Cataract ranch

Being the highly-efficient procrastinator that I am, I managed to delay the annual eye exam, which was due around Labor Day, until yesterday. (Of course, if I were a perfect procrastinator, it would still be on the back burner more or less indefinitely.) I arrived about fourteen minutes early, and was immediately paid back for being dilatory: some time between the time I was supposed to show up and the time I actually did show up, they’d relocated the practice.

Okay, fine, another two miles and change. I can do that in … well, twelve minutes, counting the return to the car. Rush hour’s over, isn’t it? (“At 8:18 in the morning? You should live so long.”—ed.)

My formerly spotless bill of health was slightly less so this time around: still no macular degeneration, and apparently I have optic nerves of steel, but there’s the faintest hint of cataractivity on the fringes. On a scale of zero to “hire a seeing-eye bat,” this ranks about 0.5, said the doctor, and I might have to worry about this in, oh, fifteen or twenty years.

(Aside: I threw this up as a question on Facebook: “Is it somehow counterproductive to utilize the services of an extremely pretty optometrist?” Because of the distraction, you know.)

Extra bonus: an object lesson in Why Health Insurance Is Hosed. First, some background, from a presumed industry insider:

It is best to always charge for a refraction (assuming the test was done, of course) and show it as a separate line item fee on the patient’s ledger and receipt. I would do this in all cases: private pay, vision plan coverage or medical insurance coverage. The refraction fee can then be billed to a third party or may be collected from the patient, depending on the coverage, but I believe the fee should always be entered. It is simply good policy.

Medicare, as it happens, won’t pay for refractions. (This is the procedure that involves squinting at illegible bug marks on the wall while lenses are whirled in front of your nose.) Neither will most standard insurance plans, though vision-care plans apparently will. I don’t have a dedicated vision plan, and the practice was following the above advice on breaking it out separately.

Now here’s the fun. The part of the exam that didn’t involve refraction, which took approximately half of the exam time, was listed as $125, and CFI Care (not its real initials) will be billed for $68.49 after a $30 copay. I conclude that this is supposed to be worth, well, $98.49.

The refraction fee, noted as a separate item on both the invoice and a wall plaque, was — wait for it — twenty bucks.

Now you could argue that the refraction can be, and in this case was, done by an assistant. (To the dilate delight of these old eyes, the assistant was just as gorgeous as the doctor.) But the doctor has to review the results anyway, so that won’t wash as an excuse. Which leads me to believe that insurance coverage, aided and abetted by government, has so screwed up medical pricing that the best way to save money, when circumstances permit, is to opt for something that isn’t actually covered. Obviously circumstances won’t always permit, but I have to figure that the $50 I actually paid was pretty close to what all this would sell for in a freer market than this. In the meantime, some poor sod with no insurance at all is going to get a bill for $145, because that’s the way the system works.

And come to think of it, $50 for an hour’s work is about half what I pay to get my car worked on. On the other hand, it’s easier to get parts for the car.


  1. The Sanity Inspector »

    30 March 2010 · 12:24 pm

    My employer’s vision plan is so feeble, I find it better to just use a vision coupon out of the Sunday paper.

  2. McGehee »

    30 March 2010 · 2:59 pm

    I’m glad the only thing wrong with my eyes, as a rule, is that I’m getting old. I bought two $15 three-packs of reading glasses at Walgreens a few weeks back on a two-for-one deal.

    If I had a vision plan to cover such things, I’d take all year using up the deductible.

  3. sya »

    30 March 2010 · 3:10 pm

    My school’s health care plan sucks, so I kind of put off my eye exam to, uh, over four years. Although after the exam last week, I didn’t feel too bad about it when my optometrist told me my vision hadn’t changed that much.

  4. miriam »

    30 March 2010 · 11:05 pm

    I’ve tried the vision plans offered by most insurance companies, and they cover only cheaper glasses–no Varilux–and end up costing you a little less for an inferior product.

RSS feed for comments on this post