Dr. Lisa Galluzzo explains why a visual field exam may not be fully covered by insurance. She discusses the purpose of the test and its importance in diagnosing conditions like glaucoma, retinal diseases, and optic nerve disorders. She also clarifies when insurance typically covers the exam and why patients might receive a bill if it’s done for general screening without documented symptoms or risk factors.
Video Transcript:
Hi, I’m Dr. Lisa Galluzzo from the Fort Lauderdale Institute. If you see a charge for a visual field exam on your bill, you may have some questions about why this exam is not fully covered by insurance. Let me explain.
A visual field exam measures your entire range of vision, including your peripheral vision or side vision. It plays a crucial role in diagnosing and monitoring conditions such as glaucoma, optic nerve disorders, or certain retinal diseases, and even neurological issues. Typically covers a visual field exam; however, when it’s considered medically necessary. This means that there must be clear documentation from your physician showing you have symptoms or risk factors that meet your insurance criteria.
For example, the exam is performed for general screening without specific symptoms or diagnosis. Your insurance may not cover the cost, and you may be responsible for the bill. Most insurance plans also limit how often you can have a visual field exam, often to once per year, unless your doctor can show that more frequent testing is necessary for your condition. If the exam is repeated more often without medical justification, you may be responsible for the payment. You must sign an advanced beneficiary notice of non-coverage when your insurance plan coverage is uncertain.
Another important factor is your insurance network. If your office or your provider is out of network with your insurance, full or partial costs for this test may not be covered. To avoid surprises, we encourage you to check your insurance benefits and, if needed, ask us to clarify the reason for your exam and whether or not it meets your plan’s requirements.
