Letter from my Eye Doctor

email

[ml/nj]

Dear Valued Patient:
 
This letter is to inform you that effective February 1, 2010, EyeCare 20/20 will now be billing separately for the refraction portion of the eye examination.
 
The refraction portion of the eye exam is performed to determine if glasses, or a change in your current spectacle correction, will provide the best vision possible. A written prescription is given if this would be helpful in improving the patient's visual acuity level. Please be aware and informed that you may be refracted as part of the eye examination, and that most insurance plans, including Medicare, do not cover this portion of the examination. Our office fee for refraction is $30.00 and unless your plan automatically covers for the refraction charge, this fee is collected at the time of service in addition to any co-payment or deductible your plan may require. Should your plan pay us for the refraction, we will reimburse you accordingly. If you are currently seeing 20/20 with your present prescription, the refraction may not be required. You also have the right to decline the refraction at the time of your visit.
 
What is a Refraction, and why do we charge for it?
You may know the test as the one that will determine your need for glasses, this is so but it can also detect vision loss. Some of the time vision loss is slow and progressive and the patient may not notice, that is why we will check the patient's vision by refracting them. The test can also uncover other problems a patient may be unaware of.
 
Why is this charge separate from the exam?
Medicare has deemed that a refraction is not a medical service and therefore not a covered service. Medicare does acknowledge that this is separate to the rest of the eye exam and therefore there is a separate fee for this service. Most insurance companies have followed Medicare's lead and do not cover the refraction, because they consider the test to be "vision care" and unrelated to the office visit. For further explanation of refraction coverage under your insurance policy, please refer to your membership benefits contract or contact the customer service number for your insurance carrier. Medicare patients can contact Medicare directly at their toll-free number: 1-800-333-7586.
 
Do we have to charge for the refraction?
The answer is yes, especially for Medicare patients. The Office of the Inspector General has deemed that not charging for a provided service is a non-compliance. The Federal Government therefore insists that if an exam, procedure or test is performed, it must be charged for.
 
We thank you in advance for your understanding. We look forward to seeing you at your next scheduled appointment.
 
Best wishes for a happy and healthy 2010!
 
Cary M. Silverman, M.D. and the Staff of EyeCare 20/20

EyeCare 20/20- 46 Eagle Rock Avenue- East Hanover, NJ

 

 973-560-1500         www.eyecare2020.com

[ml/nj]

So the bottom line for me would seem to be that the cost to me of my annual eye exam will likely double. It's so wonderful to know that, "Medicare has deemed that a refraction is not a medical service and therefore not a covered service," or that this has anything to do with me. I have nothing to do with Medicare except to subsidize it.

ML/NJ

[O6ret]

I can see that this is only the beginning of the eye-opening changes coming under Obamacare.

[Manta]

Rationing is starting

[Lazamataz]

Some of the time vision loss is slow and progressive and the patient may not notice, that is why we will check the patient's vision by refracting them.

I've heard it call 'screwing them', 'hustling them', 'f***ing them', 'boning them', and 'scamming them'.

I've never heard it called 'refracting them' before.

Huh.

[Virginia Ridgerunner]

Medicare has deemed that a refraction is not a medical service and therefore not a covered service. Medicare does acknowledge that this is separate to the rest of the eye exam and therefore there is a separate fee for this service. Most insurance companies have followed Medicare's lead and do not cover the refraction, because they consider the test to be "vision care" and unrelated to the office visit.

Harbinger of the ultimate result of Obamacare.

[La Lydia]

There are a number of businesses that sell glasses, that is, frames and lenses, that offer a free examination, the refraction, if you buy their glasses. Decline the exam from your doctor, if you need glasses, and wait until Sears, or Pearl Vision, or whatever, has a sale where the exam is included.

[Sloth]

They’ve already been fracted once.

[savedbygrace]

Insanity, just plain insanity. Refraction is absolutely required for the optometrist or ophthalmologist to determine the precise correction you need. How can that NOT be a medical service?

[Jedidah]

We’ve got good private insurance, and this is how they have always handled vision coverage. Nothing new, except that Medicare is apparently now handling these claims like the private firms do.

[VermiciousKnid]

Well, anybody could have seen THIS coming a mile away...

That said, I’ve never understood why vision problems are not covered as medical expenses.

After all..if I had a hand that WORKED, but did not work WELL, and the doctor could fix it, it would be covered.

Same goes for just about any other organ I can think of. A myopic eye is just another organ that isn’t functioning properly, isnt’ it? What is it about vision problems that cause them not to be covered as legitimate MEDICAL problems?

Regards,

[Jedidah]

“Medical” vision coverage, as defined by our current Aetna plan and former Cigna plan, includes eye infections, diseases (glaucoma, retinal detachment, macular degeneration, corneal ulcers, etc.), and general eye health.

Measuring your visual acuity (your need for corrective lenses), known as “refraction,” has always been a separate part of the exam and billed separately by our private insurance.

[STONEWALLS]

“There are a number of businesses that sell glasses, that is, frames and lenses, that offer a free examination,..”

...our local Wal-Mart does that....they have an optomitrst on duty and are much cheaper on frames and lenses...however now that I’m getting older I still like to have an experianced MD Opthomologist give me an exam every couple of years...I want to know the medical health of my eyes too...then I go over to WalMart for the glasses...just my two cents FWIW

[I am Richard Brandon]

And on a related subject, I notice that the AARP offering of 'Medicare Complete' through Secure Horizons/United Healthcare which in 2009 was a $0 plan, is now available only after payment of a $25 per month premium - same name, new price: no information - just a book of payment coupons through the mail. If you want a $0 plan with them, a 'no prescription coverage' plan is listed on their website with a slight variation on the name.

So soon, so much profit to be made from gullible Medicared seniors, so many scams to be run.

If you have loved ones on an AARP plan, I suggest that you check whether they are being scammed in this way. Me, I moved to a Blue Cross Anthem Medicare Complete plan with $0 premium and prescription coverage.

[Adder]

This is not new: my eye dr has had such a notice posted in the office for a while now.

[Romulus]

Refracting has never been a medical service. It is about vision correction. Refractions are performed by optometrists (Doctors of Optometry), who are not medical doctors and are not qualified to treat for cataracts, glaucoma, detached retina, etc. Optometrists do not perform laser surgery. All they do is examone for vision correction. If a medical condition is detected, they refer to an MD.

This is chicken feed. Quit whining.

[savedbygrace]

Does your plan include any coverage for the cost of frames or lenses?

[grumpygresh]

You have to realize Medicare is under tremendous fiscal pressure because of reduced tax revenue and profligate federal spending. CMS (Medicare financing arm) will continue to cut around the edges. Eventually, they will have to cut out the essential services if 0bamacare becomes law. Wherever possible, the government will attempt to pass the blame off to insurance companies and providers.
But consider this. Suppose Medicare covered refraction services but only paid $10. Great. Not necessarily. In this case the provider would have to accept a price lower than the cost to deliver the service. Any non controlled prices would go up to make up the difference. If there is no place to shift the cost, the service will not be rendered or the provider will be forced to stop accepting payment from the insurance company or medical program (Medicare).
The only way to get rational prices is to expose patients to the costs. We could do this with tax exempt high deductible medical savings accounts in the private sector.

[tx_eggman]

our local Wal-Mart does that....they have an optomitrst on duty and are much cheaper on frames and lenses...however now that I’m getting older I still like to have an experianced MD Opthomologist give me an exam every couple of years

The underlined part is what goes away under obamacare ... and because they're cheaper, the Walmart doctors will be third world.

[dawn53]

Same with our group insurance. Eye exams have never been covered, yet if you go with a problem (infection, injury to your eye, etc.) it is covered.

[Sans-Culotte]

Refracting has never been a medical service. It is about vision correction. Refractions are performed by optometrists (Doctors of Optometry), who are not medical doctors and are not qualified to treat for cataracts, glaucoma, detached retina, etc. Optometrists do not perform laser surgery. All they do is examone for vision correction. If a medical condition is detected, they refer to an MD.

This is chicken feed. Quit whining.

I have medical insurance and refraction, or any visit to an optometrist has never been covered. I've had 7 eye-related surgeries over 8 years. All those were covered. Just not refraction, frames or lenses. So, I would not say this is the beginning of Obamacare.