Sometimes yes, sometimes no.  It is helpful to try and sort this out in advance of your child's scheduled appointment. 

Some children may need a referral from their primary care physician in order for their insurance company to pay for the care of medical eye conditions.  If a referral is required for medical eye care and has not been obtained, there may be some delay at the time of your child's scheduled office visit while we try to sort this out for you.  If a referral is needed and cannot be obtained at the time of the office visit, the parent may elect to pay for the exam in full or reschedule to another day to allow a referral to be obtained.

Children seen solely for routine eye care typically do not need referrals.  Many medical insurance companies do not pay for routine eye care visits.  Others may pay but will only cover this service once every year or two.  If the child needs a routine visit before they are eligible, the parent would be responsible for paying for that examination in full.  We do not participate with VSP or other similar "Vision Plans".  The parent would be responsible for paying our bill for routine care in this circumstance.  They can, however, submit a receipt that we provide to file on their own for possible partial reimbursement.

Especially in the case of new patients to our office, we may not be able to determine the nature of your child's eye problem (routine vs. medical) until the child has already undergone an initial evaluation.  If you obtain a referral to cover a possible medical problem and no medical problem is found, the exam will be billed as routine eye care.  The parent may then may be responsible for paying the exam fee in full if the insurance does not cover routine eye care, referral or not.  Obtaining a referral therefore does not guarantee payment for routine eye care but may be necessary for payment if a medical problem is diagnosed. 

Our office staff does their best to try to sort these issues out for you in advance.  We understand that insurance coverage issues can be very confusing.  Again, it is very helpful if you call your medical insurance company in advance to check if your child is covered for routine eye care services or if your child requires a referral for medical eye care services.