This is the situation:
A friend of mine has insurance that covers one eye examination per year. Today he went to the ophthalmologist and did need a new eyeglass prescription. This ophthalmologist does not make glasses. When he went to pay his $40 copay and asked for a written prescription to take away to an place to get the eyeglasses, the office person charged him an additional $35 for the written prescription. He asked why, and she said something like, “Because the insurance doesn’t cover that.” Cover what?
Is this common? I’ve worn glasses since I was a kid and never heard of this or encountered it when I started getting my own glasses for myself in 1964. I’ve also never had insurance that covers eye exams/glasses (and most of the time didn’t have any insurance at all).
What would be the rationale for this extra charge? If a person needs glasses and that doc’s office doesn’t make the glasses, the patient is going to need to take a prescription somewhere to get the glasses, right? Seems like charging $35 to copy some numbers from the chart to a prescription pad is rather high. Seems to me that ANY charge for that is rather high.
I work in an ophthalmology department, and this is true - generally, medical insurance does not cover refractions. My department charges something like $40-50 for a refraction (I forget, I don’t deal with that) and has posted signs warning about this, but people do overlook them.
Ophthalmologists are medical doctors that handle more complicated or advanced eye problems, generally, and where I work, the vast majority of the ophthalmology visits do not involve refractions. An optometrist is sufficient to handle most people’s eye checkup needs (barring perhaps as they get older, where you have more worries about degenerative diseases starting slowly), but these visits aren’t paid for by medical insurance or are only partially covered.
ETA: So you’re saying that my friend isn’t paying for the written prescription, he is paying for the part of the eye exam that determined his new prescription? (I.e., the flipping of lenses, “A ir B? C or D?”)
I’m not sure what happened. Are you sure your friend went to an ophthalmologist and not a regular optometrist? I have an issue with my optic nerves for which I see an ophthalmologist maybe every 5 years, and those are covered by my HMO. I do, however, see a regular optometrist yearly, which is also covered supplementally (via a secondary eye insurance company - Davis - but linked somehow to my HMO - Blue Cross) for a checkup once every 12 months.
Since the ophthalmologist sees me for a medical problem, there is no checking for what I need for a prescription - my regular optometrist does that for no extra charge, and he is the one I get the written Rx from, not the ophthalmologist. I see the ophthalmologist as an extra visit, on top of my regular optometry visit in the year I get the checkup. I can imagine the specialist can do it, but I wouldn’t be surprised it would be an extra charge, though I would expect it to be included with my co-pay and not extra.
Ok, I looked up that refraction is the eyeglass exam.
Next question: my friend said that if he had not asked for a copy of the written prescription, he would not have been charged the extra $35. He said that when you first get to the office, an assistant (likely an optometrist) does the eyeglass exam (“refraction”), then they dilate your eyes and you see the ophthalmologist after that.
When my friend got ready to leave, the doc said, “Will you be getting new glasses?” My friend said yes because there was a slight change in the prescription, and because he had recently broken his frames. Then the doc said, “In that case, you’ll need a prescription.” My friend had made his $40 copay at the beginning of the visit, and when he went to the desk to get the eyeglass prescription, that’s when he was charged the $35. So it kind of does seem he was charged for the prescription, not for the refraction.
Does this make any sense?
ETA: SeaDragon, my friend absolutely did go to an ophthalmologist. I also went to an ophthalmologist for my last eye exam and got a written prescription for my glasses to take away for no extra charge. BTW, my ophthalmologist said that most of his patients come to him for eye exams.
I see an ophthalmologist regularly because I got shingles in my left eye in 2004. I require prednisolone drops in that eye or I loose my vision. I see the ophthalmologist 3 times a year to check my eye and the pressure in it.
My ophthalmologist has written eye glass prescriptions for me twice at no charge.
ThelmaLou: My wild-ass guess is that they do a refraction (yeah, that’s the “which one looks better, one or two” part) both to get the best vision (best-corrected visual acuity) for their records, and because at some point later in the visit, you may decide yeah, I do want new glasses - and once they’ve dilated your eyes, they can’t do a refraction any longer. If you don’t want a prescription, they essentially eat the cost of the refraction. If you do, they get to bill for it. It’s possible they’ve had enough people get mad afterwards when they’re told they can’t figure out a prescription now and they’ll have to come back, that they decided that it’s worth just refracting everyone.
The office where I work requires you to state upfront if you want a glasses prescription or not. If you say no, you get a simpler vision test that might include looking through a pinhole to see if your vision can be improved, but it’s just a quick check of how well you see, not involving using lenses or anything.
I work in the research end of things in my department. I can do refractions but am not licensed to write prescriptions for them, and I’ve had to tell new patients up front that I cannot do prescriptions.
I also had shingles in my left eye but in 2003. Very scary. I don’t have to use drops or anything any more, but part of my left eyebrow and eyelid are and will forever be numb. I was fortunate that my GP recognized IMMEDIATELY what was going on, and she called this ophthalmologist and got me in to see him that very day. I went to him every week for months to follow up.
I still went to my regular optometrist for glasses until the last time, when he said he the cataract in my right eye was at the point where he could no longer correct my vision in that eye with a prescription lens. I went back to the ophthalmologist so as to pave the way for eventual cataract surgery, and in the course of the eye exam (refraction), I told him what the optometrist had said about not being able to correct my vision in the cataract eye with a lens. The doc said, “Let’s see what we can do,” and proceeded to flip-flip-flip lenses, and by George, he DID correct the vision in my cataract eye. So I decided to fire my optometrist.
I told the ophthalmologist I didn’t know that people went to them for vision exams. I thought it was only for eye diseases, surgery, and such. And he said, no, most of his patients come for eye exams to get glasses.
He never charged me extra for a written prescription. So I’m still not sure what happened at my friend’s exam.
This is the most time in my entire life that I have typed the word ophthalmologist. And I’m proud to say I knew how to spell it from the very first time.
ETA: Thanks, ferret.
They’ve tried taking me off prednisolone drops several times. I was off them for a few months last year and my vision really deteriorated in that eye. I regret not getting to the doctor quicker when I had shingles. A couple days delay makes a big difference.
I go to an ophthalmologist every year. The assistant does the refraction, the the ophthalmologist comes in and does whatever additional tests I need. At the end of the appointment they routinely give me a printout of my new prescription. I don’t even have to ask for it, and there’s never a charge.
Yikes about the shingles - for you guys who had them, what’s your opinion on getting the vaccine these days? I had chicken pox when I was 13, I don’t think I ever had a vaccine, and I do wonder occasionally whether I should get a shingles vaccine as I approach 42. I didn’t know it could happen in the eye and eye stuff really squicks me out, on top of knowing how bad it can be with just a “regular” location!
That insurance thing, ThelmaLou, still sounds hinky to me. I guess everyone’s is different, though. I have to pay a $15 co-pay at the ophthalmologist when I go there for my visual fields test and dilation, but my yearly optometrist appointment ($130 on the bill) is totally covered and then there are discounts if I order glasses through his service. Weird.
Bolding mine. That person is most likely NOT an optometrist–an optometrist can make quite a bit more money doing exams on his own patients than doing intake stuff on someone else’s patients. Who your friend saw first was most likely an ophthalmic assistant (maybe certified, maybe not.)
At my workplace, refraction is a standard part of a new patient establish care exam (as opposed to a new patient with an acute problem). As FH says, you have to document best corrected vision, regardless of whether or not the patient wants a lens prescription. My understanding is that some practices just test with the prescription the patient is currently wearing or the autorefraction (the measurements from the little machine with the picture of a barn inside) and if it’s 20/25 or better call it a day unless the patient specifically wants a new script. But in all reality, unless you have a diagnosis that requires follow-up, your insurance is only going to pay for one eye exam a year, so new patients pretty much always want a prescription, either at the first visit or at the last follow up. It’s just more efficient for us to go and do one on everybody while we’re taking the history and doing the other preliminary tests than to do it midstream on some patients.
If we can show that there is a valid medical reason to do a full refraction on a patient (like, say, they want a prescription for corrective lenses), we can bill for doing the refraction. (And yes, the refraction is a separate billing code from the actual exam.) If there’s not a demonstrable medical reason for a refraction, we basically eat that 10 minutes or so of tech time. We’ve not run into any problems with insurance companies refusing to pay for refraction yet, but then again we’ve only been open 3 months. What I suspect happened in your friend’s case is this: Many insurance plans that offer vision coverage have, in essence, a separate policy that pays for vision care–but since an ophthalmologist is a medical doctor, they bill your health policy, not your vision policy. In such a case, I can totally see the chintzy bastard insurance company refusing to pay for the refraction because that code should be submitted to your vision coverage.
