Monday, February 16, 2015

Gotta keep on top of these things!


In January, I returned to my opthamologist, who I have used since 1986, for a complete exam. Although I had seen him just a year prior, my vision had changed. Eyes are healthy otherwise, great. New glasses ordered, and subsequently picked up, I can see much, much better now. Still have to decide about replacing the lenses in my year old glasses. Not pressing, but something I'd like to do.

I noted that a claim was sent to my insurance, and denied, with a notation that it was forwarded on to the vision claim center in CA. Fine. A month goes by, still no news, and I can't access any EOB's on line, so I phoned a week or so ago, and was told that if there had been an underlying, medical eye problem, it would have been covered at 100% thru my insurance. Since it was coded as "routine," a check for only $45 was sent to my MD, who is considered out of network thru the vision plan. Talk about confusing!! When the appointment was made, I confirmed that my MD was indeed, still an in plan MD with my insurance. I contacted my insurance liaison and she reiterated that this was a routine visit, $45 paid out.

As I suspected (this has happened at least three times now), this was not coded properly. I phoned the business office of the eye MD's and sure enough, my medical issue has been and should have been coded accordingly. My MD is away for another 3 weeks (he goes to Israel for a few months annually)but when he returns, he will be asked to review my chart again, and authorize that a claim on my behalf be resubmitted to my insurance under medical, with the anticipation that it be 100% coverd by my insurance. As it stands now, I owe $213 (less the $45 sent or soon to be sent to the "out of vision plan" MD). Additionally, my insurance coverage for vision changed for the better 2 years ago and now actually covers refractions. I was made to pay $55 in Jan, but I knew that it was an error. So, a note is placed in my file, the file will be reviewed and as I look into the crystal ball, I expect that when all is said and done, my financial obligation for that Jan visit will be $0.

So yes, it's worth keeping on top of things like this, and knowing my benefit. : )


Belinda said...

Such good planning of you to keep on top of this. I'll be rooting for you to not having to pay anything for this. :)

saraband said...

These sort of complications are just one more reason to cherish the UK's National Health Service