How much do you charge for a routine eye exam and what is included in the exam?
If you do not have insurance coverage for a routine eye exam, our fee in 2009 is $155. This is a discounted rate available only when paid in full at the time of service. We include the medical examination of your eyes along with the refraction in this service. The refraction is the portion of the exam where the doctor determines the prescription you need for glasses or contact lenses. There is an additional charge if the doctor needs to also do a contact lens fitting / check.
If you have insurance coverage for routine eye care and Horizon is a participating provider, there is a contracted reimbursement rate that we receive from your insurance company. We will bill your insurance company our standard charge and you will receive an explanation of benefits from your insurance company. Please note that if you have a deductible or co-insurance, your responsibility is as a portion of our contracted rate with your insurance company and not as of the $155 price described above. Additionally, insurance companies frequently deny the refraction portion of your eye exam as a non-covered benefit. When this happens the patient becomes responsible for this charge.
How much does a contact lens exam cost?
Our fees for a contact lens exam are in addition to our fee for a routine eye exam. This fee generally ranges between $30 and $100. If you currently wear contact lenses and do not expect to change the type of contact lens you wear the charge is usually $30. If you currently wear contact lenses but want to change the type of contact lens you wear, the charge is usually $65. If you are going to be a new contact lens wearer the charge is normally $100. There are instances where we charge more than $100 for a contact lens exam and this is usually reserved for a high level of service involving a patient with a condition such as keratoconus.
Contact lens exams are critical to ensure that the lenses fit your eyes correctly. Poor fitting contact lenses can lead to serious eye problems.
Since most insurance companies do not cover this service, we collect the fee at the time of the exam. If you have a medical condition such as keratoconus for which you may be covered, you can file this fee to your insurance company and be reimbursed.
Can you bill me for my copay?
No. Our policy is to collect copays, prior balances, non-covered charges (such as refractions) and unmet deductibles at the time of service. If for some reason we need to bill you for your copay, we will include a service fee. Read more about copays, deductibles, and Non-Covered Charges. Why do I have to pay for refraction separately?
A refraction is the procedure performed by an eye doctor to determine the prescription needed for eyeglasses or contact lenses. A phoropter, fitted with various lenses, or our Epic machine is used to perform the refraction. This is the part of the exam where the doctor or technician asks questions such as "which is better, one or two?"
As dictated by the federal government, the refraction is a non-covered service that must be billed separately from the exam. Because Medicare determined that this service is non-covered, some medical insurance carriers have mandated the same policy. It is also required by Medicare and therefore the insurance companies that the patient pays for the refraction separately from the exam.
