Today my son is going to get a re-evaluation at Hunterdon Family Eye Care. My “little” six-foot tall young man has a vision issue, but not the kind you’re probably thinking about. You see, there are vision issues which focuses on the mechanics of the eye and how well they see (or don’t). Then there are vision issues that are related to how the brain uses (or doesn’t use) the visual input that it receives. My son is in the latter group.
Since his brain and eyes weren’t working together he had difficulty with reading, catching a ball, depth perception and more. Since beginning therapy he has improved in a lot of areas, but due to money constraints we took a break. Today’s visit is to see how much “muscle memory” he retains and how much more therapy may or may not be needed in the future.
My Gripe with Insurance
Now you would think that the powers that be would see value in helping young people with this condition to be treated. I mean, unless there is an intervention the kids will struggle in school, it will affect their self-esteem and make them less productive as adults. It looks like a no-brainer, right? Wrong!
Before a person can enter vision therapy they have to be seen by a behavioral optometrist to get a diagnosis. This visit is covered by most health insurance plans because it is a physical exam. Once the diagnosis is made, however, insurance companies get stingy and difficult.
From what I’ve learned from the many people I’ve challenged on the subject, unless the vision/brain issue is caused by a stroke or other brain injury you’re just out of luck. If you decide to go forward with the therapy, it’s coming out of your pocket. If you are one of the “lucky” people who have suffered from a brain injury the number of visits is capped off, so whether you’re 100% or not, you are done. Huh?
What About FSA and HSA Accounts?
If you’re like us, you may have a FSA or HSA account through your job that you can use to get some of your out-of-pocket expenses reimbursed. Technically, it should work, but boy do they make you work to get your own money back.
In our case, the therapists at Hunterdon Family Eye Care has a couple of plans. There is weekly, monthly and one-time payment. The one-time payment gives you a significant discount, so we took advantage of it. Wrong move, abort, abort!
Our FSA Horror Show
You see, our FSA (a pox on them) wouldn’t reimburse us until we gave them receipts for each therapy session. Their reasoning is that we didn’t actually receive the services so why should they pay for them in advance. Our point was that paying for them in advance meant savings on everyone’s part. That was a waste of breath.
Like good little hostages we had the therapist give us a receipt for each week that we visited. You’d think that would solve the problem, but oh no, that would be too easy. Instead they complained that a code was missing, the didn’t like the ink (I made that up, but it was a dumb reason), the sun didn’t shine brightly enough. So each therapy session became a strategy session to make sure that the FSA couldn’t wiggle out of giving us the money back.
Needless to say when the next round of 24 sessions was suggested we decided to take a break. I think the therapists administrative staff was happy for the break too. They spent just as much time as we did arguing with these yahoos about why they needed to pay up.
This time we saved up the fee and we’ll just leave out the Insurance and FSAs and pay them directly.
I Wish We Had Handled the Insurance Situation Better
When my son was diagnosed with these issues it was new territory for me. While I spent time reading up and learning about his difficulties, I never considered taking a course in insurance management and insurance “speak.” I would have saved myself a lot of headaches if I had. I would have been prepared for the random ways that the industry avoids reimbursing us.
Six Ways to Avoid Pulling Your Hair Out
Here are six tips from the Virginia Vision Therapy Center. They suggest that you ask:
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Is vision therapy covered? Sometimes referred to as orthoptics in the insurance industry. If coverage is a part of your plan, it might also be smart to ask if there is an annual limit, or lifetime limit, for coverage. Note that vision therapy is most often applied to a medical policy as opposed to a vision policy.
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Which CPT insurance billing codes are covered under your policy with regard to vision therapy? Most therapy providers use code numbers 99203, 99204, and 92015 to bill for an initial vision exam of between 1 – 2 hours. For assessing a patient’s visual information processing, and a 2-hour appointment, commonly used CPT codes may include 96111, 96116, or 92060. Therapy sessions lasting up to an hour often use the code number 92065. For progress visits, codes 99213, 92060, 96111, and 96116 are commonly cited.
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Do therapy visits have to be pre-authorized in order to be covered? Make sure you understand and comply with the requirements.
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What will the out-of-network deductible be if your provider is not a recognized provider with your insurance company?
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When your deductible is met, what will your coinsurance payment be?
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How long it will take for the insurance company to reimburse you.
If you’re a parent who has a child with vision issues, I’d love to hear how you handled your insurance company.
