Highmark change in Medicare eye exam coverage irks some
Visits to eye doctors gave some seniors a surprise this year: They paid out of pocket for a refraction eye exam.
Refraction testing — a term familiar to people who wear glasses — involves viewing an eye chart while looking through various lenses to determine the strength of glasses needed.
Highmark Inc., the predominant health care insurer in Western Pennsylvania, stopped reimbursing for the test as a medical expense under its two Medicare Advantage plans with nearly 195,000 members in the region.
The test typically costs $43, Highmark says.
Until Jan. 1, Highmark allowed eye doctors treating Medicare Advantage members to bill for a medical eye exam, such as checking a diabetic patient's eyes for problems, and for the refraction test.
Highmark said it stopped the double-dipping practice because its members with either FreedomBlue PPO or Security Blue HMO also have Davis Vision insurance, which covers refraction exams and eyeglasses.
“We review medical policy on an ongoing basis, and this duplicate benefit was identified and implemented for a benefit change,” Highmark spokeswoman Kristin Ash said.
Medicare Advantage plans are a type of Medicare health plan for retirees. Private insurers contract with the government to provide doctor and hospital benefits. The nation's Medicare program never covered refraction.
Ash could not say when Highmark began covering refraction as a medical benefit in its two Medicare Advantage plans.
UPMC Health Plan, the second-largest insurer in the region, does not cover refraction as a medical benefit under the Medicare Advantage plans it markets as UPMC for Life, spokeswoman Gina Pferdehirt said. All UPMC for Life plans come with vision insurance that cover refraction, she said.
Dr. Alexander Chang, a Green Tree ophthalmologist, said the change creates problems for his patients, because Highmark doesn't allow eye doctors to charge Security Blue or FreedomBlue for a medical eye exam and Davis Vision for a refraction on the same day, he said.
“You cannot bill the two insurances on the same day or for the same visit,” he said. “That's against their policies.”
Chang said he and other eye doctors around Pittsburgh are telling patients with Highmark Medicare Advantage plans that if they want the refraction test when they get a medical eye exam they'll have to pay $30, or come back another day.
Dr. Paul Lobby, a Kittanning optometrist, said the change isn't a problem for his practice. Though he suspects not many colleagues agree, Lobby said Highmark told him the reimbursement for a medical eye exam includes refraction testing.
“The medical exam includes evaluating the refraction status of the eye,” he said. “It's really a matter of interpretation.”
Lobby sits on a committee for the Pennsylvania Optometric Association that works with insurers on policy issues. The Harrisburg-based trade group discussed Highmark's change and didn't oppose it, Lobby said.
“I think they know we were a little disappointed with the decision,” he said of Highmark executives. “I don't think we thought it was a battle worth fighting.”
Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or firstname.lastname@example.org.
Add Alex Nixon to your Google+ circles.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- LaBar: Future of Rusev in WWE critical
- Steelers’ defense unfazed by noise, believes in potential
- Pittsburgh Mayor Peduto works to smooth path for business ties with Cuba
- Gameday: Pirates vs. Padres, May 29, 2015
- Overhaul possible for West Mifflin’s Century III Mall
- Starkey: NHL playoffs suddenly sublime
- Dormont man missing since Wednesday found dead at Station Square
- Greensburg train station earns honor from Pittsburgh foundation
- Trib Cup: Greensburg Central Catholic celebrates WPIAL title
- Gorman: Team Dugan gets gold, like a champ
- Kiski Valley slugs way to early Legion win