What is the Difference Between a Routine Eye Exam and a Medical Eye Exam?

Posted in Optometry Information

Maybe you’re like the average person who goes to the eye doctor once a year (or less) and doesn’t think much about what that visit is called. Or maybe you’re someone who has heard terms like “routine eye exam” and “medical eye exam,” and experienced a little confusion. Either way, it’s a good idea for you to understand how these different types of eye exams are classified. After all, this simple terminology can impact your insurance and, as a result, your finances.

Routine Eye Exam

A routine eye exam is pretty straightforward. It’s something that takes place usually once a year, and includes updating your glasses or contact lens prescriptions and screening for eye diseases. If you have vision insurance, one routine eye exam per year is usually covered in some form or another. Even if your provider doesn’t cover the actual exam, they may offer certain discounts to you when you visit the eye doctor, so you’ll want to look into the details of your specific plan. If you don’t have vision insurance at all, you may have to pay out of pocket for this type of eye exam.

If your visit concludes with a diagnosis of nearsightedness, farsightedness, or astigmatism, then this appointment remains classified as a routine eye exam and is billed to your vision insurance plan. If it ends with a different diagnosis, however, the terminology of the visit could change.

Medical Eye Exam

Sometimes, you may go in for a routine eye exam and find out that something is wrong, beyond your eyesight. If your eye doctor expresses concern while evaluating you and gives you a diagnosis of something like conjunctivitis or glaucoma, then your exam has officially shifted to a medical eye exam.

Other times, you might have a hunch that something is wrong with your eyes and schedule a medical eye exam from the get-go. In this case, if the purpose of the visit is for the eye doctor to evaluate you based on certain symptoms of pain or other complaints, or to check in on existing medical conditions, this will also be considered a medical eye exam. This type of exam is typically billed to your medical insurance carrier, rather than your vision insurance plan. This means that medical eye exams often receive better coverage through insurance than routine eye exams, as they’re viewed as more serious to your overall health.

The differences between the two types of eye exams might seem slight, but it’s still important for you to be aware of them. And most important of all, keep your eye health in tip-top shape by scheduling annual routine eye exams and making an appointment for a medical eye exam if you suspect something could be wrong with your eyes beyond mere vision issues. Contact us today to ask about our exams.

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