely disregarded by insurers, and why do some doctors not charge this fee? Healthy eyes versus seeing better Refraction - the part of the exam when patients are asked to look through different lenses while reading a series of small letters and then asked which lens is better - is the test used to determine what prescription is needed for glasses or contact lenses.Įye doctors sometimes will tell patients that refraction is an essential part of the eye exam, but it generally is not covered by health insurance. Yet after the visit, many patients find that they are charged one fee for the exam and a separate fee for refraction. ![]() For many people, an eye exam is a trip to the eye doctor (either an ophthalmologist or an optometrist) for a prescription for eyeglasses or contact lenses. ![]()
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