Insurance coverage to see Ophthalmologist for annual visit relating to high myopia
Background:
I have high myopia and I have always seen ophthalmologists for a once yearly or twice yearly regular visit.
Vision Insurance
I have been paying for this OOP as my employer sponsored vision insurance does not cover seeing an ophthalmologist. My vision insurance does cover seeing an optometrist or an optician, which I do not wish to do. My understanding is that ophthalmologist visits are not typically covered under vision insurance, however they can be covered under medical insurance depending on insurance plans/provider.
Medical Insurance
I have an employer sponsored high-deductible medical plan from UnitedHealthcare (UHC). I have never hit my deductible and do not foresee reaching it anytime soon. I believe my medical plan covers near 100% of what they consider in-network preventative services. My ophthalmologist is in-network, however the recent visits have not been coded such that UHC covers them as preventative. Non-preventative services are 100% my obligation until the deductible is hit.
Problem:
When I see the ophthalmologist, I typically am hit with a $250-$500 bill that I just pay OOP. Should this be considered a preventative service? If so, does anyone have advice as to how I can get my future appointments coded such that UHC covers them under preventative services?
Alternatively, any other advice on how to reduce this expense? I am not interested in seeing an optician or optometrist for my vision exams, given the severity of my myopia, I prefer to see a medical doctor.
Additional context:
26M, live in NYC High myopia is also called being nearsighted. My eye glasses lens power is above 12.0 I am an accountant, my personal finance skills are pretty strong, but I need to learn much more about how my insurances work. I have (thankfully) been relatively healthy and thus have got by in life without learning this stuff in stronger detail, looking to improve my knowledge.
submitted by /u/CCC911
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