Hey Optiboard, it's been a long time.
Not so quick question I got from a friend who just saw a new Optometrist. He recently moved and found this OD through some people he works with.
My friend is diabetic and made the Optometrist's office aware when he made the appointment so they requested he bring both his vision and medical insurance information. After the routine exam (with dilation) he was told he owed $X for the copay. $X is the amount his medical insurance lists as the copay to see a specialist. The medical insurance lists $Y as the copay for a general office visit.
He called his insurer and the CS person he spoke with said that a OD billing medically should not collect the specialist copay unless he was seeing the OD under a referral for a specific need (ie... fitting contacts for keratoconus). I would agree with his insurer. The office manager at the OD's office refuses to refund the (substantial) difference between X and Y because (1) a dilation was done and (2) the chart shows the patient acknowledged he is diabetic and thus a check for diabetic retinopathy was performed.
I know for some this may be splitting hairs, but I'd like to hear opinions on the matter and reasons for/against how this was handled.
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