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Thread: Eye exams

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    #1

    Eye exams

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    I know that Tricare only pays for one eye exam per year... But I have a question about that.

    I have a daughter who did have a lazy eye but now its no longer lazy only crossed. It is medically necessary for her to see her specialist every 3-6-9 months (depending on whats going on with her eyes at the time). She also has to wear medically necessary bi-focals. She normally gets a new prescription every other eye exam.

    Will they be willing to pay for this or should I plan on everything being out of pocket always?

    I am pretty sure she will be put in EFMP, so hopefully that will help ease the path a bit. We are hoping they will do corrective surgery but so far every specialist she has been to has wanted to try to avoid it. But in the long run it will be more cost effective and less damaging to her (being picked on is pretty rough on her).
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    #2
    Quote Originally Posted by dgwheeler View Post
    I know that Tricare only pays for one eye exam per year... But I have a question about that.

    I have a daughter who did have a lazy eye but now its no longer lazy only crossed. It is medically necessary for her to see her specialist every 3-6-9 months (depending on whats going on with her eyes at the time). She also has to wear medically necessary bi-focals. She normally gets a new prescription every other eye exam.

    Will they be willing to pay for this or should I plan on everything being out of pocket always?

    I am pretty sure she will be put in EFMP, so hopefully that will help ease the path a bit. We are hoping they will do corrective surgery but so far every specialist she has been to has wanted to try to avoid it. But in the long run it will be more cost effective and less damaging to her (being picked on is pretty rough on her).
    Yes, Tricare should cover all of that. I have Keratoconus and see an ophthalmologist on a regular basis. Tricare covers all of my visits/exams, as well as my gas permeable contact lenses.
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    #3
    AS long as it is medically necessary Tricare SHOULD pay for those exams. It all comes down to how the doctor bills Tricare.
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    #4
    Quote Originally Posted by BigMama View Post
    I know that Tricare only pays for one eye exam per year... But I have a question about that.

    I have a daughter who did have a lazy eye but now its no longer lazy only crossed. It is medically necessary for her to see her specialist every 3-6-9 months (depending on whats going on with her eyes at the time). She also has to wear medically necessary bi-focals. She normally gets a new prescription every other eye exam.

    Will they be willing to pay for this or should I plan on everything being out of pocket always?

    I am pretty sure she will be put in EFMP, so hopefully that will help ease the path a bit. We are hoping they will do corrective surgery but so far every specialist she has been to has wanted to try to avoid it. But in the long run it will be more cost effective and less damaging to her (being picked on is pretty rough on her).
    If it is deemed medically needed they will pay for more than one visit a year.

    My son actually had his eyes cross out of nowhere and so we had to see a optamologist and have surgery which meant several follow up appts for the year afterward. But now he is back on once a year.

    I don't know if he got put on the efmp because we went from diagnoses to surgery to no further problems in approx 6 months time.
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    #5
    Yes they will cover it. You will have to get a referral though for the appt.
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    #6
    Quote Originally Posted by Southern-momma View Post
    My son actually had his eyes cross out of nowhere and so we had to see a optamologist and have surgery which meant several follow up appts for the year afterward. But now he is back on once a year.

    I don't know if he got put on the efmp because we went from diagnoses to surgery to no further problems in approx 6 months time.
    So they gave him surgery? That is our goal. They said back when she was 4 that she should be completely out of glasses by the age of 10 and now her eyes are worse than ever.

    I wouldn't mind them being worse if it wasn't them making the good eye weaker just to make the weak eye stronger...

    Her eye messed up out of nowhere too back when she was 4. It was fine then there it went!
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    Quote Originally Posted by BigMama View Post
    So they gave him surgery? That is our goal. They said back when she was 4 that she should be completely out of glasses by the age of 10 and now her eyes are worse than ever.

    I wouldn't mind them being worse if it wasn't them making the good eye weaker just to make the weak eye stronger...

    Her eye messed up out of nowhere too back when she was 4. It was fine then there it went!
    That is exactly what happened with us (my son was 5). So we had him checked (via mri) to make sure it wasn't anything due to a brain issue and that was fine. So they sent us to an ophthalmologist off base. We got a diagnose from that dr and a suggest method of treatment. Was not happy with that option right off the bat. Got a referral to another dr and he had that treatment as the end suggestion. So they patched my son for several months which helped, and than we did surgery which fixed the problem so now his eyes are as good as they can be. He has to wear glasses but his vision is perfect with those.

    Is her diagnoses Amblyopia?
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    I am not sure the exact diagnosis... but that looks like the word that was written on her medical records that I saw. They never did an MRI or anything.

    All three doctors we have went to have wanted to do the bifocals. They said she was past the stage of patching, but no one wants to do surgery. The 2nd guy we went to actually gave me a big spill on parents wanting their kids to have surgery before I even mentioned it to him on our first visit. Needless to say it was also our last with him.
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    #9
    Quote Originally Posted by BigMama View Post
    I am not sure the exact diagnosis... but that looks like the word that was written on her medical records that I saw. They never did an MRI or anything.

    All three doctors we have went to have wanted to do the bifocals. They said she was past the stage of patching, but no one wants to do surgery. The 2nd guy we went to actually gave me a big spill on parents wanting their kids to have surgery before I even mentioned it to him on our first visit. Needless to say it was also our last with him.
    Well surgery is what will make her eye go back to where it was. If it is the same issue than you might have to advocate for surgery. That is NOT a bad thing at all. Like I said my son was 5 and in kindergarten. He missed less than a week of school if I remember properly (and it was not done during any breaks smack in the middle of the school year).

    But you need a good dr. Luckily we had a fantastic dr who put our whole family (including my son) at ease. The first dr he flipped off
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    #10
    Well as soon as we get Tricare started, we will start our quest once again for another new doctor. It will also be summer time so plenty of time to find a good one.
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