Gotten your eyes examined recently? When Ruth and I had lunch I told her several have called about their eye exam for new glasses. Why did I get a bill? Why is the bill more than my vision insurance copay?

Here’s how it should work. If you have a Medicare Supplement plan that provides an annual asymptomatic eye exam (that’s an eye exam to check your vision and not related to a medical condition), you should not be billed or owe anything IF you go to a participating provider (that’s someone who has agree to participate in the program offered by your insurance company). If you have vision insurance, you should only be billed for your copay.

Don said he went to a participating provider who is an ophthalmologist. An ophthalmologist is trained to treat and manage eye diseases, prescribe glasses and contact lenses but is also licensed to practice medicine and surgery. Don had his annual eye exam and got a bill for $89. In addition to having a Medicare Supplement plan that provides an annual asymptomatic eye exam at no cost, he has a vision plan with an annual eye exam copay of $10. Don was unhappy and confused as to why he got a bill. I contacted the provider on his behalf and asked questions about his bill.  The reason Don was billed $89 was because the ophthalmologist diagnosed him with a cataract. His office visit was “coded” a medical procedure by his provider and it was processed through Medicare and his Medicare Supplement plan. (Claims are processed the way your provider’s office “codes” your visit.) If he had only had an eye exam without a diagnosis, he would have owed -0-. 

    

Rita went to a participating provider who is an optometrist.  An optometrist is trained to treat and manage eye diseases, prescribe glasses and contact lenses and remove foreign bodies from the eye. Rita had her annual eye exam and got a bill for $119 – she was unhappy as well. Her Medicare Supplement plan does not provide an annual asymptomatic eye exam at no cost but she does have a vision plan with a $10 copay for an annual eye exam. After checking into this for Rita, she got a bill because she neglected to tell the optometrist’s office that she had a vision plan. Once she provided her vision insurance information she only owes the $10 copay (instead of $119).

If all you want is an annual eye exam to check your vision for glasses or contacts, tell your provider’s office that before your exam. The “cost” of your annual eye exam will be determined by the services you receive (and how it was coded) and if you see a participating provider - not whether you see an ophthalmologist or optometrist.

 I hope Don’s and Rita’s experiences help you “see” how important it is to communicate with your provider’s office.  Got questions – call 501-868-6650 and say “Caroline, can we talk?”.