costs to get eyes dilated for plaquenil and peripheral vision test? if ins doesn

[valene2009]

does anyone know the out of pocket expense if insurance only covers eye dilation 1 x a year??? just curious thanks.. also does medicare pay for dilation more than once a year? thanks.

[anita]

My primary insurance (due to disability) is Medicare and I have my eyes dilated twice a year with full eye exams...with no problem.

[Nancy60]

Medicare/Insurances don't determine the frequency of a test, just if a particular test or procedure is something they will cover.  The frequency of any test or procedure is still up to the doctor to determine and justify why you would need the test.  To justify the test to insurance companies, doctors have to include things such as clinical exams, signs and symptoms, diagnosed diseases, medication risks, accepted standards of practice and research supporting effectiveness etc...

It sounds like your doctor is thinking he will be able to justify 2 x a year since recent recommendation standards are now for 2 x a year.  Your really need to ask your doctor these questions as they will be able to be more specific for your case and prices in your area.  Prices do vary in different parts of the country, between different doctors. 

[valene2009]

o that is awesome!  well i wont worry about Anthem cause that ends in late August and i am covered for the testing once-which i will do next month.. i get to sign up for Medicare in Sept-have been on SSD since Dec... thanks to you both!   you have relieved mymind!!

yeah my docs here are great.. they do the new thing that is out too that has been talked about on here when dilating.. O somethin?? cant remember.. anyway i will be seeing 2 diff docs next visit at the same place-and i spoke with both today--the guy who dilates was insistent that i do it 2x a year on plaquenil..

[jazzlover]

It would be included in the cost of a regular eye exam. So whatever that would be.

[slccom]

Your eye doctor should be able to write a letter justifying the extra exams. Sharon

[anita]

I have never had one of my doctors need to submit any special letters or requests in order for Medicare to pay for eye exams (which include dilation.

This morning I am having the third exam and dilation since July (one for plaquenil and two double vision)...and I don't expect there to be a problem.

Val, I think you'll be just fine with whatever your doctor orders in regards to eye exam and dilation.

[A66eyroad]

There is probably a difference between what your insurance will pay for DIAGNOSTIC testing and THERAPEUTIC testing. Diagnostic is when you're trying to figure out what's wrong, while therapeutic is done to help manage an existing illness.

You might need to call your HR department or your insurance company.