Medicare Glaucoma Coverage
Medicare Covers Glaucoma Eye Exam 100%
Although Medicare covers for glaucoma eye exam with zero copay for people at high risk for glaucoma such as family history, getting that free exam is not to be had without a fight.
For those without any insurance coverage, contact the Lions Clubs for free glaucoma testing for those without insurance.
This is my story of fighting for coverage when I'm already covered. I shouldn't have to fight for something that is stated in many resources that I am covered.
Published on Aug 7, 2012 Dr. David Friedman discusses Wilmer Eye Institute's analysis of Medicare data to determine success rates of diagnosing and treating g
Medicare Now Covers Glaucoma Detection Eye Exam
According to the information about medicare coverage, 'If you are at high risk for glaucoma Medicare will cover an eye exam."
I am currently under AARP MedicareComplete which is part of UnitedHealthcare insurance. On page 12 it sates that glaucoma screening with an in-network health provider is $0 copay for the exam if at high risk for glaucoma. My Hispanic Grandma had glaucoma and therefore I am eligible to have this exam because the high risk factors are:
- have diabetes;
- have a family history of glaucoma;
- are African American and age 50 or older; or
- are Hispanic and age 65 or older.
So I called an in-network place for a free exam and they said the copay was $50 for the specialist visit. Then I called my health plan insurance and explained what happened and to please refer a doctor with $0 copay as stated in my evidence of coverage. I was given the name of my local ophthalmologist, Cochise Eye & Laser located in southeastern Arizona along the Sonoran border of Mexico.
During the phone call to make the appointment, I stressed and made a blunt point that this is a zero copay because I simply want to have a glaucoma test and nothing else. The appointment was made. I went to Cochise Eye & Laser Center at the appointed time and was asked to make the $50 copay. I responded to the receptionist that during the phone call I had confirmed clearly that is was only for glaucoma and nothing else which is $0 copay. The receptionist said that the $50 copay was for seeing a specialist. I disagree and she said that I would not have to pay the $50 and that they will charge my insurance to see if they would pay. I refused this shifty 'deal' they were 'giving' me. I said that I will contact my insurance and left the office.
I called my insurance while in the parking lot of the eye doctor. I told the customer service representive Brandon of AARP MedicareComplete that Cochise Eye & Laser wanted to chage $50 even after being referred by AARP MedicareComplete to a in-network eye doctor who offers $0 copay glaucoma exams. I stressed to Brandon that someboy lied to me, or that there is a breach of contract because the evidence of coverage clearly stated that there is $0 copay. I continued to complain to Brandon that I am going to write a formal complaint to medicare.gov about AARP Medicare complete for breach of contract because American taxpayers are paying for a nonexistant benefit and that AARP MedicareComplete contract with the United States medicare should be dropped due to insurance fraud. And if that is NOT the case then I will complain about Cochise Eye & Laser breach of contract with AARP MedicareComplete for not providing coverage as stated and that Cochise Eye & Laser contract with should be dropped as a in-network provider.
Because Brandon the phone representative can not make a call to Cochise Eye & Laser center, I requested that he send my complaint to the higher ups which he must've done while I was still on the phone because right after that call with AARP MedicareComplete I called Cochise Eye & Laser and the supervisor mentioned that she just got off the phone about me which I presumed to be from AARP MedicareComplete and that there was a "misunderstanding on the receptionist part" and that this was an "easy mistake to make" because my insurance card said it had a $50 copay. She also mention that it was herself that I made the phone call a week prior and that she was about to say something to correct the receptionist when I stomped out of the office.
Published on May 14, 2013 Dr Sanjay Sharma explains the results of his study on glaucoma published in the Journal of American Medical Association (JAMA) as pa
Was it a misunderstanding - or attempted medical fraud?
I don't believe that without me making a huge stink on the phone with AARP MedicareComplete who then called Cochise Eye & Laser that I would ever get a $0 copay for a glaucoma eye test. I wrote this for others who may be bamboozled into paying a huge copay when they are entitled to a free exam that prevents becoming totally blind for life since there is no cure once eyesight is gone.
Wrangling a medical benefit that is fully covered is not my idea of having a secure sense of medical piece of mind.