Paul Sanchez
Contact lens wearers often face additional costs for eye examinations, including refraction and contact lens fitting. While some insurance plans may cover annual eye exams, contact lens services are frequently excluded or only partially covered. This results in out-of-pocket expenses for contact lens wearers, who must pay for extra tests to ensure their lenses fit properly and their eyes remain healthy. The legality of charging a separate fee for contact lens fitting has been questioned, with some consumers suspecting insurance fraud when they are charged for a fitting that never occurred. This has prompted discussions around the Contact Lens Rule, which outlines consumers' rights regarding eye examinations and prescriptions.
| Characteristics | Values |
|---|---|
| Contact lens fitting fees | $50-$189 |
| Reasons for fees | Extra time taken for questions, history, complications, measurements, answering queries, etc. |
| Insurance coverage | Varies, some cover part of the fee, others don't |
| Legal requirements | Optometrist must provide a prescription after charging a fee |
| Prescription usage | Can take prescription to another provider to purchase contacts |
| Training | Some providers offer training on handling, inserting, removing, cleaning, and hygiene |
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What You'll Learn
- Contact lens fitting fees are often not covered by insurance
- The fitting fee covers follow-ups and writing prescriptions
- Vision insurance providers view glasses as medically necessary, not contacts
- Optometrists are required by law to provide a prescription after the fitting fee
- Contact lens services are separate procedures with additional tests
Contact lens fitting fees are often not covered by insurance
Contact lens wearers often have to pay additional fees for eye examinations, which are not covered by insurance. This is because vision insurance providers often view glasses, not contacts, as "medically necessary". As a result, contact lens wearers may have to pay for the extra time and testing required to ensure their eyes are healthy, the lenses fit properly, and that their vision is as good as possible.
The contact lens fitting fee is charged by the optometrist to cover the cost of the doctor's expertise and time spent evaluating whether the contacts are a good choice for the patient. This includes asking additional case history questions, looking for contact lens complications, calculating measurements, and answering questions about contact lens overuse. Some optometrists may also include follow-ups (related to the contact lens fit) and the writing of the prescription in the fitting fee.
The cost of a contact lens fitting can vary, with some places charging different amounts depending on the complexity and difficulty of the fit. Typically, the fee ranges from $50 to $150, with some practices charging as little as $60 and others charging up to $189.
It is important to note that, while insurance may not cover the cost of the fitting fee, it can be used to offset the fee. Additionally, once a patient has paid for the contact lens exam and received their prescription, they are not required to purchase their contacts from the same optometrist. They can take their prescription elsewhere to purchase their contacts from a discounter, which may offer further savings.
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The fitting fee covers follow-ups and writing prescriptions
Contact lens wearers are often charged a contact lens fitting fee, which is sometimes not covered by vision insurance. This fee is typically between $50 and $75 but can be as high as $150 or more. The fitting fee covers the cost of follow-up appointments related to the contact lens fit and the writing of the prescription. This means that if a patient decides they want to try a different type of contact lens, they will not be charged for the follow-up appointment up to a certain date.
The contact lens fitting fee is typically charged because vision insurance providers consider glasses, not contact lenses, as "medically necessary." However, some insurance providers, such as VSP and EyeMed, may cover part of the fitting fee with certain vision insurance plans. For example, VSP offers a 15% discount on contact lens exam services, with a copay of no more than $60. Additionally, some insurance plans may allow using part of the contact lens allowance to offset the fitting fee charged by the eye doctor.
It is important to note that the cost of the fitting fee can vary depending on the complexity of the fit. Some places may charge different amounts based on the difficulty of the fit, but this system has its flaws, as the level of complexity can change during the fitting process.
While the fitting fee covers follow-ups and prescription writing, it is separate from the cost of the contact lens evaluation or examination. During a contact lens evaluation, the doctor assesses whether the contacts are still suitable for the patient and makes a prescription based on that evaluation. This process takes extra time, as it involves asking additional questions, evaluating case history, checking for complications, calculating measurements, and discussing contact lens overuse.
Overall, the contact lens fitting fee covers the cost of ensuring that patients receive the appropriate contact lens prescription and have access to follow-up care related to their contact lens fit.
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Vision insurance providers view glasses as medically necessary, not contacts
Vision insurance providers typically view glasses as medically necessary and not contacts. This means that while insurance may cover the bulk of the costs for an eye exam and glasses, contact lenses are often considered an additional expense. This is because contact lenses are often seen as a cosmetic choice, rather than a medical necessity.
However, this is not always the case, and there are instances where contact lenses are medically required. For example, those with very poor eyesight, an irregularly shaped cornea, or a disease that affects the eye's surface may need contacts. In these cases, insurance providers may be more likely to cover the costs of contact lenses. Ultimately, it is up to the insurance provider to determine what constitutes a "medically necessary" contact lens, and this definition can vary between providers.
The cost of contact lenses can be significant, with contact lens evaluation and fitting fees ranging from $50 to $189. These fees are charged because of the extra time and expertise required to fit contacts, and they are typically not covered by vision insurance. However, some insurance providers may cover part of the fitting fee, and it is worth checking with your provider to see what is included in your plan. Additionally, some eye doctors may charge less for this service, so it can be worth shopping around to find a more affordable option.
While contact lens fitting fees are generally not covered by insurance, it is important to note that once you have paid for the initial evaluation and fitting, your optometrist is required by law to provide you with a prescription. This prescription can then be taken elsewhere to purchase contacts at a lower cost. This allows consumers to shop around for the best price on contact lenses, rather than being restricted to purchasing from their eye doctor.
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Optometrists are required by law to provide a prescription after the fitting fee
The Contact Lens Rule, enforced by the FTC, prohibits eye care prescribers from requiring patients to purchase lenses from them or charging additional fees for the prescription. Patients have the right to obtain their prescription and purchase lenses from any seller they choose. The prescriber must provide the prescription after the fitting is complete, which may require a follow-up visit after using trial lenses.
While optometrists can charge for the refractive eye exam and contact lens fitting, they cannot withhold the prescription for non-payment of these fees. If a patient has proof of insurance, it is considered payment, and the prescription must be provided. However, if the insurance does not cover examination fees, the optometrist may require payment before releasing the prescription.
It is important to note that contact lenses should be properly fitted to ensure eye health and safety. Optometrists are responsible for evaluating whether the contacts are suitable for the patient and making prescriptions accordingly. The fitting fee typically covers follow-ups related to the contact lens fit and the writing of the prescription.
If patients believe an eye doctor is violating the Contact Lens Rule or the Eyeglass Rule, they can report it to the FTC at ReportFraud.ftc.gov. By enforcing these rules, the FTC aims to protect consumers' rights, enhance consumer choice, and encourage competition in the eyewear market.
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Contact lens services are separate procedures with additional tests
Contact lens services are often considered separate procedures that are not covered by insurance or are only partially covered with a copay. These services include additional tests to ensure the health of the patient's eyes, the proper fit of the lenses, and optimal vision. Contact lens wearers require specific tests that are not necessary for patients who do not wear contact lenses. For example, the use of a microscope to examine the fit of the lens and the health of the cornea.
The contact lens fitting fee is a charge that covers the doctor's expertise and time spent evaluating the patient's needs and ensuring the proper fit of the contact lenses. This fee may vary depending on the complexity of the fit and the time required for the evaluation. It is important to note that the fitting fee also covers follow-up appointments related to the contact lens fit and the writing of the prescription. In some cases, the fitting fee may be covered partially or fully by vision insurance plans offered by providers such as VSP and EyeMed.
The contact lens evaluation process involves a range of additional steps, including taking a case history, looking for contact lens complications, calculating measurements, and answering patient questions. These extra steps require more time and expertise from the doctor, justifying the additional fee. It is worth mentioning that some eye doctors may refer to the contact lens fitting as an evaluation to emphasize the decision-making process behind the contact lens prescription.
While the contact lens fitting fee is a common charge, it is not always well-received by patients, especially when they feel there was no actual fitting involved. In such cases, it is important to understand that the fee covers the doctor's expertise in evaluating the continued suitability of the contact lenses and ensuring they are still a good choice for the patient. This evaluation process is an essential aspect of eye care and can impact the patient's comfort, vision, and eye health.
To summarize, contact lens services, including fitting fees, are typically considered separate procedures with additional tests and evaluations. These services may not be covered by insurance plans, leading to out-of-pocket expenses for patients. However, the fees associated with contact lens services reflect the specialized nature of the care provided and the time and expertise required by eye care professionals.
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Frequently asked questions
Contact lens fitting fees are not insurance fraud, but they are often not covered by insurance. Vision insurance providers usually only consider glasses to be "medically necessary".
Contact lens services are separate procedures that require additional tests to ensure your eyes are healthy and the lenses fit properly. These procedures are only necessary for contact lens wearers.
The cost of a contact lens fitting varies. Most people report paying between $50 and $150, with some paying as little as $60 and others as much as $189.
A contact lens fitting may require more than one appointment. During the fitting, your prescriber will evaluate whether the contacts are a good choice for you and make a prescription based on that. They will also provide training on how to handle, insert, remove, clean, and disinfect your lenses.
While many insurance policies do not cover contact lens fitting fees, some may cover part of the cost. For example, VSP offers 15% off contact lens exam services with a copay of up to $60.
