Help me understand my optometrist bill
January 24, 2016 8:59 AM   Subscribe

I just received a bill from my standard annual eye exam. There are two charges on it: EP Comprehensive Exam, and Exam Refraction. It looks like the comprehensive exam was submitted to my insurance (and fully covered), but the refraction wasn't submitted at all. What's going on?

Last year, I didn't receive a bill at all, as my insurance covered all of it after my co-pay. My insurance hasn't changed. Something seems wrong to me: either the refraction should have been included w/the comprehensive exam, or submitted to my insurance, or...? Does this seem like something worth fighting, or should I just suck it up and pay it? Possibly relevant, last year was my first eye exam ever. I needed, and now wear, glasses. Both last year's and this year's exams were done at the same place. If the charge is worth fighting, what's the best way to go about it? Many thanks!
posted by csox to Health & Fitness (7 answers total)
I'd call the office and ask why it wasn't submitted to insurance. They should be able to answer the question or remedy the issue.
posted by heathrowga at 9:02 AM on January 24, 2016 [1 favorite]

Most medical offices will submit bills based on what they expect will be covered. Presumably this office's experience and expectation is that insurance will pay for an eye exam but not for the refraction (measuring to check that the glasses prescription is still valid).
posted by megatherium at 9:27 AM on January 24, 2016 [1 favorite]

Data point: My ophthalmologist warns me every year that my insurance doesn't cover the refraction. I pay out of pocket for it.
posted by immlass at 9:33 AM on January 24, 2016

this explains what the examination is, and why it's often not covered. but that doesn't explain why insurance paid everything first time round. perhaps your insurance does cover this, but the optometrist assumed it wouldn't and so (mistakenly) didn't ask?
posted by andrewcooke at 10:06 AM on January 24, 2016

Refraction is usually not covered by insurance. I'd bet that their billing department knows what your particular insurance covers and what it doesn't cover. That said, I have never had an eye exam where they didn't tell me UPFRONT that the refraction wasn't covered by my insurance.
posted by PorcineWithMe at 10:50 AM on January 24, 2016

(I should add that as a visually impaired person I have had A LOT of exams.)
posted by PorcineWithMe at 10:51 AM on January 24, 2016

I ended up finding my explanation of benefits from last year's exam, where everything was covered, and calling the dr's office to point out the discrepancy. They re-billed the insurance, and everything got covered. (Whoo!) I'm not sure what happened, but I'm glad it got resolved in my favor! Thanks for your help!
posted by csox at 5:59 AM on February 26, 2016 [2 favorites]

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