‘Medical Expenses’ Category Archives


Routine Eye Exam for Free

by Ziva Beck in Medical Expenses

American Optometric Association recommends routine eye exam for adults every 2 years or every year if you are wearing glasses or have a medical condition that puts you at risk. Everyone in my family wears glasses so annual eye exams are a necessity. This time we needed an eye exam for my daughter.

There are many options available for eye exams. You can go to a retailer like Costco, Sears or Walmart, an optical store like LensCrafters or EyeDrx or a private ophthalmologist or optometrist. My daughter wears both glasses and contacts. So, we needed an updated prescription for both. There is typically an additional fee for contacts evaluation and fitting.

We considered three options: an optical store like EyeDrx, an optometrist we’ve used in the past and an ophthalmologist. The regular price at EyeDrx is $119. This is $79 for an eye exam and additional $40 for contact lens evaluation. They often have coupons and promotions that provide extra $20-$30 discount. Our optometrist charges $159 or $169 if you have stigmatism. The ophthalmologist’s office quoted a price of about $260 for self-paying customers without insurance. This was the most expensive option. Before making a decision, I decided to call our medical insurance provider, Horizon Blue Cross Blue Shields of New Jersey. We didn’t have a vision plan but I wanted to check if our medical plan provided some benefits. Indeed, the customer service representative explained to me that since the healthcare reform, our medical plan covers a routine eye exam performed by an in-network ophthalmologist for free. It is considered a preventive maintenance procedure and is not subject to deductible or co-pay. That’s great news!

We found a local in-network ophthalmologist and proceeded with the exam. Still, I wasn’t completely sure that everything will be covered by the insurance and waited to see how the insurance claim will be processed. Once the claim was processed, I noticed that the exam was billed for $364 and the insurance allowed amount was $169. The insurance paid the full allowed amount and there was no cost to us. Everything worked out!

Before you schedule an appointment with the ophthalmologist, it is important to check with your insurance that they cover routine eye exams. It is also important to check what is not covered. For example, refractive assessment might not be covered by your plan. In this case, you can check the cost of this assessment with the ophthalmologist in advance. In addition, the routine eye exam doesn’t cover contact lenses evaluation. However, if you already wear contacts and have your previous prescription, the ophthalmologist may provide you with the updated contact lenses prescription. It is good to clarify this point with the doctor’s office ahead of time.

I like this new change in our medical insurance policy. It will save us hundreds of dollars on regular eye exams every year. With prescriptions in hand we are ready to shop for contacts and eyeglasses for my daughter.


Medical Expenses are Not Created Equal

by Ziva Beck in Medical Expenses

What a difference a few miles can make! In my case, the surgical facility fee for the same medical procedure performed by the same doctor was 68% higher in one location than the other.

This year, I had to undergo a medical procedure that was done in same day surgical facility on an outpatient basis. My doctor mentioned that they perform the procedure in several locations and suggested the one that was closer to my home. That sounded like a good idea until I spoke to the procedure coordinator. I have mentioned that cost is a concern and she kindly suggested that I speak to the billing manager and check the cost of the procedure in their second location as it might be lower. To my big surprise, it was lower. Indeed, the facility fee in Paramus was 68% higher than in Emerson.

This discrepancy in cost is possible because each facility negotiates the fee with the insurance company separately and there can be a big difference as I have discovered.

Another important question to ask is if the outpatient facility is in-network provider for your insurance. Just because your doctor is in-network provider doesn’t mean that the facility they use is in network. Out-of-network providers don’t have negotiated fees with the insurance company and therefore can charge higher fees that can be 2 or 3 times higher and sometimes up to 10 times higher. If you find that the facility is not in-network, you have to negotiate up front that you should not pay more than what you would normally pay for an in-network provider.

To be on a safe side, whenever I need to have a procedure done, I follow the 3 steps below:

1)      Ask if the outpatient facility is in-network provider

2)      Ask for all costs, including physician fee, facility fee and anesthesiologist fee. Sometimes there are Lab fees as well.

3)      Ask if there is more than one location and the cost for each location.

If your doctor does the procedure in several locations it is a good idea to compare which one has a lower contracted fee with your insurance. Different doctors will have different contracted fees and will use different facilities to perform the same procedure. It pays to shop and compare!