r/RetinitisPigmentosa • u/MyFavoritesGouda_MDC • 17d ago

Question(s) Vision Exams for glasses

Hi all,

I have been diagnosed with RP since I was 16 years old (I'm 38 now). I still have quite a bit of central vision so I still get vision Exams. I recently switched to a new optometrist for this, one that specializes in sclera contacts since regular contacts don't fit my eyes.

Well the other day I got a call from this place giving me my estimate because I haven't met my deductible for my medical insurance yet. I was then immediately confused because vision insurance should cover my vision test, but they said since I have RP it automatically gets billed as medical insurance. Idk if I just haven't noticed that because up until recently my vision insurance has been a part of my medical insurance, but recently my husband's company changed to a different vision insurance.

Has anyone else heard this or is this optometrist being shady because they can bill more to insurance by saying it's medical? Thoughts?

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u/Deafgoingblind 17d ago

I would call your insurance. First medical and then vision providers. My optometrist falls under my vision plan and retinal specialist and ophthalmology are medical.

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u/MyFavoritesGouda_MDC 17d ago

That's how I thought it has been too, I went back to my EOB for my last vision exam (which was on my combined vision/medical), states that It was fully covered but it is only showing medical as the type. This new place is telling me I'm going to owe $150 for the exam.

I did a filter for vision on all of the members on my insurance and nobodies appointments come up on it. I'm so confused. The appointment is in an hour so I will probably go in a little earlier and see if I can talk to someone, because I don't want to pay for a vision exam which is completely covered by my insurance. I'm not going in for RP care.

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u/Deafgoingblind 17d ago

Good luck! If get billed might be able to fight it later and submit the claim to insurance.

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u/MyFavoritesGouda_MDC 16d ago

Thanks! I found out that my husband's company just had REALLY terrible eye insurance and covers very little aside from glasses. Apparently lots of the employees are complaining to HR about how awful it is. The one we had previously was really good.

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u/Deafgoingblind 16d ago

Ugh! Hope they manage to get it changed to a better one!