Routine eye examinations / Self Pay exams are annual baseline eye exams for patients who have no eye diseases or symptoms. Your eyes will be examined and you will be prescribed any needed correction for eyeglasses. Contact lens fittings / evaluations are a separate fee from a routine eye exam.
Examples of Routine Vision Insurances are Superior Vision, Spectera, EyeMed, and Community Eyecare.
If you report medical symptoms during a routine eye examination (dry eyes, itching, watering, redness, headaches/migraines, flashes/floaters, etc.) the doctor will schedule a separate medical visit to address those issues.
All initial and subsequent medical visits will be billed to your Medical Insurance pertaining to the diagnosed medical condition(s). All medical visits are subject to medical insurance copays and deductibles as required by insurance companies.
Medical Eye Examinations are exams for evaluation of a medical-related complaint or follow up of an existing condition are examples of an eye examination that would be billed to your medical insurance. Medical eye conditions that your doctor may diagnose may include but are not limited to; cataracts, macular degeneration, glaucoma, corneal problems, retinal problems, dry eyes, ocular allergies, floaters/flashes, headaches/migraines, and retinal pigment changes (ex. choroidal nevus).
If a medical condition is diagnosed that needs to be monitored for progression or change over time, the doctors will schedule additional medical visits as determined by the diagnosed medical condition.
Please note that if you have diabetes mellitus, and would like us to send a letter to your primary care physician regarding your eye examination, the visit will be coded as a Medical Eye Examination.
Your e-signature, below the HIPAA description, indicates that you understand the differences between Routine / Self Pay and Medical Eye Examinations and the potential implications of these differences on the type of exam that gets billed and the potential for fees that may include co-pays, deductibles, and/or co-insurance fees. You understand that you are responsible for any of these fees as determined by your insurance carrier.
By e-signing below, you are authorizing Chapel Hill Eyecare, OD to file insurance on your behalf, when applicable, for all services rendered. I further understand that although insurance will be filed, I am ultimately responsible for the timely payment of this account.