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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 
again.

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?
Bonnie Richardson
Huntsville, AL 

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