Frequently Asked Questions
1. If I do not have insurance, what will my exam cost?
That depends on the nature of your visit and the number of ancillary tests that are performed. Generally, a simple office visit for a medical eye condition starts at $130, and goes up depending on the complexity of the problem. Many new glaucoma referrals need a combination of visual field testing, optic nerve imaging, and corneal thickness measurements by ultrasound, all of which are charged on top of the basic fee for an office visit. Additional fees also apply for refractions (determination of eyeglass prescriptions) and contact lens fittings.
2. If I am coming in for a glaucoma evaluation and I have had all of the necessary tests done at another office. Will I have to have them repeated and pay for them?
Many visual field tests done at other doctors’ offices are simple screening tests, so they are not suitable when the diagnosis of glaucoma is in question. For this reason, your doctor might recommend that our office perform a full threshold visual field test. Optic nerve imaging is often performed because it gives us a baseline image of your optic nerves, which will be extremely useful for future comparison. Corneal thickness measurements by ultrasound do not need to be repeated unless you have had recent laser vision correction surgery.
3. Why do I have to pay for an eyeglass prescription? Shouldn’t that be considered part of a routine eye exam?
Refraction is the process of determining the eye’s refractive error and testing for best corrected vision, or need for corrective lenses (glasses or contacts). It is an essential part of an eye examination, and is covered by vision insurance plans, such as VSP, Medical Eye Services, and Superior Vision Plan.
However, since refraction is considered vision care, it is NOT covered by Medicare or most medical insurances. If you do not have vision insurance, the fee for refraction is $70 and it is collected at the time of service (day of your exam) and is in addition to any copayment or deductible required by your insurance company—the co-pay or deductible is for the medical portion of your exam and is separate from and not included in the refraction fee.
4. What is the difference between medical insurance and vision insurance?
Medical insurance generally covers medical problems. Glaucoma is considered a medical condition so you would use your medical insurance for exams related to glaucoma and any other diseases of the eye. Dry eyes, cataracts and conjunctivitis are also considered to be medical conditions.
Vision insurance plans generally only cover ‘healthy eye’ care. Refractions (prescriptions for glasses) and contact lens fittings fall in this category.
5. I have been wearing contacts for many years and I have never paid for a fitting in the past, why would I have to pay at your office when I just need a renewal on my prescription?
Contact lenses are medical devices placed on the eyes. They require expert fitting and conscientious care to maintain the healthy functioning of your eyes. Because the determination of contact lens prescription is not part of the usual eye examination, extra measurements including keratometry and/or corneal topography (corneal curvature and contour) are necessary to ensure proper centration and movement of the lenses. Contact lenses should be evaluated on an annual basis to ensure healthy corneal integrity, proper fit, optimal comfort and adequate vision. Even if the contact lens prescription remains the same the following year, a contact lens refit fee applies
6. How long does a typical exam take?
The average initial office visit takes from 30 minutes to one hour, depending on how much diagnostic testing is done.
7. Do I need to bring a driver with me to my exam?
Generally, no. Your pupils might need to be dilated, so you might be sensitive to bright lights for a few hours after your visit. If you do not have sunglasses, our office will provide you with a disposable pair.
8. What is the difference between an Ophthalmologist and an Optometrist?
Ophthalmologists are medical doctors, or M.D.s. They have gone to four years of medical school, where they studied diseases affecting all parts of the human body. They followed medical school with one year of a general medical internship, in which they cared for a large number of sick patients in a hospital setting, and then three years of intensive training in an ophthalmology residency. Some ophthalmologists then receive additional subspecialty training during a fellowship year. Ophthalmologists are qualified to perform surgery.
Optometrists, or doctors of optometry, have gone to optometry school for four years after college. Some optometrists perform additional training in a sub-specialty field. Most optometrists in private practice provide routine eye care, including eyeglass prescriptions and contact lens fittings.
9. If I need eye surgery, how long will I have to wait for an appointment?
Urgent operations are done within one week or sooner at the discretion of your surgeon. Elective cases are generally scheduled within three to four weeks.
10. If I have insurance, do I need to pay for my appointment up front or will you bill the insurance company first and I pay the remaining amount?
If you have a PPO, you will be expected to pay only your copay at the time of your visit. After your claim has been processed by your insurance company, our office will send you a bill for any additional copay, coinsurance, deductible charges, or procedures that were not covered by your plan.
If you have an HMO with which we are contracted and your insurance requires prior authorization/referral, we will need to have this on file before you can be seen. You will be expected to pay your copay at the time of your visit. After your claim has been processed by your insurance company, our office will send you a bill for any additional copay, coinsurance, deductible charges, or procedures that were not covered by your plan.
If you have traditional Medicare, you do not have to pay for anything up front unless you are having a refraction or procedure that Medicare does not pay for. After Medicare has processed your claim, our office will send you a bill for any additional coinsurance, deductible charges, or procedures that were not covered by Medicare. If you have a secondary insurance, we will forward you claim to your insurance company on your behalf. You will be responsible for any portion of your bill not covered by your secondary payer.
If you have signed up for a Medicare Advantage plan, you may need prior authorization or a referral. You may also have a copay. You will be expected to pay your copay at the time of your visit. After your claim has been processed by your insurance company, our office will send you a bill for any additional copay, coinsurance, deductible charges, or procedures that were not covered by your plan.
All plans are different and we recommend that you call your insurance company ahead of time so you are aware of what your plan covers and what your coinsurance and deductible responsibilities may be.
If you arrive for your appointment and we cannot verify your insurance coverage or authorization, you may pay in full at the time of your visit or reschedule your appointment.
11. Do you have a fee for last minute cancellations?
Yes, there is a $20 fee for a missed office visit without at least 24 hours notice. A no show or cancellation of a surgical procedure without at least three days notice is subject to a $100 cancellation fee.