If I do not have insurance, what will my visit 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 for a new patient starts at $75.00 and goes up depending on the complexity of the problem. Glaucoma suspects, for example, 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 prescription) and contact lens fittings.
How much is a contact lens fitting?
The professional fees for contact lens fitting begin at $65.00 for current or previous wearers and $105.00 for new wearers. The fees include all trial or diagnostic lenses, training, starter care kit and necessary follow-up care. Fees are higher for complex fittings, astigmatism fittings and medical fittings such as for keratoconus. For existing contact lens wearers, a $45.00 fee is charged for annual contact lens evaluation in order to update their contact lens prescription.
Where can I purchase my supply of contact lenses?
While we encourage you to purchase your annual supply of contact lenses from our office, once your contact lens prescription is finalized you may purchase from any authorized vendor. Please ask about our Contact Lens Advantage Program.
When does my contact lens prescription expire?
Your contact lens prescription will expire in one year from the date the final prescription was determined. After that date, an eye health exam including a contact lens evaluation will be required in order to renew the prescription.
I have been wearing contact lenses for years, so why do I need an annual contact lens evaluation?
Contact lenses are FDA prescription medical devices and even though they may feel fine, there are health risks, particularly involving the cornea, that must be taken seriously. Contact lens complications can occur which may have the potential to cause permanent loss of vision.
Therefore, in order to renew your contact lens prescription and to clear you for continued successful and safe contact lens wear, your doctor performs additional tests and procedures which are not part of a standard eye exam. Currently, we charge $45.00 for this service.
I have been wearing contacts for many years, so why am I being charged a re-fitting fee?
If you and the doctor agree to switch or upgrade to a new or different brand or type of contact lens from the type you are presently wearing, a contact lens re-fit fee is charged. This fee covers all trial lenses and all necessary follow-up care associated with the new lenses. This fee is only slightly more that the usual annual contact lens evaluation.
Why do I have to pay for an eyeglass prescription when I have Medicare? 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, EyeMed, Davis Vision, Spectera and Superior Vision.
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 $35.00 and it is collected at the time of service (day of your exam) and is charged 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.
What is the difference between medical insurance and vision insurance?
Medical insurance generally covers medical problems. Glaucoma, for example, is considered a medical condition so you would use your medical insurance for exams related to glaucoma and any other diseases or injuries of the eye. Dry eyes, floaters, cataracts and conjunctivitis are also considered to be medical conditions. Other conditions like lazy eye, double vision, focusing problems, eye misalignment are covered under medical insurance.
Vision insurance plans generally only cover ‘healthy eye’ care. Refractions (prescriptions for glasses) and contact lens fittings fall into this category. Farsightedness, nearsightedness, astigmatism and presbyopia are all considered vision problems and would be covered under vision insurance.
However, just to complicate matters, some medical insurance plans do cover routine vision or annual eye health exams. Check with your carrier or call our office.
How long does a typical eye exam take?
The average initial office visit takes from 30 minutes to one hour, depending on how much diagnostic testing is done.
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. You should, however, bring your driving glasses with you.
What is an Optometrist?
An optometrist, or doctor of optometry (OD), is a state-licensed primary health care practitioner for the eye and has gone to optometry school for four years after college. Some optometrists receive additional training in a subspecialty field. Most optometrists provide routine eye care, including eyeglass prescriptions and contact lens fittings. Most contact lens fitting, low vision therapy and amblyopia (lazy eye) treatment is provided by optometrists. Optometrists also provide most primary medical eye care for conditions like red eye, allergy, dry eye, foreign body removal, glaucoma and many other conditions. Although most optometrists do minor surgery, none are licensed to do cataract surgery, retinal detachment surgery or eye muscle surgery for strabismus. Only ophthalmologists are licensed to perform such surgeries. However, some optometrists in some states are licensed to do minor laser procedures.
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 billing your insurance company. 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 B and a supplemental or secondary plan like Medex, you do not have to pay for anything up front unless you are having a refraction or procedure that Medicare does not pay for. If you do not have a secondary or supplemental plan, then you will be responsible for meeting your deductible or paying a 20% co-insurance. After Medicare has processed your claim, our office may 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 your 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 which can be done by our office at the time of your visit. 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.
Will my eyes be dilated?
Whether eye dilation is necessary for every eye exam depends on the reason for your eye exam, your overall health and your risk of eye diseases.
During an eye exam, your doctor uses special eye drops to cause eye dilation. The drops cause the black portion at the center of your eye (pupil) to widen, allowing your doctor a good view of the back of your eye. Eye dilation can help your doctor diagnose many diseases and conditions, such as: diabetes, tumors, hypertension, macular degeneration, retinal detachment, vitreous floaters, etc
Many diseases and conditions can be detected at their earliest stages during an eye exam. For this reason, most eye doctors recommend eye dilation as part of a routine eye exam schedule.
Still, eye dilation can be inconvenient, since it makes it difficult to focus on close objects. This can interfere with your ability to drive or work for a few hours after your eye exam. Eye dilation also makes your eyes more sensitive to bright light. If eye dilation is recommended and is not convenient at the time of your visit, ask your doctor about returning for a dilation visit at a more convenient time. In determining whether eye dilation is necessary for you, your eye doctor may consider:
- Your age. The risk of eye diseases increases with age. Most patients are routinely dilated after age 45.
- Your eye health. If you have a history of eye diseases that affect the back of the eye, such as retinal detachment, you may have an increased risk of future eye problems.
- Your overall health. Certain diseases increase the risk of eye disease. If you are diabetic or pre-diabetic, an annual eye exam with pupil dilation is necessary.
- Your reason for an exam. If you’re seeking an eye exam because you have new, worrisome eye symptoms or vision problems, then eye dilation may be necessary to make a diagnosis.
- Results of previous eye exams. If recent eye exams have included eye dilation with no unusual findings, it may be possible to skip the eye-dilation portion of your next exam. If this is your first eye exam, it’s a good idea to have the eye-dilation portion of the exam. Discuss this with your eye doctor.
If I have my eye exam elsewhere, can I still purchase glasses or contact lenses through your optical shop?
Absolutely! We have an extensive collection of frames ranging from budget to designer. We offer lenses by Essilor, Zeiss, Varilux, Shamir as well as other manufacturers. Our trained staff and licensed opticians will fit you with the frame and lenses that are best suited to your individual needs. We can order all major brands of contact lenses at very competitive prices.
Please visit our optical shop where our trained technicians will assist you in choosing the frame and lenses that will work best for your individual needs. We carry hundreds of frames including such designers as Gucci, Coach, Guess, Saks Fifth Avenue, Valentino, Sophia Loren and Prada. We also have sunglasses and sport glasses by Maui Jim, Ray-Ban, Nike, Carrera and others.
Can I purchase glasses or contact lenses from VALENTINE EYE CARE if you are not listed on my vision plan?
Absolutely! While Valentine Eye Care is accepted by major vision plans such as Davis Vision, EyeMed, Spectera, VSP and others as an out-of-network provider for contact lenses and glasses for some plans, we are in-network providers for all VSP and most EyeMed vision plans. So, if you have an out-of-network benefit for contact lenses or glasses, you simply purchase your contacts or glasses through Valentine Eye Care and submit the itemized invoice that we provide along with your out-of-network claim form for reimbursement from your insurance company.
If you have any questions, please call us at 1-978-696-5674 and we will be glad to assist you!