annual refraction exam

Discussion in 'Optometry Archives' started by Liz, Jul 21, 2003.

  1. Liz

    Liz Guest

    For years my doctor has been performing a refraction test during my
    annual check up. In fact, he performs this exam an every one of his
    patients. My insurance does not pay for this, nor in fact, does
    medicare. Therefore, I have been paying the $36 out of pocket. Does
    every md perform this test on his patients annually? Thanks Liz
    Liz, Jul 21, 2003
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  2. Liz

    Mark A Guest

    No, never heard of it. He must have been an Ophthalmologist prior to being
    in general practice. He is probably trying to recover his investment in

    Next time you schedule an annual check-up, tell them you don't want an eye
    exam (if you don't want one). Sounds like the Dr needs to check your voice
    box on the next exam.
    Mark A, Jul 21, 2003
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  3. Liz

    Edward Guest

    Given that it's unlikely that your GP has the time or equipment to do a
    proper refraction, I will assume that you're referring to your eye doctor.
    In that case, a refraction is generally performed during the annual
    examination, as it should be. Strangely, those who set the rules with
    Medicare do not consider refraction to be a part of the exam important
    enough in which to provide reimbursement, so you will be charged for that
    component. Those doctors who do a refraction on Medicare patients and don't
    charge them for it are either 1) taking a loss or 2) "upcoding" when they
    bill Medicare... the later is a BIG no-no.

    Edward, Jul 21, 2003
  4. Liz

    Mike Tyner Guest

    It might vary by state. Here Medicare doesn't pay for refraction ever, and not
    more than one pair of glasses per lifetime.

    Mike Tyner, Jul 22, 2003
  5. Liz

    Edward Guest

    As far as Medicare and the various Part B carriers are concerned there is a
    distinct difference between a "refraction" (i.e. determination of refractive
    state) and an "eye examination" (i.e. an eye examination sans determination
    of refractive state). "Refraction" is never covered, but they will cover an
    "eye examination" if a patient has a "medical diagnosis". There may be
    exceptions to the rule, as Dr. Tyner alluded to, but I've yet to find one.

    Edward, Jul 22, 2003
  6. Liz

    The Real Bev Guest

    My MIL's ophthalmologist does a refraction every once in a while. She has
    MD and is legally blind. She can see the big E with only one of her eyes,
    but not the second line. He charges her $55 for this in addition to
    whatever he charges Medicare/Blue Cross. He says he needs to do this to
    see if her vision has deteriorated. I think it's just a rip-off.

    Her internist has a Snellen chart posted on the wall but I have no idea
    what she does with it. She certainly has no other optical stuff in her

    "Calling someone an asshole for being rude to a telemarketer
    is like accusing someone who's shot a burglar in his home
    of being a poor host." -- W.S.Rowell
    The Real Bev, Jul 23, 2003
  7. Liz

    Mark A Guest

    Refraction is rarely covered in any corporate medical plan (only in a
    separate vision plan). Same for dental (unless caused by accident or
    Mark A, Jul 24, 2003
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