THE INSURANCE GAME

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I need to “fail” a pair of contact lenses in order for my medical insurance to cover surgery for Intacs for keratoconus in my right eye.  I was lucky enough to get in today to see my optometrist, just a few days after learning I needed this surgery.  Of course, none of the records from my ophthalmologist’s office were sent, the receptionist never recorded exactly why I was coming in today, and I can’t recall exactly what else went wrong.

I was escorted back to the exam room after having more corneal measurements taken and I explained to the medical assistant why I was there and that I needed my optometrist to prescribe “the cheapest contact lenses possible” (repeating what the ophthalmologist said), as they were just going to go in the garbage since my eye couldn’t go much longer without surgery.  She looked completely perplexed, but I don’t make up these ridiculous rules.  Blame the insurance companies who are now paying for two things instead of one.

My doctor came in and I explained the whole situation once again.  I was having Intacs in the worse eye and corneal collagen cross-linking (CXL) via a clinical trial in the better eye and I needed to “fail” a pair of contact lenses for my insurance to cover the Intacs (let’s repeat this one more time).  I was a little worried that he’d think I was making him lie, but I had copies of my corneal topography—thank the Lord I thought to get those—and he could see my eyes’ progression since this all began about 9 months ago, or at least compare the current topography with my K-readings. He agreed that Intacs were the way to go and would help him in fitting me with the hybrid contact lenses that I will eventually be wearing, since my cornea will be so much flatter in that eye.

My doctor did an eye exam and refraction and prescribed a trial pair of soft contact lenses, but with a stronger prescription than my glasses.  I’ve never worn contacts—and never wore glasses except for really long drives until this year, so his assistant taught me everything I needed to know about cleaning and storing them and how to put them in and take them out.  I had no idea it was such a big deal and figured it was a good primer for the hybrid contact lenses I’ll be wearing in the future.

After that, I went back into the exam room to make sure the prescription and fit were fine.  I wasn’t aware that I could see better, but I got to 20/25 on the eye chart with them in—using both eyes, and I’m at 20/50—using both eyes—with my glasses, which is no longer legal for driving.  Yikes! However, everything close-up looked fuzzy and I still had a lot of ghosting on the eye chart.  Ghosting is seeing the faint, double, or multiple, images of everything you look at.  I could also really feel the contacts in my eyes, but my doctor said that would go away.  Again, best to get used to it now.

Then I had to deal with getting samples of new eye drops since I have very dry eyes from a separate ocular condition I’ll write about at another time.  Apparently everything I currently use will fog up the contacts, but I barely get relief from my “liquid gel” drops as it is and now I’m back to the “regular” dry eye drops.  More frustration and I’d really like to just have my old myopia, or nearsightedness, back and wear my beautiful D & G glasses that cost a fortune a mere 6 months ago.

I headed to the front to check-out and asked what insurance this was going through.  Vision.  I said I thought these were “medically necessary” so my medical insurance would cover it at 85%.  Negative.  Well, there went close to $100 on a trial pair that provide better—but unstable—vision and are good for one month.  Then I asked who would tell my medical insurance that I failed these.  Oh, that needs to come from the ophthalmologist.

I asked for a copy of my records from today so that he’ll have it in writing.  Today’s records were about as botched as my last two, since there is nothing about failing the contacts and the “plan” is to just get medically necessary contacts; it actually says “plan.”  Sounds like he just negated what my insurance needs, but I sure hope it will suffice.

As I mentioned in my ABOUT section, I live in the desert SW and it was probably 110°F today and the sun/glare is a killer, whether you have keratoconus or not.  So, I reached for my sunglasses, but forgot there’s a prescription in the lenses. What to do?  Contact lenses in my eyes and now no sunglasses and it’s due west to get home at 5 pm.

Well, I did make it and noticed that things were clearer, aside from the blinding sun, which was odd.  I came home and could see the TV for the first time in months and the computer is much easier to see, too.  Of course, I have a stronger prescription and I could also see pretty well with my glasses prescribed 6 months ago before they failed me in less than 90 days, which is before anyone suspected I had keratoconus (can I get my $500 back?).

I see the optometrist at my ophthalmologist’s office in 3 days to get measured for Intacs and hope the insurance loophole can be cleared up at that time via the bizarre medical record I got today.  This will also be the third time I’m getting my eyes dilated—sans driver—in 2 months and I’m not looking forward to it.   I had the worst headache the last time, which I blame on the desert sun.

Now I wonder how I will be able to see after Intacs surgery since it’s only on one eye and isn’t a cure.  Do I pay for another trial pair of contacts until I get the cross-linking in the better eye, which hopefully will be within 45 days?  Once both procedures are done, I can get the hybrid contact lenses, but how do I manage in the meantime?

I think I need an Ocular Liaison if one exists.  I also need a rich benefactor, as all this “treatment” is adding up rather quickly.

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