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Medical Eye Care

Medical eye care is care prescribed by your doctor to address a diagnosis.  Read below to see how insurance works for these appointments.

Not all medical eye care is covered under insurance, but every time that a visit under insurance is billable the office visit will be billed to your MEDICAL INSURANCE carrier first, NOT YOUR VISION PLAN.

Vision plans are not the same as medical insurance and don’t have to obey by all the regulations followed by Medicare, Blue Cross Blue Shield, Humana, Cigna, Aetna, United Health Care and others payers in the insurance space. Medical insurance is contracted with your optometrist (eye doctor) in much the same way it does a cardiologist (heart doctor), dermatologist (skin doctor), or even ophthalmologist (eye surgeon). As a specialist of the organ system responsible for vision we take great pride in the trust you bestow upon us eye doctors. Insurance requires just two things to constitute an examination: there must be a doctor and patient in direct communication, and there must be a problem that is the focus of the exam – that’s why we call office visits covered by medical insurance Problem-focused Medical Eye Exams.

Your annual physical for the eye (wellness exam) identifies the problems that need to be evaluated and managed further if present; then your problem-focused evaluation with the eye doctor determines if there is a treatment needed and the frequency the problem must be evaluated.  That plan is shared with the other doctors on your team as necessary, and if the service is not paid by your insurance we will inform you before we schedule that service: most commonly the consultation, evaluation, and treatment visits are defined in a specialty eye care service like our

  • MVP (Maximum Vision Protection/Performance),
  • TCT (Tear Care Treatment),
  • MMP (Myopia Management Program),
  • VST (Vision Shaping Treatment,
  • or VTP (Vision Training Program).

Each of these programs are unique to 4Sight iCare because they were developed by our clinical director through years of research, evaluation, and practical eye health care experience.

Dr. Burke’s pro-active approach to eye care is that prevention is the best medicine; prescribing one of these services for current diagnosis means that a deficiency exists and there is a proven treatment to alleviate the problems associated with the diagnosis.  For instance, you don’t have to demonstrate loss of vision to be evaluated and managed for glaucoma – there simply has to be a diagnosis of concern that could result in vision loss and the amount of risk dictates your eye doctor’s level of concern.

On your thank you page handed to you at the conclusion of every encounter at 4Sight iCare, where it says “Services beyond eyeglasses, prescribed by your doctor” we list all the services and when necessary the doctor will fill in the blank where “Medical eye care within _____ month(s)”.  This means that if he writes 12 months the problem is present but not a great threat to vision, but if he crosses out month and writes 2 days the degree of risk is much higher and the problem needs urgent attention.