Levine: Keep your eye on your eye doctor

Last year, I received a bill from the ophthalmologist, I could say my ophthalmologist but I won’t be seeing her again. She had performed a fundus photography, or taken a photograph, instead of just looking into the fundus (the back of the eye). When my insurance “correctly" decided this was a non-indicated procedure they declined to pay for it and I received a bill for $150.

Coburn Technologies, the maker of the equipment, notes on their website, “Many insurance companies have strict policies in place when it comes to when fundus photography is considered medically necessary and therefore covered by the policy.”

They also note, “a medical necessity is generally granted when diagnosis or tracking progression of the following: Carcinoma in situ of the eye, Glaucoma, HIV disease, Retinal detachment, Sickle- cell anemia, and Multiple sclerosis". Fortunately, I do not have any of these ailments.  

I called and spoke to the office manager who told me that although they did not mention that the exam was likely not to be covered it was mentioned somewhere in the HIPPA forms they asked me to sign. We both sought of chuckled, out of sarcasm, when she mentioned that. When she realized I was a physician, she told me it would be waived.

I spoke to a representative at Coburn who acknowledged that many insurers were not paying for fundus photography but he also mentioned that some eye doctors offer the exam  to their patients at a cost of about $35 to $40. He suggested that patients might wish to have a baseline photo of their fundus.   When I told him the charge of $150 from the ophthalmologist in Ridgefield he appeared outraged. He was equally upset when I mentioned that the physician never personally informed us that the insurer would likely not provide payment for the exam.

Ophthalmologists are part of the wealthy triad of physicians that also include dermatology and orthopedics, and they can earn many multiples of what your  pediatrician or internist does. Why would some of them need to create this duplicitous scam? And, at $150, it is just that, a scam. The machine costs about $20,000 so the investment, for a dishonest physician is quite attractive. For the honest ophthalmologists, who provide the service to patients that actually need it the investment is not as lucrative.

Two weeks after my complaint, I received another bill, this one for my wife who also had a fundus photography. I wrote back, “As discussed, we will not be providing payment for this non-indicated procedure. We were not informed directly by the physician and feel this is an inappropriate way of practicing medicine and doing business.”

Fundus Photography is a valuable test when used on appropriate patients. It may not be unreasonable to obtain one for a baseline study if its cost is $35 but when billed at $150, to patients who do not require it,  it is just a scam to enrich the pockets of ophthalmologists who prey on their innocent patients.  

Ridgefielder Dr. Evan Levine, author of What Your Doctor Won’t (or Can’t ) Tell You has a new podcast, Real Medicine, with more than 10,000 listeners in just the past few months. It’s a top 10 podcast according to Sleeping Dog Entertainment, LLC. The podcasts introduce the listener to stories of dangerous medication interactions that often physicians are not aware of, how pharmaceutical companies push drugs to physicians, when patients should “run” out of their doctor’s office, and his own  experience with the tainted media, including his Today Show interview. To listen click on https://www.podomatic.com/podcasts/realmedicine or follow on iTunes at Real Medicine.