The Uproar About Refraction Fees
An influencer recently went viral for posting that eye doctors cannot charge for a refraction. That is incorrect. What the influencer meant to say is that the eye doctor cannot charge for a copy of the refraction. Our charge is for performing the refraction in accordance with Medicare regulations. Our charge is not for printing the refraction.
“What is a Refraction and Why Do I Have To Pay For It?”
Medicare
President Lyndon Johnson signed Medicare into law in 1965. From that day forward, refraction has never been a covered service for Medicare recipients. Medicare patients must pay for the refraction as a non-covered service. In fact, it is illegal for us to include the value of a refraction in the comprehensive exam for Medicare patients. Doing so could cause the federal government to charge us with fraud.
How We Inform Our Patients of The Medicare Regulations
Our brochure entitled “What is a Refraction and Why Do I Have To Pay For it” was first printed in 2007. Versions with updated graphics have been patient-facing at checkout since that time. Repetitive information is included on our website and in recurring blog posts.
Other Medical or Routine Vision Insurances
We always bill the refraction fee as a separate charge in addition to the exam code, regardless of whether the insurance coverage is medical or routine vision coverage.
- Routine vision plans pay a flat rate for all eye care services provided, they split their payment between the exam and refraction.
- Medical health insurance never covers refraction.
We are not allowed to mix and match insurances. Patients with medical eye conditions are billed under the rules of their health insurance. Patients with refractive conditions can only be billed under the rules of their routine vision insurance, although not everyone with commercial health insurance has routine vision insurance.
