Bethlehem Eye Associates

August 17, 2015Dear Sirs, [redacted] has been a patient of ours for several years and was last seen in the office on February 16, 2015, at which time, for the first time in many years, [redacted] complained of decreased vision in his right eyeHe does have a long-term history of diabetes, In order to determine the cause of his decreased vision, we performed a refraction, which is the checking of the eye for glassesA refraction according to the rules of Medicare is a non-covered ophthalmic procedure, as is the purchasing of glasses,In the exam, it was determined that his vision did indeed change significantly; and it was recommended for the patient to obtain a pair of glassesIn the past, [redacted] had come in having no specific complaint of a decreased visionTherefore, a refraction was not done and there was no chargeBecause of his complaint at 8:in the morning on February 16, 2015, we performed the refraction and, again, it was determined that the reason for his decreased vision was not his diabetes or his cataract, but it was the development of a slight prescription for glasses.The remainder of his exam, including a dilated exam to check blood vessels, and the exam for cataracts and glaucoma was submitted to Medicare, as is our procedure, and was covered in its entirety, What was not covered, and what [redacted] disputes, is the charge for a refraction, the non-covered aspect of a Medicare eye exam,Sincerely,William *K M.D

August 17, 2015Dear Sirs,*** *** has been a patient of ours for several years and was last seen in the office on February 16, 2015, at which time, for the first time in many years, *** *** complained of decreased vision in his right eyeHe does have a long-term history of
diabetes, In order to determine the cause of his decreased vision, we performed a refraction, which is the checking of the eye for glassesA refraction according to the rules of Medicare is a non-covered ophthalmic procedure, as is the purchasing of glasses,In the exam, it was determined that his vision did indeed change significantly; and it was recommended for the patient to obtain a pair of glassesIn the past, *** *** had come in having no specific complaint of a decreased visionTherefore, a refraction was not done and there was no chargeBecause of his complaint at 8:in the morning on February 16, 2015, we performed the refraction and, again, it was determined that the reason for his decreased vision was not his diabetes or his cataract, but it was the development of a slight prescription for glasses.The remainder of his exam, including a dilated exam to check blood vessels, and the exam for cataracts and glaucoma was submitted to Medicare, as is our procedure, and was covered in its entirety, What was not covered, and what *** *** disputes, is the charge for a refraction, the non-covered aspect of a Medicare eye exam,Sincerely,William *K M.D

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: They have danced around the issue which is I was never informed they were performing a procedure which cost $40.00 and was not covered by medicare. The part about the eye complaint was never made by me at all. The nurse came in the room and started testing me without telling me anything. When the doctor came in he then asked me about my eyes. At no time did the nurse or the doctor prior to the doctor first entering the room ever say anything about an additional test or a fee not paid by medicare.
Regards,
[redacted]

August 17, 2015Dear Sirs,[redacted] has been a patient of ours for several years and was last seen in the office on February 16, 2015, at which time, for the first time in many years, [redacted] complained of decreased vision in his right eye. He does have a long-term history of diabetes, In order to...

determine the cause of his decreased vision, we performed a refraction, which is the checking of the eye for glasses. A refraction according to the rules of Medicare is a non-covered ophthalmic procedure, as is the purchasing of glasses,In the exam, it was determined that his vision did indeed change significantly; and it was recommended for the patient to obtain a pair of glasses. In the past, [redacted] had come in having no specific complaint of a decreased vision. Therefore, a refraction was not done and there was no charge. Because of his complaint at 8:30 in the morning on February 16, 2015, we performed the refraction and, again, it was determined that the reason for his decreased vision was not his diabetes or his cataract, but it was the development of a slight prescription for glasses.The remainder of his exam, including a dilated exam to check blood vessels, and the exam for cataracts and glaucoma was submitted to Medicare, as is our procedure, and was covered in its entirety, What was not covered, and what [redacted] disputes, is the charge for a refraction, the non-covered aspect of a Medicare eye exam,Sincerely,William *. K.  M.D