Insurance and Glaucoma
Chat Highlights
January 16, 2002

Norma Devine, Editor

On Wednesday, January 16, 2002, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Insurance and Glaucoma."

Moderator:  Welcome,  Dr. Rick, the topic tonight is "Insurance and Glaucoma."  

Dr. Rick Wilson:  Hello gang.  I get points for being punctual tonight, eh?

P:  You're even early, Doctor Rick.  

Moderator:  What can you tell a patient who has glaucoma, but no insurance?

Dr. Rick Wilson:  Try to get insurance, obviously.   If that's not possible, see if you can qualify for Medicaid.  Most public hospitals have to take care of you if you show up in their emergency room and will usually bill you on an ability-to-pay basis.

P:  If a glaucoma specialist decides that, say, three visual fields per year are indicated for a particular patient, will the insurance companies sometimes be flexible? 

Dr. Rick Wilson:  That depends upon the insurance company and the plan.  Since we do a lot of cutting-edge procedures at Wills, I run into rejections fairly commonly.  Then I have to call the Medical Director or Consultant.  Often, however, he or she is a retired pathologist who lacks even rudimentary knowledge about glaucoma.

P:  Is there a limit on the number of visual field tests most insurers will pay for in one year?

Dr. Rick Wilson:  I'm sure there is, although they may not be forthcoming about it.  Most like to limit the number of visual fields, disc photos and computerized measurements a patient can get in a one-year period.  Some like to limit the number of routine visits, as well.

P:  How do you get glaucoma covered if you don't already have insurance?  Insurance companies don't like to pay for pre-existing existing conditions.

Dr. Rick Wilson:  True.  You may have to pay for six months to a year of care before they will cover it.

P:  I am wondering if it is okay to name names while talking about insurance companies? Not to report anything negative, but to rate or compare?

Dr. Rick Wilson:  I think that as long as the information is truthful, there should be no problem.   

P:  What about insurance that doesn't cover the cost of medication?  If a person is on three or four of the new meds, the cost hurts.

Dr. Rick Wilson:  That is true.  Beta blockers are a mainstay and now are no longer under patent.  A generic, 1/2 percent timolol or levobunolol for eyes with dark irides, and 1/4 percent for light irides, used once a day, gives good value for the money. 

Moderator:  Do you know of any laws that prohibit insurance companies from denying coverage for pre-existing conditions?  

P:  There was one proposed, but I do not think it passed.

P:  In Washington state, so long as a person has been continually insured for the past 18 months, pre-existing conditions are not a concern.  Washington state was in the forefront of insurance reform.  That's why we have a hard time getting individual policies here.  Only two insurance companies offer them.  

P:  What is your opinion of the prescription drug plans that are offered outside of insurance plans?  Do you have much experience with them and whether they cover glaucoma medications? 

Dr. Rick Wilson:  No, I have no personal experience with that.  Some drug plans have a closed panel of medications that can be chosen from and some try to persuade you and the doctor that another (cheaper) drug may be better for you.

P:  As a Canadian, I'm surprised to hear that an insurance company can discontinue someone's coverage.  Is that common in the U.S.?

Dr. Rick Wilson:  It's hard for an insurance company to discontinue coverage if you pay your fees and abide by the contract.  

P:  I think group insurance has different "rules" than individual insurance.  It's easier to get group insurance, that's for sure.  

Dr. Rick Wilson:  But if you don't belong to a group, it's hard to get group rates.  My in-laws had that problem.

P:  Is Medicare more or less strict in their coverage than private insurers?

Dr. Rick Wilson:  Usually less strict.  

P:  I have Medicare and AARP, so the cost of thousands of dollars for eye surgeries in the past 13 months was fully covered.

Dr. Rick Wilson:  That's a nice situation to be in if you have to have repeat surgeries.

P:  In New York state, I have Blue Cross/Blue Shield, which is very expensive.  But no questions are asked, I can go anywhere and be covered, and go as often as I need without any referrals.  It really helps when I am in trouble and have to see my doctor sometimes bi-weekly.

Dr. Rick Wilson:  It is hoped that you get what you pay for.  In Pennsylvania, Blue Cross and Blue Shield have such a large segment of the market that they can dictate fees. That, combined with the malpractice insurance crisis here, has driven 25% or more of our obstetricians out of the state. 

P:  I have Blue Cross/Blue Shield here in Pennsylvania, and when I picked up a 15 ml bottle of beta blocker, I was told I can't get a refill for 90 days!   

Dr. Rick Wilson:  Something will get passed here soon or they won't have doctors left in Pennsylvania.  It is extremely critical right now.  

P:  I think we seriously need tort reform in Washington State,  but so many of the legislators are lawyers, and it would never get done.  The only managed Medicare company left where I live is going broke and hasn't paid their doctors for a year.  Patients aren't being admitted to nursing homes because the doctors won't see them. There's a clinic in our area that doesn't take insurance at all.  The clinic takes take cash only, the rates are incredibly low, and it's really busy. 

Dr. Rick Wilson:  It takes courage to do that, but it can work out well for patients and doctors.

P:  Medical care here in New Brunswick, Canada, is free, but there are not enough doctors.  We have to pay for Blue Cross/Blue Shield.  

Dr. Rick Wilson:  It's not as bad here, but Congress is lowering Medicare fees about five percent when malpractice rates are increasing by 60 to 100 percent.  Canada has taken the opposite (and effective) track from America.  They have rationed the number of doctors that can practice in a certain area, which limits costs, because there is a back-up for surgery and care.

P:  My glaucoma doctor has written off three HRTs (Heidelberg Retinal Tomography) because Blue Cross/Blue Shield of Virginia is one of the few insurance companies to still label the HRT "experimental" and of little value.

P:  I understand that GDx is still considered experimental.  Will insurance pay for it?

Dr. Rick Wilson:  In most areas, insurance companies will pay for a GDx once a year.  (GDx is a computerized way of imaging the thickness of the nerve fiber layer around the optic nerve; that is, the fibers that then go on to make up the optic nerve.)

P:  Here in Brazil, when a doctor gets enough patients and becomes known, he or she stops accepting insurance. 

Moderator:  If an uninsured glaucoma patient needs surgery, but can't afford to pay for it, can Project American help?  

Dr. Rick Wilson:  Do you mean EyeCare America, the Glaucoma Project?

Moderator:  Yes.  

Dr. Rick Wilson:  EyeCare America does not provide any treatment.  Their goal is to educate the population about the risks of glaucoma, especially if there is a family history, African American race, older Hispanic, or age over 60.  They have also been pushing the free screening of individuals to identify patients who have glaucoma.

End of highlights for January 16, 2002.

On January 23, Dr. Wilson discussed "Pain and Glaucoma" in the Chat room. Click here for highlights of that meeting.

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