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My insurance will only pay for an eye exam if I have a “Medical Diagnosis.” What is that?

April 26, 2017exam eye Insurance medical diagnosis pay

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My insurance will only pay for an eye exam if I have a “Medical Diagnosis.” What is that?

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Some insurance plans will not pay for a general or routine eye exam but will pay if the patient has a medical diagnosis. This means that the patient has an abnormal eye health condition that requires periodic monitoring or treatment other than glasses. Examples of conditions that are considered to have a medical diagnosis are glaucoma, cataracts, diabetic retinopathy, retinal detachment and many others. Conditions that do not qualify as having a medical diagnosis include hyperopia (farsighted), myopia (nearsighted) and astigmatism. If your insurance will only pay for a medical diagnosis and you do not have one, it becomes your responsibility to pay for the eye examination.