Important Information

We participate with many medical insurance carriers, and as a courtesy to you we will
gladly file your eye exam to your insurance carrier. To find out if Pediatric
Ophthalmology Associates, PA is a preferred provider in your insurance company, you
may call the customer service department of your insurance carrier (the number is usually
listed on your insurance card) or contact our office. We do not currently participate with
any vision plans, such as VSP, UHC Vision, Blue Vision, EyeMed, Superior Vision, or
Davis Vision. Your insurance is an agreement between you and your insurance
carrier, not between your insurance carrier and the doctor. It is your responsibility
to know what your insurance plan covers and does not cover. Also remember that
“coverage” does not always mean “payment.” Many times there are deductibles or copayments
that must be paid on your part before your insurance company will pay anything.

Refraction
Refraction is the process of determining whether there is a need for corrective eyeglasses
or contact lenses. It is an essential part of an eye examination and is necessary to
write a prescription for glasses or contact lenses. A refraction does not always result in
a glasses prescription, however. Medicare and most insurance plans consider refraction a
“vision” service, not a “medical” service, and will not pay for it. Our refraction fee is
$35, and is collected at the time of service in addition to your co-pay or deductible.
Should your insurance carrier pay for the refraction, we will refund the $35 to you.
Please print the refraction_form.pdf and deliver the completed form to our office.

Routine Vision Exams and Medical Exams
In general, a routine eye examination (also referred to as a “well-vision exam” or an
“annual” exam) is done for the purpose of checking vision, checking the health of the
eyes, and updating eyeglass or contacts lens prescriptions. A refraction is performed as
part of a routine or annual examination. If your medical insurance plan does not cover
routine vision, it will not pay for a routine exam, even if you were referred by another
physician. Many times children are referred to an ophthalmologist because of a “failed
vision screen” at school or the pediatrician’s office. This is considered a “routine” vision
exam, and is billed to your medical insurance plan only if you have vision coverage
through the medical plan, not a separate vision plan, or if a medical condition such as
amblyopia is found as the reason for the failed vision screening.

Examinations for medical reasons, whether a new problem or to follow an existing
medical condition, is considered a medical exam and is billed to your medical plan.

Contact Lens Evaluation and Fee
Contact lens patients require additional testing and monitoring over and above what is
done during a routine eye exam. Contact lenses are medical devices and even though they
may feel fine, there are health risks that must be taken seriously. In order to renew your
contact lens prescription, the physician performs the following tests on a yearly basis.
These procedures are not part of a routine eye exam.

  • Slit lamp microscope exam of the contact lens on the eye to check the lens fit
  • Detailed slit lamp microscope exam to check the health of the eye from contact
    lens wear and to look for any adverse effects from contact lens wear
  • Contact lens refraction to determine the correct contact lens prescription power (a
    contact lens prescription is different that an eyeglass prescription)
  • Review of new lens designs, materials, and solutions that may improve comfort
    and/or health

The fee for this service is $15 and is collected in addition to the fee for an eye
examination without contact lenses.

RELEASE OF MEDICAL INFORMATION
To request the release of your medical forms, please download and complete the ROI form and submit with the applicable fee or fax the completed form to our office at 336-271-2904.




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