Insurance and Billing FAQ
How much is a routine eye exam?
Our fee for a comprehensive routine examination runs from $150-200, depending on the complexity of the exam, and all fees are due at the time of service. This includes a computerized vision analysis to determine if you need visual correction, and an eye health evaluation including dilated retinal exam. Contact lens examinations are $80 for an established patient and $150 for a new patient. Return visits generally run $100. Depending on the severity of your eye problem, additional testing or procedures may be necessary and would be a supplemental charge that you would be notified about prior to having the testing done.
What if I have insurance coverage?
Every insurance plan is unique. Some cover all of the examination to its entirety and others are to subject to copays, deductibles or even co-insurances. Please know that it is your responsibility to know the details of your coverage and we only ask that you supply us with important information, such as your insurance ID numbers, which are needed to verify your services before your actual appointment date.
Why does my insurance cover the examination, but not refraction. What does that mean?
When an insurance company is involved, we are forced to divide our examination charges into the comprehensive medical eye exam, and refraction,according to universal insurance coding standards. Many insurance companies cover the examination. However, the refraction–the part where the doctor asks you, “Which one is better, one or two?”–is considered an allowable non-covered procedure. As a result, if you have insurance that covers the examination with a co-pay, you will still be responsible for paying your copay plus $40 (the refraction fee). Most vision plans cover the refraction of the examination. Once the refraction fee is paid, however, you will receive a $40 coupon off glasses at our optical, to help offset the cost.
What will it cost for me to wear contact lenses?
Contact lens professional fees are billed in addition to the comprehensive eye examination. These professional fees vary from $80-150, depending on whether it is an established or new fitting. This usually includes a diagnostic pair of contact lenses to try and includes unlimited follow-up visits for 30 days, so long as they are related to contact lens wear. Office visits related to your contact lenses 30 days after your contact lens examination are billed at $50 per visit, or charged to insurance if applicable.
What are contact lens professional fees for?
As a contact lens wearer, additional tests are done for you that are necessary to make sure your eyes are healthy, to make certain your lenses fit properly, and to ensure that you are seeing as well as possible. We take the health of your eyes very seriously at Orlando Eye Institute, and the contact lens professional fees are for the extra testing, our doctors’ expertise and the time taken by the staff and doctor to properly evaluate your for contact lenses. A corneal topography is also done to examine the curvature of the cornea and to look for any irregularities. A contact lens matched to your cornea is then fitted and you are given a trial pair which customarily lasts two weeks, along with some complimentary cleaning solution and a lens case. The refraction fee is included in the price of the contact lens fitting fee. Because dry eyes can commonly cause contact lens intolerance and can make the fitting process very difficult, our state-of-the-art tear osmolarity test is recommended to see if the eyes are dry prior to the fitting. This lab test is done in our office and is billable to a number of medical insurances.
Writing a prescription for your contact lenses places a certain amount of responsibility for the health of your eyes on the doctor. Contact lenses are a medical device that can cause blindness if they aren’t fit properly or if adequate lens hygiene is not practiced. As a result, your eyes and the fit of the contact lenses need to be checked annually.
My deductible is not met; will I be responsible for all of the charges on the day of my examination?
Yes. Payment is due when services are rendered. Your insurance will be electronically filed immediately as a courtesy to you. After we receive a copy of the explanation of benefits from your insurance company, we will refund any money that is due to you.
What if I have an insurance from the the Health Insurance Marketplace (Obamacare)?
If you have obtained health insurance coverage through the health insurance marketplace, you will need to provide proof that you have paid your premium for the current month before receiving services from Orlando Eye Institute and its physicians. If proof of premium payment cannot be provided, the amount due will be collected from the patient at the time of service and held for 180 days. After payment has been provided to Orlando Eye Institute by the insurance company for the service date and held for 180 days, a refund check will be issued for the balance of funds.
I have a vision plan and a medical plan, which one do you bill for my visit?
Vision plans are designed to provide you with coverage for a comprehensive routine eye examination. However, sometimes the examination may be more medical in nature…such as a patient that needs their vision checked but also has ocular allergies, dry eye, diabetes, glaucoma, macular degeneration or other medical problems. These diagnoses usually require a higher level of examination and sometimes additional tests. In this case, your medical insurance may cover your eye exam and your vision plan will cover your glasses or contact lenses. If you have both, typically we cannot bill medical insurance and vision insurance in the same day (the exception is Humana/VCP). In this case, we recommend an initial medical exam to address any underlying problems. Depending on the severity of the problem, this may require one or more visits. When the medical problem is stable, vision insurance can be used for glasses and/or contact lenses. If there are no pressing medical issues and only a routine eye examination is needed, then only the vision insurance will be used. Because of the significant difference in plans and benefits, we ask that you please notify us about your medical and vision insurance and which one you plan on using at the time when you make the appointment. This saves us time, avoids confusion, and allows us to see you in a timely manner. Thank you for your cooperation!