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A Typical Visit to an Optometrist – What Your Claim Will Pay For

Even if you don’t need eyeglasses, it’s about time for a routine visit to an Optometrist. Our eyes play a very important role in our daily lives and a checkup can help prevent vision problems before they occur. If you’ve never had a vision exam, here’s what you can expect.


First, your doctor will ask you to read letters of various sizes from a chart to test your close and long distance sight. You will also be tested for glaucoma with a device called a tonometer that blows a puff of air into your eye. Depending on your age and health, you may also be tested for your side or peripheral vision, 3D, and color vision.

Medicated eye drops may be used to make your pupils larger. This procedure allows the optometrist to get a clear view of the inside of your eyes to detect cataracts, muscle degeneration, and diseases that can impair your sight. It may be helpful to bring a pair of sunglasses along because your eyes may be sensitive to light for a few hours afterwards. Some practices provide these for you, but it is smart to bring your own just in case!

If you do wear eyeglasses or contacts, bring them along for the visit. It’s essential to check your vision regularly because it’s quite normal for our sight to change as we age. You will also want to bring information about your medical history and any prescriptions.

 an eye

Most medical insurance policies don’t cover routine eye exams, unless there is a diagnosis. Vision plans cover routine eye wellness exams. At Apex EDI, we’ll make it easy for you to pay for your exam. We’re aware of the specific billing differences between medical and vision claims. It’s important to have a plan of action that will meet your specific needs, utilize all of your benefits and protect the health of your eyes.   

Contact us today to find out more about Apex EDI and how we can help you and your practice.

Posted in: Apex EDI, Opthamology Claims

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A Typical Visit: What Your Endodontistry Claim Will Pay For

Endodontists specialize in performing root canals and other procedures in order to save teeth. Endodontic treatment helps the patient maintain a natural smile, continue to eat foods that he or she loves and limits the need for ongoing dental work.


A typical visit begins with the patient completing a medical history, including all current prescription medications and medical consent forms. Then a series of x-rays will be completed and the endodontist test the tooth in question along with adjacent teeth. After the tests are complete, the endodontist will discuss treatment options with the patient.

The Endodontist will advise the patient of the proposed treatment options and any reasonable alternatives, so the patient can make a fully informed decision. The treatment procedure may start immediately by giving the patient a local anesthesia to numb the area to be treated. If the procedure can’t be performed in one visit, medications may be used in the tooth in between visits.

spooky teeth

A dentist or endodontist may periodically x-ray the tooth to ensure that healing has occurred. At times, the tooth may become painful or diseased months or even years after successful treatment. When this occurs, often repeating the endodontic procedure can save the tooth.

Submitted claims usually pay for an initial office visit, x-rays, testing, local anesthesia, medication and treatments recommended such as a root canal and post-treatment crowns. After the tooth has been restored, it’s important to practice good oral hygiene, including brushing, flossing, regular checkups and dental cleanings so that you do not have to go back and have and pay for an additional visit. With proper care, most teeth with treatment can last as long as other natural teeth and often for a lifetime.

We at Apex EDI are more than happy to help and answer any questions you have about claims. Contact us today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.


Posted in: Dental Claims, Endodontristy Claims

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A Typical Visit: What Your Audiology Claim Will Pay For

Audiologists are highly trained professionals who specialize in evaluating, diagnosing, treating, and managing issues related to hearing, tinnitus, and balance disorders. They use a variety of tests and procedures to fully evaluate the hearing ability and/or any balance issues of the patient. Some audiologists may also fit and dispense hearing aids or other hearing devices.  Audiologists perform three main types of tests which are all covered by audiology claims.


1. Otoscopy

The audiologist looks in the ear canal with an ‘otoscope’ and magnifying pen light. Blockages such as ear wax or problems within the ear canal or eardrum are diagnosed.

2. Tympanometry

The audiologist tests the middle ear function by testing to see how well the eardrum responds to light pressure. The test detects disruptions that inhibit motion of the eardrum like fluid, infection, or eustachian tube dysfunction.

3. Audiometry

The audiologist performs this test by placing the patient in a soundproof booth or room and then asking the patient to raise his or her hand (or push a button) when he or she hears a sound. This test determines air conduction, the softest sound you can hear through earphones at several different pitches, and bone conduction, the softest sound you can hear by stimulating the inner ear directly.


Afterwards, the test results and recommendations will be explained to the patient. An Audiologist may refer the patient to an ENT doctor specializing in ear, nose and throat or a hearing aid specialist depending on the test results and further medical care required.  

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.


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Optometry vs. Ophthalmology

Trusting a doctor with eye care is an important health care decision. The type of eye doctor a patient uses is largely a matter of personal preference if the eyes are healthy and don’t require specialized medical or surgical treatment. There are two types of eye doctors: optometrists and ophthalmologists. Both perform routine eye exams and are trained to detect, diagnose and manage eye diseases that require medical and non-medical treatment. Apex EDI handles both Optometry and Ophthalmology claims.

an eye

An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists examine eyes for both vision and health problems, and correct refractive errors by prescribing eyeglasses and contact lenses. Optometrists in the United States are also licensed to prescribe medications to treat certain eye problems and diseases. The scope of medical care that can be provided by optometrists is determined by state law.


An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO) who specializes in eye and vision care. Ophthalmologists are trained to perform eye exams, diagnose and treat disease, prescribe medications and perform eye surgery. They also write prescriptions for eyeglasses and contact lenses. It is important to seek care from an eye doctor highly trained if you already have a medical eye problem such as glaucoma, macular degeneration or cataracts. In many cases, this means that medical or surgical eye care by a specially trained ophthalmologist is in order.

Another factor in the patient’s selection of an eye doctor is determining if he or she is an authorized provider under the vision or medical insurance plan. Most optometrists and ophthalmologists accept Medicare for older patients. However, while Medicare covers your visits to an eye doctor for medically necessary eye care, it does not cover routine eye exams. Prior to the submission of a claim, it’s helpful to verify coverage and out-of-pocket expenses for the exam.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.


Posted in: Opthamology Claims, Optometry Claims

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Acupuncture Claims

Acupuncture is a safe ancient form of Chinese medicine received by millions annually.  According to the National Institutes of Health reports that acupuncture is one of the most common forms of alternative medicine covered by insurance.

120216-N-PB383-414 ARABIAN GULF (Feb. 16, 2012) Cmdr. Yevsey Goldberg conducts an acupuncture procedure on a patient aboard the amphibious transport dock ship USS New Orleans (LPD 18). New Orleans and embarked Marines assigned to the 11th Marine Expeditionary Unit (11th MEU) are deployed as part of the Makin Island Amphibious Ready Group, supporting maritime security operations and theater security cooperation efforts in the U.S. 5th Fleet area of responsibility. (U.S. Navy photo by Mass Communication Specialist 2nd Class Dominique Pineiro/Released)

During the first session, a practitioner inquires about the patient’s health and medical history, and examines the pulse and tongue. Practitioners ask about the medical ailments the patient hopes to treat and medications currently taken. Fees for an initial medical consultation and an acupuncture session where thin, sterile needles are inserted into pressure points in the skin, should be paid for with a medical claim.

During this session the practitioner also determines the appropriate number and duration of follow-up visits to treat the medical condition. Costs are similar nationwide and don’t vary greatly between clinics and private practitioners. Fees for an initial visit range from $75 to $95. Routine visits cost $50 to $70.  

Many practitioners recommend patients take specialized Chinese herbs, such as ginseng and gui pi wan, that are designed to supplement the acupuncture. These types of supplements may not be covered under medical claims.


While clinic practices vary, some practitioners also accept gratuities of 15 to 20 percent of the bill. Gratuities are generally not paid and not considered compulsory. For a claim to be fully paid, there must be an appropriate diagnosis to establish the medical necessity of the procedure.

Coverage for any claim should be verified before treatment from a clinic or private practitioner. Verifying coverage and communicating clearly with the patient regarding essential and optional services can minimize concerns and ensure claims are processed timely. Contact us today at Apex EDI and we can help you with your claims today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.


Posted in: Acupuncture, Acupuncture Claims, Apex EDI, Resources

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