Are Eyeglasses considered a part of Durable Medical Equipment?

[LENNY]

Are Eyeglasses considered a part of Durable Medical Equipment according to Medicaid?
Can someone provide me the link to this info? We are in NY. I understand that Medicare considers Eyeglasses to be a part of DME but it is only after a cataract surgery?
Need help with the written info on Medicaid and/or CHP.

[Lelarep]

From what I know of medicaid coding, no. As far as specific references, sorry, its just what I remember from when I was in NY.

[LENNY]

From what I know of medicaid coding, no. As far as specific references, sorry, its just what I remember from when I was in NY.

Thanks!
Does not it seem strange for Medicare to consider eyeglasses as DME and Medicaid not!?!?!

[Beth641]

yess.. they are

[Chris Ryser]

(n) The term "durable medical equipment" - DME - includes, but is not limited to, wheelchairs (manual and electric), hospital beds, traction equipment, canes, crutches, walkers, kidney machines, ventilators, oxygen, monitors, pressure mattresses, lifts, nebulizers, bili blankets and bili lights.Insurance companies will provide coverage for Durable Medical Equipment when it is determined to be medically necessary because the medical criteria and guidelines for its use are met.
Durable medical equipment may be covered when All of the following criteria are met:

• 1. The equipment provides therapeutic benefit to a patient in need because of certain medical conditions and/or illnesses; And
• 2. The DME is prescribed by a licensed provider; And
• 3. The DME does not serve primarily as a comfort or convenience item; And
• 4. The equipment does not have significant non-medical uses (e.g., environmental control equipment, air conditioners, air filters, and humidifiers).

source: =============>
https://en.wikipedia.org/wiki/Durable_medical_equipment

[Lelarep]

I think #2 is where you would run into trouble, traditionally. You get an Rx for optical correction, not for glasses, specifically. If you can get an Rx slip that says "One pair of glasses" then you are probably good to go. NY rules are a little strange compared to nearly any other state, so I have seen docs write unusual Rx's like this. You can even get OTC stuff covered 100% by medicaid if you can talk a doc into writing an Rx for it, such as Vitamin D, etc... The memory is a little fuzzy, but I believe I once saw a doc write for a pair of OTC readers and it was covered because he wrote the Rx specifically for that.

[Chris Ryser]

You can even get OTC stuff covered 100% by medicaid if you can talk a doc into writing an Rx for it, such as Vitamin D, etc... The memory is a little fuzzy, but I believe I once saw a doc write for a pair of OTC readers and it was covered because he wrote the Rx specifically for that.

I am wondering how these insurances pay for glasses when ordered through all those on-line opticals, or do people just forget to make a claim in such cases ?

[mervinek]

I think people who order online do not use their insurance. In most cases they consider the online specs to be "cheaper." Little do they know that if they went to a provider and used their insurance, they would most likely get a better quality product for the same or lower cost.

[ekays1809]

Medicare does cover glasses but only after cataract surgery like you mentioned. As far as Medicaid goes, we've never received payment from them for glasses but we are non-par with Medicaid. It may be different for providers that participate.

[Tallboy]

I'll just be waiting for someone to get an RX for "One Maui Jim wrap dual gradient sunglasses" lol lela

[rbaker]

I think people who order online do not use their insurance. In most cases they consider the online specs to be "cheaper." Little do they know that if they went to a provider and used their insurance, they would most likely get a better quality product for the same or lower cost.

I don't know of any online sellers that accept vision insurance . . . YET ! ! ! Coming soon though.

[pknsbeans]

https://www.eyeconic.com/

(Meant to be a reply to previous post)

[Lelarep]

I'm betting the online sites that will eventually take insurance will be the ones owned by the big guys, because they can guarantee minimum quality. The ones that aren't owned by the big players offer quality that is too low to deal with insurance. The error/remake/frame-lens break rates will be so high, insurance will dump them in no time, they won't want to be bothered to deal with them.

The one thing I haven't been able to figure out is why the luxottica owned sites don't take Eyemed. I mean, doesn't that just make sense? They would put them way ahead of the competition in many respects. Maybe they don't want to bring the eye of sauron of the regulators they have managed to evade so far (how they are able to make the frames, sell the glasses, provide the insurance, and not be seen as an inappropriate conglomeration is beyond me)?

[Chris Ryser]

I

Maybe they don't want to bring the eye of sauron of the regulators they have managed to evade so far (how they are able to make the frames, sell the glasses, provide the insurance, and not be seen as an inappropriate conglomeration is beyond me)?

.....................and maybe they have already dealt with the regulators and parked them on a side track.

[Lelarep]

.....................and maybe they have already dealt with the regulators and parked them on a side track.

That's a scary thought. Even ATT couldn't defeat them. The only company I know of on record that has ever defeated them was Microsoft, and they basically got lucky.

[Chris Ryser]

That's a scary thought. Even ATT couldn't defeat them. The only company I know of on record that has ever defeated them was Microsoft, and they basically got lucky.

Then you have another case that got lucky. It must be worth it to pay millions of Dollars for a good going lab, purchase it and close it down and move the equipment overseas and continue to supply from there.

Maybe your new President might put a stop to it if he thinks it might be worthwile.