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MoreRopePlease t1_iujicu2 wrote

I made the mistake of going to my regular clinic to get an optical exam for new glasses. I told the person at the counter I was using VSP, and that nothing was wrong with me, I just needed new glasses.

They still set me up for a medial eye exam, not a regular one (at the time I didn't know there was a difference). VSP doesn't cover that. And since I had in fact gotten a medical eye exam, I had no recourse. I was so pissed off at having to pay for the exam that I was expecting to get for free... (and a medical exam costs a lot more than a regular one)

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11ej25 OP t1_iujloj3 wrote

Couldn't they have billed medical insurance instead?

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MoreRopePlease t1_iuk5zi9 wrote

I have a High Deductible plan. They billed, yes, and there was a very small discount. But I had to pay the rest out of pocket. If I had known/understood they were giving me a medical exam, I would have declined and gone to America's Best.

At the time, I had no idea there were two different kinds of exams you could do, so I didn't even know enough to ask the right questions or say the right magic words.

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boadicea-h5 t1_iujyvid wrote

Most medical plans specifically exclude eye conditions like farsightedness, etc. If you have an eye infection or injury, your medical could be filed. Otherwise, not.

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onetwentyeight t1_iujlnt6 wrote

Does your health insurance cover medical eye exams? I don't know the differences between the type of exams. Still, given that health insurance tends to cover ophthalmological exams and procedures since they are "medical," perhaps there is a way to get that cost covered given your current insurance coverage.

For example, I had an eye infection and saw an ophthalmologist, had an ocular ultrasound, had lab work, and got some prescriptions, and they were all covered by my PPO plan.

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boadicea-h5 t1_iujyrol wrote

Your medical covered it because you had an infection. Most medical policies exclude eye conditions like farsightedness, nearsightedness, etc.

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Kuhnhudi t1_iuk1ziy wrote

VSP basically covers a “here’s your glasses prescription.” Anything else with the eyes (bumps, infections, aches, etc) are medical. Call the office back and ask why you’re charged as medical? I went to my PCP for an annual physical and mentioned a knee ache. It wasn’t an annual exam anymore and I was charged as such. Just saying there’s more nuances to insurances than most people may realize.

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MoreRopePlease t1_iuk6rrf wrote

> Call the office back and ask why you’re charged as medical?

I did that when I originally got the bill in the mail, because I was very confused. And they said the procedure I got was a medical exam, so the billing was correct. I don't recall the exact words, but they told me I should have asked for the regular exam.

It seems to me that the person behind the counter should have been a lot more careful to make sure they understood why I was there and what kind of appointment they were setting for me. I had no idea there were two kinds of eye exams, and I've been wearing glasses my whole life.

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tinyrbfprincess t1_iujqnnw wrote

Do you have a medical dx? Cataracts, glaucoma, lattice degeneration, or diabetes? Some eye practices automatically classify you as medical if you have a medical dx

ETA the list is for example, there are many different medical dxs where the eyes are concerned.

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MoreRopePlease t1_iuk6f79 wrote

At the time, I had no complaint. I just needed a routine exam so I could get a new prescription (and determine if I needed progressive lenses yet). The exam resulted in no Dx either.

I have a high deductible plan, so they billed my insurance, and I still had to pay. When I called the clinic to question the bill, they said "it was a medical exam, there's no billing error". And even though I told the person behind the counter exactly why I was there, they didn't clue me in there there are two different kind of exams. And the exam they gave me was not the kind that VSP would pay for.

How are people supposed to learn all these nuances?

I could have gone to JC Penny and paid nothing.

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