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An encouraging word about insurance and Vision Therapy


MommyX8
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The verdict is in. It is possible to get your insurance company to pay for vision therapy.

 

 

We have United Healthcare. They have been awesome although I did have to babysit my claims, which really isn't a surprise.

 

I brought my son to a local VT (COVD.) That appointment was $325, which I thought that I was going to eat since he was an out-of-network provider. But, it gave me the medical necessity report that I needed to get the insurance company to precertify that my son does indeed need the services.

 

Next, I scoured through the COVD list and cross-referenced with my health insurance company to find an in-network provider. I found one about 1.5 hours away. I double-checked that the therapy code was the same. So that is when I applied for a gap exception. With UHC, if your closest in-network provider is more than 30 miles from your home, they will pay the difference between the out of network price and the contracted in-network price. In my case, my local guy charged $145 per session, whereas the in-network contracted price was $34.68. So then I submitted my first month's worth of claims. Well, the insurance company went ahead and processed the entire 48 visits of vision therapy.

 

My initial price for VT was $7780.

 

My bottom line out of pocket is $228.

 

So it can be done. It just might take some work.

 

Blessings,

Kim

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Thanks for posting! I just made vision appointments today for kids, one I'm wondering if she'll need some vision therapy. It's with a local COVD, and we carry United Healthcare Vision! I will say, we changed healthcare from them because they would not cover a neuropsych eval :/.

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  • 10 months later...

We also cannot get it covered with BCBS.

 

My plan is to start the therapy in January so the cost will go toward our out of network deductible. Once we hit a certain amount, they will contribute toward out of network expenses. That won't happen with the vision therapy but it might be helpful if we decide to to an np eval later in the year. :)

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I thought it was a medical benefit, but I'm not completely sure.  I have just found and made an appointment for an evaluation with a practice that actually directly bills insurance.  So I will come back and post info on how that process goes for us.  Our appointment is in January.  

 

I found this document online: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Visual_Info_Process_Eval_Orthoptic_Vision_Therapy.pdf

 

It lists a lot of exclusions, including rehab from a neurotrauma which is our underlying medical diagnosis.  So if my son doesn't have convergence insufficiency specifically, I'm not sure if we will be covered.  

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  • 3 months later...
Guest mikkelborg

Hi -- I am looking into vision therapy for my 9-yr daughter and came across this posting.  I've gone to the www.COVD.org website and have located a few doctors in my United Healthcare plan; however, those doctors are not Board Certified (they are not "fellows," but "associates").  A Board Certified doctor is more than 30 miles away.  Do you recall if NO docs at all from your insurance plan were listed on the COVD website, or were no "Board Certified" docs not listed?

Thanks for replying to this old post!

 

 

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You're lucky. Ours flat-out refused, and said it is not medically proven to help. We appealed it and got the same response. Our insurance at the time was Blue Cross Blue Shield.

 

 

We have BC/BS too. Last week I called to see if my ds would be covered for VT. Since it's a muscle issue, they said that would be a medical issue and be covered under medical.

 

Hmmm....I'm gonna call again to MAKE SURE this is correct.

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United Healthcare has said they do not cover vision therapy under my husbands policy.   We have excellent coverage, but the employer did not purchase that rider on the insurance plan. 

 

There are less than 100 employees in the USA who work for my husbands company and they are spread all over the US (he is the only one in our state) so it isn't really worth the battle with HR to try to get them to buy the insurance rider. 

 

 

 

 

 

 

 

 

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Hi -- I am looking into vision therapy for my 9-yr daughter and came across this posting.  I've gone to the www.COVD.org website and have located a few doctors in my United Healthcare plan; however, those doctors are not Board Certified (they are not "fellows," but "associates").  A Board Certified doctor is more than 30 miles away.  Do you recall if NO docs at all from your insurance plan were listed on the COVD website, or were no "Board Certified" docs not listed?

Thanks for replying to this old post!

It looks like your question got buried!  An associate can be FINE.  I'd look at the overall picture.  How much VT are they doing?  Do they have the level of experience to handle the level of problem you have?  Our practice has multiple docs, one of whom is a Fellow with COVD.  The others are associates.  We got perfectly fine care.  If they have someone coming in who has extreme problems (prior surgeries, problems going way beyond simple convergence/tracking/depth perception issues, unusual problems) those people are going to the Fellow.  But sure an associate can do it!  They're just going to vary as to quality and experience, as with any other doc.  

 

Look for feedback from people who have used them.  Look at online and in person reviews.  Visit their office and see their therapy room.  Try just a regular visit with the doc and ask for a screening before you commit to the full developmental vision eval.  See if their therapists are COVD certified.

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  • 3 months later...

Wow! Just popping on here.

 

I use a COVD fellow. When I looked for a VT, I did use the COVD list. Then I searched my insurance database to find an in-network provider. Once I found one, I applied for the gap exception so that my out of network doc would be covered.

 

There have been a few changes in my insurance protocol. At first, they reimbursed us in full and I only needed to take to National Intake once per year for approval. It has now changed to my submitting claims once I have the therapy appointment and 90-day National Intake approval windows. So this takes a bit more work on my end, but still worth it.

 

I currently have one who graduated, one who is about to graduate, and 3 others (including myself) currently in VT. Anyone who has depth perception is also on a home-based computer program (so they don't have to do that part IN therapy.) 

 

I just had an end of unit visit with the doctor. My depth perception is beginning to come in, my eye is not turning off hardly ever now and my eyes are fusing much better. When I walked in the door, I could barely track well enough to read the second line on the eye chart. Yesterday I read the bottom line with no problem whatsoever.

 

 

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Wow! Just popping on here.

 

I use a COVD fellow. When I looked for a VT, I did use the COVD list. Then I searched my insurance database to find an in-network provider. Once I found one, I applied for the gap exception so that my out of network doc would be covered.

 

There have been a few changes in my insurance protocol. At first, they reimbursed us in full and I only needed to take to National Intake once per year for approval. It has now changed to my submitting claims once I have the therapy appointment and 90-day National Intake approval windows. So this takes a bit more work on my end, but still worth it.

 

I currently have one who graduated, one who is about to graduate, and 3 others (including myself) currently in VT. Anyone who has depth perception is also on a home-based computer program (so they don't have to do that part IN therapy.) 

 

I just had an end of unit visit with the doctor. My depth perception is beginning to come in, my eye is not turning off hardly ever now and my eyes are fusing much better. When I walked in the door, I could barely track well enough to read the second line on the eye chart. Yesterday I read the bottom line with no problem whatsoever.

 

MommyX8, you rock!  :hurray:

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  • 1 year later...

We are looking into a healthcare plan that will cover vision therapy for convergence insufficiency for 2016. Has anybody been able to identify a special plan?

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