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[IP] Retinopathy Exam
My Physician has always told me to be sure and get an eye exam for
retinopathy annually. For 12 years I did that, with an Ophthalmologist.
The doctors always split out the Retinopathy exam from the visual exam and
I paid that part...Bill was usually $30 for visual, $30 for Retinopathy
exam. Last year (September 98) my eye doctor, after seeing me, of
course, sent me a bill for the whole thing $75.00. I called and said,
rebill my insurance as BCBS has always paid for the Retinopathy portion of
the bill. This doctor said her BCBS director said BCBS will not pay for
a retinopathy exam unless the person already has the disease. She (the
doctor) further said that she could be fined a big fine and even lose her
license if she wrote retinopathy on the charge code as I did not have any
sign of the disease. Things got pretty hot between us, letters going back
and forth...she wanted me to pay full $75 for the exam, all though I kept
telling her she can't change the rules in the middle of the game without
informing players, etc. I ended up paying half and she never billed me
I dropped her. However, just before the year was up, I bought a spare pair
of contacts cause I knew I couldn't get replacements after a year. I
haven't been to anyone since 1998.
Now I have no obvious symptoms...but I am not sure which way to go now.
Insurance is a blessing to diabetics. My new company doesn't have
prescription coverage (I pay then submit billing and they reimburse at 80%)
and it is turning out to be tougher than I anticipated when I accepted
their offer. I thought I had that portion covered with a hefty salary
increase, but it is not quite covering it and I really can't afford the
cost right now.
Have any of you had this experience? How do you handle getting the exam
covered by insurance?
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