My new health insurance plan, issued by Anthem Blue Cross, covers certain preventive care services. One is an annual eye health screening. I just had my annual eye exam done by my eye doctor who is an in-network provider. So I’m eligible to order more contact lenses, I am required by law to have my eyes examined once a year.
Yesterday I received a phone call from my eye doctor’s office. They submitted my claim for my eye exam and let me know that Anthem Blue Cross denied it. I was told that annual eye exams, according to my health insurance company, are “eye chart vision screenings” performed by my primary care physician at my annual well-woman visit.
At age 52, I am only entitled to have my PCP tell me to look at a chart and read the letters with one eye covered.
Are you kidding me?
I called Anthem Blue Cross this morning and asked why my claim was denied. I was told the same thing as what my eye doctor explained and in addition that “eye chart vision screenings,” performed by a PCP, are considered adequate screenings for eye health.
Not according to the American Optometric Association.
The AOA’s website explains that, “Periodic eye and vision examinations are an important part of preventive health. A comprehensive adult eye and vision examination includes an evaluation of eye health, such as depth perception, color vision, muscle movements, peripheral vision or side vision, Keratometry, Refraction and more. These are performed by “eye care professionals.” See their website for info http://www.aoa.org/eye-exams.xml
Does a vision-screening test performed by my PCP qualify as a “comprehensive eye and vision exam”?
According to the AOA, an eye health examination is “external examination of the eye includes evaluation of the cornea, eyelids, conjunctiva and surrounding eye tissue using bright light and magnification.” This recommendation also includes measurement of the pressure within the eye.
Is your PCP equipped to perform these tests in your annual exam?
According to the Affordable Care Act, we are all entitled to certain preventive care services. On July 14, 2010, the ACA “helps make preventive care affordable and accessible by requiring health plans to cover recommended preventive services without charging a deductible, co-payment or co-insurance.” See link here http://www.healthcare.gov/law/features/rights/preventive-care/index.html
Apparently, the ACA left out qualified eye health exams by optometrists and ophthalmologists even though the American Optometric Association reports that “periodic eye and vision examinations are an important part of preventive health care.”
A comprehensive eye exam can detect signs and symptoms of vascular diseases such as diabetes and hypertension. The Centers for Disease Control and Prevention (CDC) reports that, “taking care of your eyes also may benefit your overall health. People with vision problems are more likely than those with good vision to have diabetes, poor hearing, heart problems, high blood pressure, lower back pain and stroke, as well as have increased risk for falls, injury and depression.”
Note that the National Eye Institute recommends “comprehensive dilated eye exams” and those exams must be conducted by an “eye care professional.”
Apparently my health insurance company disagrees with the National Eye Institute and thinks my PCP is an “eye care professional.”
Your health plan may state it covers eye health exams but in reality they may not. Check your plan for the details.
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