A refraction is a test performed by your eye doctor to assess whether or not glasses will improve your vision.
Refractions, for example, are not covered by Medicare since they are considered part of a “regular” exam, and Medicare only covers health-related treatments.
If you have a medical eye condition such as cataracts, dry eyes, or glaucoma, Medicare and most other health insurance plans will cover the medical portion of the eye exam but not the refraction.
Some people have both health and vision insurance, which covers “regular” eye care (non-medical issues) such as refractions and eyeglasses.
If you have a vision plan and come in for a routine exam with no medical eye problems or complaints, your refraction is usually covered by your vision insurance.
Does insurance pay for eye refraction?
A trip to the eye doctor (either an ophthalmologist or an optometrist) for a prescription for eyeglasses or contact lenses is what many people think of when they think of an eye exam.
However, many patients are surprised to learn that they were charged one amount for the exam and a another fee for refraction following their visit. Refraction is the test used to determine what prescription is needed for glasses or contact lenses. Patients are asked to gaze through different lenses while reading a sequence of small letters and then asked which lens is better.
Although eye specialists may remind patients that refraction is an important element of the eye exam, it is rarely covered by health insurance. Why would insurance neglect such an important service, and why do some doctors refuse to charge this fee?
Healthy eyes versus seeing better
Part of the answer to these queries stems from a rather artificial difference made by health insurance companies: keeping eyes healthy vs increasing eyesight with glasses or contacts.
Doctor’s office coverage under Medicare Part B is not supposed to include eyeglasses or refractions, according to the Medicare Act. The majority of private health insurance companies have followed Medicare’s lead, requiring patients to pay these costs out of pocket or purchase vision insurance.
Eye exams to evaluate for eye illness are, nevertheless, covered by Medicare and other health insurance. These exams are covered by Medicare and include glaucoma, macular degeneration, and diabetic retinopathy testing.
Eye doctors have discovered that invoicing Medicare or other health insurers for an eye exam to test for disease is more profitable than relying on vision insurance reimbursements, which are often lower than health insurance payments. However, because refraction is not covered by Medicare or most private health insurance, an eye doctor who does it during the exam will usually issue two different bills: one for the eye exam and one for the refraction.
Some optometrists do not charge separately for refraction, thus patients simply have to pay the co-pay for the eye exam and do not receive a second bill. However, this approach is strictly prohibited by Medicare and other insurance companies: A doctor who does not charge a refraction fee could be accused of overcharging for the exam to compensate the refraction expense. If the insurance company discovers this, the doctor may be required to reimburse the insurer for all unbilled refraction rates.
Another reason doctors charge for refraction separately is that it is a profitable practice. “Efraction is a service that is useful and people will pay for it,” one supplier bluntly acknowledged in a trade newsletter aimed at eye professionals. If the service isn’t insured and the patient must pay for it out of pocket, all the better!”
What can patients do?
The practice of charging separately for refraction is becoming more common among eye practitioners. Unfortunately, charging patients individually for refraction results in increased out-of-pocket expenses, especially for those without adequate health or vision insurance.
It may be feasible to save the refraction cost for people with good vision who do not require glasses or contacts by simply denying the service. If refraction is charged separately, a doctor should inform you prior to the exam. This is frequently accomplished through a standard notice that patients must sign when they come at the office. Patients may be pressured to undergo refraction in such notices, which state that the procedure is required to examine the health and function of the eyes.
While some eye physicians believe that refraction is the most accurate approach to identify vision loss, a standard eye exam should include several other tests that are particularly designed to detect visual disorders and disease. Simple vision tests, such as reading letters on an eye chart, are already familiar to most patients. Patients are asked to stare at a small grid and describe any fading, broken, or distorted lines as part of a routine macular degeneration screening test. Glaucoma tests may include measuring the inner pressure of the eye with a machine that delivers a little puff of air. An eye doctor may also dilate your eye to check for damage to the retina and optic nerve, which are located in the inner portions of your eye.
Patients who can see well without contacts or glasses should feel comfortable respectfully dismissing refraction as a superfluous service, especially if it involves an additional price, given the availability of various tests expressly designed to evaluate vision loss and diagnose eye illness.
How Often Should You Have an Eye Exam?
Routine eye exams are not required for those under the age of 40 who do not have diabetes, are not at high risk of glaucoma, and have not experienced any signs of eye illness, according to the American Academy of Ophthalmology. The association suggests having a test every two to four years for adults aged 40 to 54. Individuals aged 55 to 64 should have their exams every one to three years, while those above 65 should have them every one to two years.
Exams should be done more frequently for people at higher risk for glaucoma, including as African-Americans and Latinos: every two to four years for those under 40, every one to three years for those 40 to 54, and every one to two years for those 55 to 64.
Patients with type 1 diabetes should see an ophthalmologist five years after the onset of the disease and at least once a year after that. Type 2 diabetics should be checked at the time of diagnosis and at least once a year after that.
Whether or not refraction is included in the exam, these monthly screenings should be adequate to detect significant eye disorders.
Why is eye refraction not covered by insurance?
Refractions, for example, are not covered by Medicare since they are considered part of a “regular” exam, and Medicare only covers health-related treatments.
If you have a medical eye condition such as cataracts, dry eyes, or glaucoma, Medicare and most other health insurance plans will cover the medical portion of the eye exam but not the refraction.
Some people have vision insurance as well as health insurance, which covers “regular” eye treatment such as refractions and eyeglasses (but not medical eye disorders).
If you have a vision plan and come in for a routine exam with no medical eye problems or complaints, your refraction is usually covered by your vision insurance.
How much does eye refraction cost?
With and without insurance, the national average for an eye checkup differs dramatically.
The average cost of an eye exam for people without insurance varies depending on the eye test, location, and type of eye doctor you visit in your area.
The cheapest solutions will be found at huge brand names like Walmart and America’s Best. To discover the best eye exam pricing for your needs, we recommend phoning several optical/optometry facilities in your area.
- When compared to subsequent trips, you can anticipate to pay slightly more on your first visit.
- People who reside in large cities (especially those near the seaside) might expect to pay more for eye care than those who live inland.
According to VSP, 80 percent of first eye exams cost less than $200. However, take in mind that a contact lens test will be more expensive.
Of course, based on the parameters described above, the typical cost of an eye test may be slightly lower or greater for each individual.
Check out FairHealth to see how much an eye checkup without insurance costs in your area.
Should I pay for refraction?
We’ve all heard patients ask this question, and dealing with a patient who is upset about non-coverage can be difficult. Typically, you can solve the problem by properly communicating with patients about which services are covered and which aren’t – and this is especially true when it comes to refraction.
If you need a refresher (or a quick definition you may provide patients), “refraction” refers to a physician’s assessment of a patient’s refractive error in order to decide whether or not the patient requires glasses and, if so, what the prescription should be. It’s usually done as part of a standard eye exam, and CPT code 92015 describes it (Determination of refractive state).
So, what exactly is the issue? Refraction is not covered by Medicare or most other insurance plans. Patients who wish to go through the refraction process will have to pay for it out of pocket at the practice. Patients are frequently unhappy when they learn of the price, which causes problems for your front desk employees when it comes time to collect the money.
What is the difference between an eye exam and a refraction?
Arefraction is an eye test that determines a patient’s prescription for eyeglasses or contacts during a thorough eye checkup. During the refractive test, the patient will sit in a chair and gaze on an eye chart 20 feet away through a special instrument called a phoroptor or refractor. The phoroptor has a variety of lenses of various strengths. The patient will be asked to determine which lenses make the chart appear more or less clear as the doctor or technician changes the lenses. A refraction test not only indicates whether a patient need corrective lenses, but also allows the doctor to monitor the patient’s overall eye health.
Pediatric Eye Exams
Refractions are also significant in thorough eye examinations for children. The pediatric refraction test determines whether your child requires glasses and, if so, what prescription is required.
Aretinoscopy is frequently utilized for younger children. The refractive error of the eye (farsightedness, nearsightedness, and astigmatism) and the necessity for glasses can be determined objectively using this procedure. The test can be simple and quick for the child, as well as accurate and reliable, and it only requires minimum cooperation from the young patient. A handheld equipment called a retinoscope projects a beam of light into the eye during a retinoscopy. The examiner watches the movement of the reflected light from the back of the eye as the light is moved vertically and horizontally across the eye. The redreflex is the name for this type of reflection. After that, the examiner can use a hand-held device to place lenses in front of the child’s eye. When the lenses are changed, the direction and pattern of the reflection changes as well. The examiner changes the lenses until he or she reaches a lens power that corresponds to the refractive error. While this technique may appear to be simple and quick for a young kid, it is an important aspect of your child’s comprehensive eye health screening.
Are glasses covered by insurance?
Your vision insurance will normally cover at least a portion of the cost of your spectacles, although the amount depends on your plan. For a complete list of your plan’s benefits, contact your insurance provider. Vision insurance always covers eyeglasses in full.
Is eye refraction necessary?
Refraction may be required in some cases, based on the patient’s diagnosis and/or symptoms. For instance, if a patient has impaired vision or a decline in visual acuity on the eye chart, a refraction is required to determine whether the patient need glasses or has a medical condition.
When did Medicare stop paying for refractions?
Since Medicare’s inception in 1965, refraction (CPT code 92015) has been a “non-covered” procedure. Medicare has been implementing the policy of requiring eye doctors to charge separately for refractions since around 2007.
What is an insurance refraction?
A refraction is a test used to determine your prescription for eyeglasses. A refraction can be done by either a doctor or a technician, and it usually entails asking questions like, “Is 1 better than 2?” A refraction is considered regular medical care that is not covered by Medicare or many other insurance plans, so this fee is charged separately and paid directly by the patient. Because it is not a Medicare-covered service, secondary insurance plans will not cover the payment, so the $35.00 fee must be paid by the patient.
Is refraction the same as dilation?
1 The doctor can measure the degree of light refraction with a dilated eye exam. Another benefit of dilatation is that it prevents your eye from concentrating, which can help determine your true refractive defect and thus your corrective lens prescription.