Does med insurance cover the eye doctor? or was I just fleeced?

[Anonymous]

I'm so confused. I just got out of the opthalmologist with a $160 bill. I have medical insurance and used to just have a copay for an eye exam here. When I was confused at checkout, they said the doc (MD) only takes insurance for an eye injury or medical problem but charges $130 for a check up with refraction and an extra $30 for contact lens prescription. Is this normal? I swear my bill was not this high last time! I also have a vision plan (which they say they don't take) but thought the check up would be regular insurance.

Since my husband was supposed to go to this same guy next week, we'd love recs for alternatives in DC. Thanks!

[Anonymous]

I thought you needed vision insurance to be able to go to eye doctors? More than regular insurance.

[Anonymous]

Regular vision checks are only covered by your separate vision insurance. Your basic medical policy will cover injury and disease to the eye - but not glasses, contacts, fittings etc, which are also only covered on the vision plan. So if you stick a pencil in your eye, it's covered by regular medical. If there's nothing wrong, it's only covered by vision. If it's something in between, like a cataract, I'm not sure but i assume is covered by medical.

[Anonymous]

I think it depends on what the problem is. Chronic problems should be covered by medical. For vision checks/scripts you need a vision plan.

[Anonymous]

I've dealt with some pretty serious eye issues over the past seven years. My optometrist visits are covered partially by vision insurance (that doesn't fall under regular medical insurance) - this doesn't include any coverage for contacts, only for eyeglasses. However, every time I visit a retina specialist or ophthalmologist (when I'm not going to NIH), it's covered under my medical insurance. I only do a $10 copay.

Sounds like you need to find someone in your network or take a closer look at your benefits?

[Anonymous]

Anonymous wrote:I'm so confused. I just got out of the opthalmologist with a $160 bill. I have medical insurance and used to just have a copay for an eye exam here. When I was confused at checkout, they said the doc (MD) only takes insurance for an eye injury or medical problem but charges $130 for a check up with refraction and an extra $30 for contact lens prescription. Is this normal? I swear my bill was not this high last time! I also have a vision plan (which they say they don't take) but thought the check up would be regular insurance.

Since my husband was supposed to go to this same guy next week, we'd love recs for alternatives in DC. Thanks!

Are you sure you were with an ophthalmologist, or was it an optometrist?

[Anonymous]

My insurance offers a discount at the eye doctors, I think. Fed BCBS. It's not much, but helps a little.

[Anonymous]

It depends on your insurance. My current insurance covers a basic exam for glasses as well as emergency/injury services, but no coverage for additional services or glasses/contacts. My old plan did not cover eye exams, and I had a separate eye policy.

[Anonymous]

Op here. I was with the opthalmologist, MD. I'll have to check my records, but I thought I only has a copay last time.

[Anonymous]

I have no answer to you, but I am shocked he charged for the prescription separately!! WTF! It is the same as going to a pcp and aside the fee for the visit itself, he decides to charge me for my antibiotics prescription!

[Anonymous]

PP again, call your insurance to check with them it if was charged to them as well. If it was, report the doctor to the board.

[MommaRN]

Anonymous wrote:I have no answer to you, but I am shocked he charged for the prescription separately!! WTF! It is the same as going to a pcp and aside the fee for the visit itself, he decides to charge me for my antibiotics prescription!

Yes, the refraction is a separate fee. There are times you may go to your opthal, they'll refract you as part of the exam and then decide that they slight change in your prescription isn't enough to warrant changing your glasses, so they won't give you the Rx, makes for a lesser fee.

[Anonymous]

Under United, our vision was covered - yearly check ups for me, my spouse, and kids. We didn't have vision coverage.

We switched b/c my opth retired - no vision coverage (again) - and nothing is covered.

[Anonymous]

Anonymous wrote:Regular vision checks are only covered by your separate vision insurance. Your basic medical policy will cover injury and disease to the eye - but not glasses, contacts, fittings etc, which are also only covered on the vision plan. So if you stick a pencil in your eye, it's covered by regular medical. If there's nothing wrong, it's only covered by vision. If it's something in between, like a cataract, I'm not sure but i assume is covered by medical.

Former optician here and this is correct. Routine vision exams and materials are covered by vision insurance. Medical problems (stuck your eye, infections) are covered by medical insurance.

[Anonymous]

Depends. My husband's vision checks are covered by our medical insurance bc he is a diabetic.