Features, Health and Safety, New York

Managing Health Care Costs: Routine Eye Exams

November 23, 2017

By Dr. Bartley Bryt

Health care can be a maze. This is one in a series of articles to help manage costs while providing members with the best health outcomes.

Your eyesight is precious. Periodic eye exams are an important step in preserving your vision long term. In addition to detecting changes in your vision, during an eye exam your eye doctor can detect any eye disorders at an early stage, when they are more easily treated and their progress can possibly be contained or even reversed. A comprehensive eye exam can even detect early signs of diseases that affect the entire body, such as diabetes.

But navigating eye care benefits can be confusing. The first thing to understand is that there are three different types of eye care providers: opticians, optometrists, and ophthalmologists.

  • Opticians have a 1- or 2-year degree certification, and specialize in filling lens prescriptions. Once you have your eyeglass prescription in hand, an optician will assist you with lens and frame selection and fitting. An optician is not qualified to conduct eye exams.
  • Optometrists are doctors of optometry (OD) with four years post-graduate doctoral training, and they can diagnose and treat certain non-complex eye conditions, including writing prescriptions. They cannot perform surgery.
  • Ophthalmologists are medical doctors (MD or DO) who went through four years of medical school plus specialized training in ophthalmology. They can diagnose and treat complex medical eye conditions and perform surgery.

Both optometrists and ophthalmologists are qualified to conduct eye exams, where they will not only check your vision, but will also check your eye health for conditions such as glaucoma and macular degeneration.

So which type of doctor should you go to for your annual eye exam? If you are not currently under treatment for a complex medical eye condition, it is generally most cost-effective for you to visit an optometrist at a neighborhood vision location that participates in your vision plan. Here is why:

  • Optometrists specialize in eye exams for healthy people who may have some loss of vision, as usually occurs as we get older. That’s what they do all day, every day. It’s their area of expertise.
  • With most vision plans, you pay a lower copay than if you go to an eye doctor who is a medical doctor through your medical plan.
  • Importantly, many medical insurance plans will not cover your visit to an MD/DO eye doctor for the purpose of a routine eye exam.
  • Convenience — very often optometrists will share an office with an optician they trust, so you can choose your frame and lenses during the same visit – a one-stop shop. Also, locations with optometrists are more prevalent and more conveniently located.

To summarize, for simple conditions like routine eye exams or getting glasses, use your neighborhood vision store. Use your vision benefit plan where possible, not your medical plan. When you call to make an appointment, some optometrists might tell you that they prefer to use your medical health plan, not your vision plan. Don’t be afraid to insist that you will be using your vision benefit plan.

Finally, understand your coverage before you go. Check online with your vision benefit plan before you go to the appointment so you know what’s covered and what’s not, and what your costs might be.

Dr. Bartley Bryt is Chief Medical Officer at Brighton Health Plan Solutions (BHPS), an innovative health care enablement company with several industry-leading products for labor and the public sector, including MagnaCare and Create, a new marketplace of health systems and service platform.

November 23, 2017

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