Insurance covers eye exam not pictures!

[GraciAnn]

Want to thank you all who responded to my 'rx error - who pays..' Unfortunately, the little optical shop is new and can't afford to remake my progressives - she is however, offering me a 50% discount.

Here's my latest concern. I had eye exam (turned out to be huge Rx error) & paid my usual $20 copay. Insurance kicks in the rest. I know get a statement from them stating that the insurance won't pay for the 'photos' taken of my eyes. What is up with this? I didn't ask for photographs, apparantely they are automatically included (cost to me $30 more)! am I really obligated to pay for this too? (This doctor was the one that made a huge error in Rx probably because he was so concerned on getting his point across during exam when he heard the name of competitor that performed laser eye surg on my daughter! Seriously, he wa so arrogant, I wanted to run out of there!)

I can't continue to pay - his mistake is already costing me $300 more :angry: ! Thanks in advance to any advice you can offer.

[drk]

The Dr. is obligated ethically, if not legally, to explain charges to you before services are rendered. I'd bring it up with the office manager.

[Diane]

Want to thank you all who responded to my 'rx error - who pays..' Unfortunately, the little optical shop is new and can't afford to remake my progressives - she is however, offering me a 50% discount.


I can't continue to pay - his mistake is already costing me $300 more :angry: ! Thanks in advance to any advice you can offer.

Sorry, big expense. Send the doctor an invoice for his error....

Diane

[Chris Ryser]

Patient Satisfaction

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See the wole thing at :
http://my.webmd.com/content/article/...000_7001_to_23

[April_01]

What kind of insurance do you have, is it for medical or vision?We have two machines that take photos, one is called the optomap which takes retinal images and the other is a non-mydriatic camera. The reason I ask is because if you had the optomap done, it is not covered by any insurances(as far as I have noticed). Each office varies on prices, but we charge $30 for the optomap unless the exam is medical. If the other was done, it is considered medical and the your medical insurance (if you have any) should cover it/ or a portion of it. I know some places include the optomap as part of their exam but we always give the pt the choice ESPECIALLY if it is not a medical exam since they will have to pay. If it helps any, the optomap is a newer machine that is big/tall and dome shaped and you have to look at a green fixation light with a red circle around it. Hope this helps!!!

[GraciAnn]

April,

Thanks for your reply - I appreciate everyones'! The BCBS medical insurance I have covers one eye exam per year. I just pay a $20 copay. Sounds like the optimap was used but I wasn't told that insurance plans don't cover. It was automatically done during my exam. No questions asked.

Sounds like an unnecessary gimmick to me!

Thanks again.

[April_01]

Have you gone to this place before for an exam? If you have they probably just increased the amount of the exam so that everyone would have it done(The guy who set ours up mentioned this as an option to get more sales but we all agreed to let the pt decide)they wouldn't have to try and "sell" the optomap. If you haven't gone to this dr before, did you ask how much the exam would cost before hand? We have had our machine for about six months now and it has its ups and downs but we always explain how it works,advantages, and costs.The Optomap itself does help the doctor keep track of the health of your eye and checks for any retinal,choroidal,retinopathy disorders.(Which he still does on regular exam, but this gives wider angle of back of eye to give less chance of missing anything)Plus the dr. has a permanent record on file (which is really neat to look at the inside of your own eye!!) and he doesn't have to rely on his scribbles and after seeing a bunch of other people in between!!I just have a problem with the fact that you can't buy the machine, you can only rent it. Plus they really get you on the payment each month but I won't get into that!

[ksquared]

Is there any way you can feel comfortable going back to the Doc who did your RX. It seems to me, if the RX was wrong and you can't see out of your new glasses, the Dr. has an obligation to fix it or refund (at least a portion there of).



If I understand your situation correctly, you had an eye exam, your glasses were made and they didn't work. You went to a new doc and the RX you received is completely different. So obviously someone made a mistake.



Believe me, I know how hard it is to go back to a place that hasn't done the best job. It's very difficult as no one likes a confrontation. But you really owe it to yourself to try and at least give them the opportunity to fix it. A very unpleasant task for sure. IBut than, if you can't reach some resolution (even if it means a compromise), I would than personally file a complaint with both your insurance company and the better business bureau. But your complaint will lack validity unless you give the original place the opportunity to resolve the issue. Good luck!

[Johns]

GRACI ANN:

Even a small optical (usually) deals with progressive lens companies that stand behind their product and offer no-charge remakes. A new shop should be even more willing to "right a wrong" , but it doesn't sound like this is the case.

[chip anderson]

Graciann:

The reason some insurance companies don't pay for photos is: Many years ago these were usually taken by your local optical shop at the doctor's request free of charge. Object keep the doctor happy so he would send Rx for glasses, etc. Then retina work became a popular subspeciallty. The more pictures (yes a few are needed for records of possible progressive conditions) but some doctors found that the insurance company would pay exorbitant amounts for unlimited pictures. At this point it became possible for doctors to hire professional photographer/technicians.

I have seen many patients return from some offices raving about the nice office and all the pictures they took with no improvement in vision. I have seen others who went to see Alice McPherson seeing 20/80 after detachment, came back seeing 20/30 and were unimpressed.

However I digress, the insurance companies began to feel that they were getting soaked with lots of pretty but excessive retinal photographs and cut back on what they would pay for.

Chip

[UFRich]

Chip,

I agree with everything you say in your last post, but it is unfair for GraciAnn to assume it is unnecessary gimmick. If the doc dod not take the photos and something was discovered at a later date that could have been caught during the exam, then this doc would be incompetent for not doing the for not catching it at this time.

[fvc2020]

Hi Grace ann


I was wondering what type of progressive do you have? the reason I ask is that to this day, few and far between lens company don't offer some type of change policy for the first 30-90 days. In fact Varilux has 365 day policy including doctor changes......



Christina

[Rophod]

April,

Thanks for your reply - I appreciate everyones'! The BCBS medical insurance I have covers one eye exam per year. I just pay a $20 copay. Sounds like the optimap was used but I wasn't told that insurance plans don't cover. It was automatically done during my exam. No questions asked.

Sounds like an unnecessary gimmick to me!

Thanks again.

Some medical plans have a carve out vision plan but they are not the same. I would assume BCBS is the medical plan. Vision plans usually pay for 1 routine eye exam and will often have benifits for discounts on glasses and contact lenses. Vision plans do not pay for anything medical and medical plans do not pay for anything visual. For your medical plan to cover the pictures there would have to be a medical reason for doing them. Routine photos are not covered by any insurances I am awear of. In offices were photos are done as a routine, the cost is either included in the exam fee or the patient is given the option of having the additional test after being told of the need/benifit and cost of the test.
Are you sure no one mentioned the added cost for the photos? If not they should have and you should not be obligated to pay.