I have to call an insurance company tomorrow
This is going to sound like a whiner complaining about things he should be thankful for.
But I gotta whine.
I am on Medicare, and I have a supplemental coverage. A Medicare Advantage type plan. I also have vision and dental insurance through the state retired teachers.
So when I got a bill from my eye doctor for $151, I was a little curious. My vision insurance has always paid all but a copay for an exam and lenses. I had gone to the eye doctor because I had blurred vision.
A digression. I go to the eye doctor yearly for an exam. I have a potential for macular degeneration in my left eye....have had it for a few years and it is stable. Sometime in March I broke my glasses. Ordering them through the eye doctor took 7-10 days. So I ordered them.
I have seen the ads on tv for various places in Rockford where you can get a pair of glasses for as little as $59 in one hour.
My plan was to get the cheapo glasses and use them until my replacement came.
I walked into the first el cheapo place and there was no rhyme or reason about service. A technician near the front desk had to ask another technician for help in using the phone to call out. She showed him. I waited. About 10 minutes later, they guy had to make another call. He again asked for help, another person helped him. I was still waiting. When he had to ask the third time for help in using the phone, I thought perhaps I was not in the correct place. But then a Young Thing came up and asked how she could help me.
I explained my plight and my needs. Cheap frames, cheap bifocals, one hour service.
Young Thing said no problem. We picked out some frames, and she went to the back to ask about wait time. She returned and said it may be 3 hours because they were running behind, but the glasses would only be $69. I said ok, I would come back in three hours.
Young Thing went into the back again, and returned saying, ooops....three days, not three hours.
So I left.
Went to another not as el cheapo place and 65 minutes later had a new pair of glasses.
But when I wore them, I got nauseous. And I had a headache. Matter of adjustment, I am sure.
So I went a week with constant nausea and a constant headache. The upside was, I actually lost 7 pounds in a week because food made me sick.
My new glasses come in, I happily put them on, and three days later, still nauseous, still head achy, unable to see distances clearly, I return to the eye doctor and ask to have the prescription checked.
And they also checked my eyes.
Turned out I had a fast developing macular degeneration in my right eye, causing a slight tear in a retinal layer and the cause of all my ailments. Eventually, my eyes would adjust, but I would probably lose the vision in my right eye.
So instead of having a brain tumor or cancer, I was merely going blind.
And that is why I had a $151 bill. My Medicare Advantage plan does not have my eye doctor "in network." Since the blurred vision was a medical condition, they would not cover the cost. Since they denied the claim, Medicare also denied the claim.
Nice Person at the eye doctor's said she talked to insurance about this, that it made no sense, they said tough....no coverage. In order to be covered, I had to have a referral from a medical doctor and preauthorization from insurance.
So when I call I am going to ask this: When I go to the eye doctor for an exam, and she finds a medical issue, do I have to say "Wait...don't do anything. Let me call my medical doctor so he can write a referral and I can get preauthorization for you to treat my eyes?" Or do I have to have a referral from my PCP (primary care physician, which is another complaint. Tell us what the letters mean!) to go to the eye doctor in the first place?
I should be thankful it wasn't more money.
Tomorrow, in Paul Harvey's words, "The rest of the story."
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