Patients often ask us what Alberta Health Care Insurance Plan (AHCIP) covers regarding eye exam services in Alberta at an optometrist's office. So in this blog post, we will tackle some of the most common questions our staff get asked. 

As healthcare professionals, Optometrists specialize in eye and vision care. We can diagnose and treat eye conditions, prescribe eyeglasses and contact lenses, and provide pre-and post-operative care for eye surgeries. We can also treat most eye care emergencies, from infections to injuries. In Alberta, most optometrists can bill AHCIP directly for certain types of appointments.

So What appointments and services does Alberta Health Care Insurance Plan (AHCIP) cover at an optometrist's office?

Comprehensive Eye Exams: 

A comprehensive eye exam thoroughly examines your eyes and visual system. This type of exam can detect eye diseases and conditions such as glaucoma, cataracts, and macular degeneration, as well as other health conditions such as high blood pressure (hypertension) and diabetes. It also generates an updated prescription for eyeglasses. 

A comprehensive eye exam is recommended yearly for most people, depending on their age, risk factors, medications, health conditions or family history.

Under Alberta Health Care, comprehensive eye exams are only covered for children ages 0-18 and adults 65 and over. Therefore, if you are between the ages of 19 and 64, Alberta Health Care will not cover the cost of your annual eye exam. According to Stats Canada, this is about one million children and 630,000 seniors or roughly 1 in 3 Albertans.

• Kids - 0-12: Paid by AHCIP

• Teens - 13-18: Paid by AHCIP

• Adults - 19-64: Not Covered by AHCIP

• Adults - 65+: Paid by AHCIP

Eligible patients are covered for one comprehensive eye exam between July 1 and June 30. They do not follow the calendar year. 

As Alberta Health Care and the Provincial Government have not updated the fee schedule for optometrists in many years, some offices may charge additional fees for routine eye exams and extra specialized equipment like Optomap Ultra Widefield Imaging. Currently, at Helio Optometry, we don't charge any additional fees. We still honour the old Alberta Health Care fee schedule and include our premium pretesting equipment at no extra cost. 

Diabetes Eye Health Exams: 

Alberta Health Care (AHC) covers annual diabetes eye health exams for all Albertans regardless of age if they are diagnosed with any type of diabetes, including Type 1, Type 2, Gestational or Pre-Diabetes.  

Annual eye health exams are important in managing diabetes and detecting eye complications early. Diabetes can cause various eye complications, including diabetic retinopathy, cataracts, and glaucoma, which can lead to vision loss and blindness. 

If you have Type 1, Type 2, Gestational, or Pre-Diabetes, you should have a diabetes eye health exam performed yearly or more often if signs of diabetic eye disease are noted. 

It is important to note that a diabetes eye exam is not the same as a routine eye exam and will not generate a prescription for eyeglasses or contact lenses. A diabetes eye health exam can, however, be performed on the same day as a comprehensive eye exam. 

Emergency Eye Care: 

If you have an eye emergency, you can see an optometrist for urgent care instead of going to your primary care physician or the emergency room. At Helio Optometry, we are happy to see you immediately and will work to squeeze you into our day. 

Alberta Health Care covers emergency eye care appointments, including any extra testing like 3D OCT Retinal Imaging, Optomap Ultra Widefield retinal imaging or computerized visual field testing that may be required. In addition, should you need to see an ophthalmologist, our office can handle these referrals expeditiously. Furthermore, we can speak directly with the on-call ophthalmologist at the Royal Alex Hospital, who can provide guidance or an appointment time, preventing you from sitting in the emergency department for hours. 

Here are 9 of the most common eye care emergencies we see. 

1. Foreign objects in the eye: This can include anything from a speck of dust to a metal shard and can cause discomfort, redness, and tearing.

2. Corneal Abrasions: This refers to a scratch or cut on the clear, protective layer at the front of the eye. It can cause pain, light sensitivity, and blurred vision. Fingernail injuries are the leading cause, or sometimes a stuck contact lens, from accidentally sleeping in your lenses. 

3. Chemical Burns: Exposure to harsh chemicals can cause significant damage to the eye and surrounding tissues, including redness, pain, and blurred vision. Always flush the eye out with water for at least 20 minutes before doing anything else. 

4. Eye infections/Conjunctivitis: These can range from mild to severe and can cause redness, itching, discharge, and sensitivity to light.

5. Eye Trauma: This can occur from any number of causes, including sports injuries, car accidents, or falls. It can result in anything from minor bruising to severe eye injury or retinal detachment. 

6. Retinal Detachment: This medical emergency occurs when the retina becomes detached from the back of the eye. It can cause vision loss and requires immediate attention. Symptoms often include flashes of light, floaters, or painless loss of vision in one eye or a section of one eye. 

7. Acute Angle-Closure Glaucoma: This occurs when the pressure inside the eye increases suddenly, leading to pain, redness, and vision loss.

8. Styes & Hordeolums: This is an infection of the tissues surrounding the eye, which can cause swelling, pain, and sometimes fever. 

9. Seasonal Allergies: Allergic reactions can cause redness, itching, and tearing in the eyes, making contact lens wear impossible. 

Follow-Up Appointments: 

If you have an eye condition that requires ongoing monitoring or treatment, such as glaucoma, cataracts, age-related macular degeneration, allergies or dry eye syndrome, you may need to see an optometrist for follow-up appointments. These appointments are also covered by Alberta Health Care. 

Extra Testing: 

Sometimes, your optometrist may need to perform additional tests to diagnose, manage or treat an eye condition. These tests include things such as 3D OCT Retinal Images, Optomap Ultra Widefield Retinal Imaging or Computerized Visual Field testing. We may also need to dilate your pupils to get a better view of the inside of them.

Alberta Health Care covers the cost of most of these tests, but there is an annual limit. Therefore, should you require more tests than what is covered by Alberta Health Care, you would need to pay the standard customary fee. 

Referrals To Ophthalmologists: 

If your optometrist determines that you need to see an ophthalmologist (a medical doctor who specializes in eye and vision care), they can refer you to one. AHC covers referrals to ophthalmologists. 

Post-Surgical Appointments: 

Optometrists often provide all the post-operative care to patients who have recently undergone uncomplicated eye surgeries like cataracts, glaucoma, or retinal procedures. These post-operative appointments are covered under Alberta Health Care for up to 6-months after the surgical date. 

However, Alberta Health Care does not cover cosmetic procedures such as LASIK, PRK, SMILE, Refractive Lens Exchange (RLE), or Implantable Collamer Lenses (ICL). Your optometrist will usually perform all of these post-operative visits, but they will be part of the surgical cost and are typically paid for by the surgical centre for up to 6-months after the surgical date. 

So what appointments and services are NOT covered by Alberta Health Care at an optometrist's office?

Second Opinion Eye Exams: 

You may want to receive a second opinion about your eye health or an eyeglass prescription. However, these appointments are not covered by Alberta Health Care. You will be responsible for the regular fee for these services. 

Forms & Paperwork: 

Alberta Health Care does not cover the cost of providing doctor notes or filling in forms. Optometrists must be transparent about the cost of these services. They should follow the non-insured services guidelines the Alberta College of Optometrists or the Alberta Medical Association set out. 

In addition, some extra testing may not be covered by Alberta Health Care if it's required for occupational forms or driver's licenses. Your eye doctor must tell you the cost of these services before providing the service. 

No-Show & Missed Appointment Fees: 

Many people think doctors can bill Alberta Health Care or Insurance Providers for no-shows or missed appointments, but this is not the case. Missed appointments prevent patients from receiving timely treatment and other patients from seeing doctors sooner. Therefore, doctors can charge patients for missed appointments or refuse to see patients that routinely miss appointments. 

Vision Therapy:  

Vision therapy, which involves exercises and other treatments to improve visual acuity or binocular function, is not covered.

Vision therapy aims to improve a person's visual skills and abilities, such as eye movement control, depth perception, focusing, and visual processing. It is a non-surgical and non-invasive treatment option for various visual problems and conditions, such as amblyopia (lazy eye), strabismus (crossed or misaligned eyes), and binocular vision problems.

During vision therapy, a trained optometrist may use various techniques and exercises to improve a person's visual abilities. These exercises may involve specialized equipment, such as lenses, prisms, and filters, as well as computer-based programs and activities designed to enhance visual processing and hand-eye coordination.

We often prescribe vision therapy to our patients to try and improve surgical or treatment outcomes.

Cataract Surgery Lens Implants: 

Alberta Health Care fully covers necessary cataract surgery. This includes the initial visit to your optometrist for the diagnosis and referral to the cataract surgeon, the surgical procedure, a monofocal IOL lens and all the post-operative appointments by your optometrist. 

However, Alberta Health Care does not cover certain things regarding cataract surgery. For example, they don't cover Enhanced IOL implants that correct for astigmatism or multifocal IOLs that provide distance and near acuity. 

Conclusion: 

Overall, Alberta Health Care covers a range of appointments and services at optometrist offices, including comprehensive eye exams, emergency eye care, follow-up appointments, and referrals to ophthalmologists. If you have any questions, please don't hesitate to ask our staff. We always want to provide transparent service to our patients.