I believe you have to go back and look at what the insurance plans cover. The routine vision plans, like VSP, are there to cover routine visits plus a refraction for glasses. A routine exam includes the 10 elements that NC-OD described above, but does not cover the treatment of eye health issues. The medical plans cover the same 10 elements plus the treatment of any eye health issues. They do not, with any regularity, cover refractions. Knowing this you have to either have a separate charge for your refraction or you have to be willing to give away services. If you bill a medical plan and they say they don't cover the refraction then it is the patients responsibility.
It is very important to know why your patient is coming in. Most patients, and some OD's, automatically assume that when the patients PCP sends them in because they have diabetes they can use their routine vision plan to cover it. That is not the case. This patient is being sent to you for your expertise on a medical issue. This patient should have there medical insurance billed and not their routine. If they have a routine plan they can choose to make another appointment to have their refraction covered or they can save themselves a trip back in and pay the refraction fee. If we continue to bill routine plans for medical issues it won't be long before we are forced to treat eye health issues under routine plans. If that happens then we are all in trouble because their won't be enough OD's around to keep us all employed.
At the last practice I managed we always collected the refraction fee from the patient when we were billing medical. If we were able to get paid on the refraction we refunded the pt.
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