topic Re: Question About Medical Billing in Community Chat

Question About Medical Billing

NicksmomESQ — Wed, 23 Dec 2020 20:49:16 GMT

On November 20th I went to the eye doctor for a checkup .This was my first time I've been to her for a checkup. She gave me a prescription for reading glasses.

Today I get a bill from her office for $20, with a note that the insurance company was billed for $320 for the visit.That charge was pending.I checked my medical insurance online account & they had not received the doctors bill for payment yet.

I called the doctors office to get an explanation for the $20 charge & why I'm being billed before insurance review. I was told that the $20 was for the prescription that the doctor wrote!! I told the woman that a doctor has never billed me for an eyeglass prescription. I told her I should have been advised of the extra charge.She seemed embarrassed & apologized but said that insurance doesn't cover the fee so the patient is billed directly.

Has anyone ever been billed for an eyeglass prescription before? DH says it's only $20, but to me it's the principle more than the money.

Sorry for the rant,but I feel taken advantage of.

Re: Question About Medical Billing

Mz iMac — Wed, 23 Dec 2020 20:56:45 GMT

NOPE!

If it was me, I would speak my concerns w/the office manager. Tell him/her that you want something in writing about the "change in pricing" procedures. They will either do that or waive the $20.

I'm like you. I read my bills w/a fine tooth comb. Any discrepancies I always call for an explanation if there is none. I don't care if it's $1. It's the principle of the thing.

Re: Question About Medical Billing

deepwaterdotter — Wed, 23 Dec 2020 21:01:04 GMT

Is your signature on any documents relating to this appointment? If so, did you get a copy of the documents and read them thoroughly before signing? If such documents do not mention this charge, I would contest it.

Re: Question About Medical Billing

aroc3435 — Wed, 23 Dec 2020 21:04:05 GMT

@NicksmomESQ I am pretty sure your eye doctor, whether she is an ophthalmologist (an MD) or an optometrist is, in fact, breaking the law, federal and state laws apply.

If an examination results in needing a prescription one should/must be provided to you. And she cannot force you to purchase your glasses from her.

Good luck.

aroc3435

Washington, DC

Re: Question About Medical Billing

Carmie — Wed, 23 Dec 2020 21:17:11 GMT

That sounds fishy. I would ask her to send the bill to your insurance before you pay it. If your doctor is participating, he might not be allowed to Bill beyond what they allow.

My DH's doctor billed him $27 for lab fees. The lab fees were not denied by his insurance company and the bill was never submitted. I called the drs office to find out what was going on. They said insurance would not cover it, so they stopped sending the bills for these specific lab charges.

I told them to bill as they are in network. They did and the insurance company paid them $7, which they had to accept. They knew the insurance co. Only would pay a small amount and tried to get around it by billing him.

I have a feeling your eye doctor might be doing the same.

Now, if the $20 is for a refraction, many insurance companies do not cover that charge. You would have to pay that seperate out of your pocket. I don't know what type of insurance you have.

If your DH has a medical condition he is seeing the doctor for and has Medicare or some other medical insurance, but not a seperate vision coverage, my guess is that the $20 is for a refraction...which is a great price for this service. A refraction is given to determine your RX for your prescription lens.

Re: Question About Medical Billing

Kachina624 — Wed, 23 Dec 2020 21:05:14 GMT

NO! I've had an eye exam every year of my adult life and have never been charged for a prescription. It's a ripoff, find another doctor. If you just need readers, go to readers.com. That's what my doctor suggested.

Re: Question About Medical Billing

azgal — Wed, 23 Dec 2020 21:10:29 GMT

Yes, I have to pay for a prescription for glasses. I'm on medicare and it does not cover it. If I'm going in for a checkup or an issue with my eyes, then I am covered.

I have to pay $50!

ETA: I'm not charged for a prescription for eye drops or any other prescription for the eyes.

Re: Question About Medical Billing

ScrapHappy — Wed, 23 Dec 2020 21:05:34 GMT

My daughter was born premature, very premature. 3 months early weighing 1 lb. 7 oz. Due to her prematurity she has been going to eye doctors since the day she came home. It's been 15 years now, still going to the eye doctor at least once a year, sometimes twice and I never have been charged a fee for writing a prescription.

Re: Question About Medical Billing

NicksmomESQ — Wed, 23 Dec 2020 21:16:32 GMT

@Carmie My husband is still on his employer sponsored medical insurance.He's not on Medicare yet. The charge was for my exam not his. After the doctor checked my eyes. When she was walking me out of the exam room I asked her for a script for reading glasses. When she got to the reception desk she reached for a pad & jotted down the prescription.

Re: Question About Medical Billing

MamaWick — Wed, 23 Dec 2020 21:20:36 GMT

If you are on Medicare...regular Medicare part B does not pay for refraction. If you have a Medicare part C (Advantafe plan), then it will pay. Other insurances vary in coverage for refraction.

Re: Question About Medical Billing

Carmie — Wed, 23 Dec 2020 21:21:01 GMT

@NicksmomESQ Do you have a seperate Vision plan or just a medical plan? Medical Plans do not cover a refraction, just medical problems with the eyes.

If you have a seperate vision plan, I would not pay the bill until it was submitted to the insurance company. It could be a service that is not billable if your doctors is in your network.

Re: Question About Medical Billing

NicksmomESQ — Wed, 23 Dec 2020 21:28:34 GMT

@Carmie This visit wasn't through separate vision coverage..It was submitted through medical coverage. Prior doctors I've been to never charged me for the script. They were through my medical plan to.🤷‍♀️
Thanks for the explanation.I'll be more aware next time.I guess some doctors bill for it & some don't.

Re: Question About Medical Billing

Carmie — Wed, 23 Dec 2020 21:38:27 GMT

@NicksmomESQ My doctor bills $80 for a refraction! The fee is always mentioned upfront before my exam though.

Re: Question About Medical Billing

patbz — Wed, 23 Dec 2020 21:54:12 GMT

My ophamalogist had a disclaimer that if I wanted a prescription for new glasses there would be a $45 charge. I still had refraction, etc but since my eyes had barely changed, no need for prescription. As I'm on Medicare ( no eye coverage by BCBS ) I paid nothing for his services.

Re: Question About Medical Billing

NicksmomESQ — Wed, 23 Dec 2020 22:28:43 GMT

Thanks everyone for your replies.I called back the doctors office a few moments ago. I spoke to the billing person this time. She put me on hold for a few minutes.When she came back she said "the doctor will waive the fee as a courtesy this time because they neglected to tell you about it."

Re: Question About Medical Billing

FrostyBabe1 — Wed, 23 Dec 2020 22:52:14 GMT

My opthamologist doesn't even do refractions!

They have an optometrist on staff that does that.

I see both in the same visit. The optometrist does the vision screening, checks my glasses and contacts, and writes the prescription for another year supply of contacts. That's $135 and I have to pay it before I leave the office, prescription in hand.

The opthamologist does the actual medical screening. I had a retinal detachement about 6 1/2 years ago, so he takes photos, etc. That all gets billed to my medical insurance.

Re: Question About Medical Billing

Still Raining — Thu, 24 Dec 2020 01:37:42 GMT

Here is the section from the FR that the FTC uses:

456.2 Separation of examination and dispensing.

It is an unfair act or practice for an ophthalmologist or optometrist to:

(a) Fail to provide to the patient one copy of the patient's prescription immediately after the eye examination is completed. Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;

(b) Condition the availability of an eye examination to any person on a requirement that the patient agree to purchase any ophthalmic goods from the ophthalmologist or optometrist;

(c) Charge the patient any fee in addition to the ophthalmologist's or optometrist's examination fee as a condition to releasing the prescription to the patient. Provided: An ophthalmologist or optometrist may charge an additional fee for verifying ophthalmic goods dispensed by another seller when the additional fee is imposed at the time the verification is performed;

(d) Place on the prescription, or require the patient to sign, or deliver to the patient a form or notice waiving or disclaiming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

Re: Question About Medical Billing

Mindy D — Thu, 24 Dec 2020 03:06:54 GMT

@Still Raining wrote:
Here is the section from the FR that the FTC uses:

456.2 Separation of examination and dispensing.

It is an unfair act or practice for an ophthalmologist or optometrist to:

(a) Fail to provide to the patient one copy of the patient's prescription immediately after the eye examination is completed. Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;

(b) Condition the availability of an eye examination to any person on a requirement that the patient agree to purchase any ophthalmic goods from the ophthalmologist or optometrist;

(c) Charge the patient any fee in addition to the ophthalmologist's or optometrist's examination fee as a condition to releasing the prescription to the patient. Provided: An ophthalmologist or optometrist may charge an additional fee for verifying ophthalmic goods dispensed by another seller when the additional fee is imposed at the time the verification is performed;

or

(d) Place on the prescription, or require the patient to sign, or deliver to the patient a form or notice waiving or disclaiming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

@Still Raining @The opthamolgist did comply with this. There is nothing written in it that says the doctor can not charge for a refraction exam fee.