Q&A with the Doc: Why Doesn't Insurance Cover Contact Lens Exams

Question: Why am I charged for a contact lens exam if I my insurance company pays for a “Comprehensive Eye Exam”?

Answer: A comprehensive eye exam includes evaluation for each eye’s focus and eye pointing capability at all distances, and an evaluation of how the eyes focus and converge. The “which is better: one or two?” portion of the exam is the refraction and results in a spectacle prescription. It also includes external and internal eye health evaluation including checks for glaucoma, cataracts and macula degeneration.

A contact lens is a synthetic device made of hard or soft plastic polymer that rests upon the living, naturally clear tissue of the cornea. Additional testing and measurements are made to assure, safe, comfortable and best possible vision correction.

I am a medically focused Optometric Physician and insist that my patients allow me to protect their eye health, in order for them to have decades of successful contact lens wear. A contact lens Examination and Fitting process requires evaluation of the lids, lashes, and corneas in order to provide the best and safest contact lens prescription. This requires extra time, training and skill on the part of the doctor. The patient must also become a student and learn from the doctor and his staff how to handle, clean, disinfects, insert and remove the lenses.

Experience and training allow me to determine the most appropriate lens for the patient, that will provide:

1. Clear vision
2. Comfortable wear
3. Safety for the eye

The patient has votes for number 1 and 2, but my vote for 3 overrides 1 and 2. I base the successful completion of the fit on how the patient adapts to the lens over a 4 to 8 week period. This requires that the patient return to my office for me to evaluate the cornea and contact lens combination during that period and annually. The contact lens examination and fitting program fees include the two months of follow-up visits and all trial lenses used for adaptation.

You may wonder why is medical monitoring of contact lens fitting necessary? Aside from the immediate benefits of a responsible fit, the long term health of the cornea is protected. Many contact lens patients convert to Lasik patients later on. If the cornea is healthy, laser surgery can proceed without an extended period of corneal rehabilitation before the patient is allowed to have the surgery. Also a healthy cornea and continuous 20/20 vision provide a best case playing field for the laser surgeon to achieve an optimal outcome.

Bison Vision Center's web-based store matches online prices of 1-800 xxxxxxxx, and delivers them to your home. As a patient of Bison Vision Center, when you purchase your contact lenses through our online store  at www.bisonvisioncenter:

• the consumer rebate coupons AUTOMATICALLY appear, reducing your cost even further;
• we provide replacement contact lenses, when a contact lens tears or you run out of lenses just before your annual exam.

Thank you. I appreciate your business and your loyalty!

Dr. Doug Smith, O.D.
(aka. Doc Bison)