Know Before You Go: Eye Exams

Your eyesight is precious. Periodic eye exams are an important step in preserving your vision long term. In addition to correcting your vision, during an eye exam your eye doctor can detect any eye disorders at an early stage, when they are more easily treated and their progress can possibly be reversed.

But navigating eye care benefits can be confusing. The first thing to understand is that there are three different types of eye care providers: opticians, optometrists, and ophthalmologists.

Opticians have a 1- or 2-year degree certification, and specialize in filling lens prescriptions. Once you have your eyeglass prescription in hand, an optician will assist you with lens and frame selection and fitting. An optician is not qualified to conduct eye exams.

Both optometrists and ophthalmologists are qualified to conduct eye exams, where they will not only check your vision, but will also check your eye health for conditions such as glaucoma and macular degeneration.

What’s the difference between optometrists and ophthalmologists?

Optometrists are doctors of optometry (OD) with four years post-graduate doctoral training, and they can diagnose and treat certain non-complex eye conditions, including writing prescriptions. They cannot perform surgery.

Ophthalmologists are medical doctors (MD or DO) who went through four years of medical school plus specialized training in ophthalmology. They can diagnose and treat complex medical eye conditions and perform surgery.

Which should I go to for my eye exam, an optometrist or an ophthalmologist?

Doctors available through vision plans are usually optometrists. If you have a vision plan, it is usually better for you to go to a participating optometrist, for several reasons:

  • Optometrists specialize in eye exams for healthy people who may have some loss of vision, as usually occurs as we get older. That’s what they do all day, every day. It’s their area of expertise.
  • With most vision plans, you pay a lower copay than if you go to an eye doctor who is a medical doctor through your medical plan.
  • Importantly, many medical insurance plans will not cover your visit to an MD/DO eye doctor for the purpose of a routine eye exam.
  • Convenience — very often optometrists will share an office with an optician they trust, so you can choose your frame and lenses during the same visit – a one-stop shop. Also, locations with optometrists are more prevalent and more conveniently located.

An eye doctor is listed in my vision plan, but their office is telling me they will only accept my medical plan. What should I do?

Use your vision benefit plan where possible, not your medical plan. When you call to make an appointment, some optometrists might tell you that they prefer to use your medical health plan, not your vision plan. Don’t be afraid to insist that you will be using your vision benefit plan.

Finally, understand your coverage before you go. Check online with your vision benefit plan before you go to the appointment so you know what’s covered and what’s not, and what your costs might be.

Proactive Ways to Fight the Opioid Crisis

Did you know that there are more accidental deaths from prescription opioids (20,101 in 2016) than from heroin overdoses (12,990 in 2016)? And that more than 80% of heroin users start out abusing prescription painkillers?

The financial ramifications are staggering as well – with much higher work absenteeism and many times more emergency room visits, car crashes, health issues in newborns, rehab treatments, and so on. In fact, health plan sponsors paid nearly twice as much in health care for opioid abusers.

Clearly we need to stem the prescription opioid epidemic.

Many people suffer from chronic pain in this country – but are opioids right for everyone?

Watch the on-demand webinar, “What Can the Workplace Do to Fight the Opioid Epidemic?” where we will explain what you can do to curb opioid abuse. You will learn how to:

  • identify workers at risk of addiction
  • limit the use of opioids among your workers
  • use your health insurance and pharmacy programs to support your workers

During the webinar we present our Opioid Oversight Program, which prevents addiction among newly prescribed members and transitions care for persistent users.

Know where to go: Urgent care, emergency room or primary care physician?

Urgent care centers are a little like Starbucks: They seem to be popping up on every corner. Well, there’s a good reason for this, and it has to do with (you guessed it) money.

Urgent care centers are like a primary care physician, but in a storefront, and without any continuity in your care. And on all health plans I’ve heard of, they also command a higher copay. But urgent care centers are popular because we’re an impatient society that wants something when we want it, and urgent care centers deliver immediacy in care.

If your condition can wait, you’re better off seeing your doctor, who knows you and your history, and will cost you less. Below are some helpful guidelines about whether you should see your doctor, visit urgent care, or go to the ER.

Should I see my doctor, visit an urgent care center, or go to the emergency room?

Unless it is obvious that you should go to the emergency room (ER) or call 911, you should CALL YOUR DOCTOR! All doctors have an on-call service or a nurse triage line that can give you some direction. Your doctor or the nurse triage line can even call in a prescription to your pharmacy if medications are called for.

What if my doctor, her partner, or her practice is not available to speak with me?

If you have access to one, you can use a telemedicine service where a physician appointment is done – right on the telephone. Another alternative is to visit an urgent care center.

Before you find yourself sitting for hours in a hospital emergency room, or end up with medical fees that are not fully covered by your health plan, explore other options first.

When should I go to urgent care?

Urgent care is basically a primary care physician who you doesn’t know you, in a storefront. It’s preferable to go to your doctor who knows you and your medical history, for better coordinated care. Plus, you pay a lower copay to your doctor than you would pay at an urgent care center. However, if you are experiencing a non-life-threatening situation that can’t wait until your doctor can see you, an urgent care center is a fast, more affordable alternative to the emergency room.

What if I don’t have a doctor?

You can find a doctor who’s in your network and make an appointment. If it’s after hours and you don’t have a doctor you can call, then go to urgent care if it can’t wait to find a doctor in the morning.

What exactly is emergency care?

Emergency care is necessary when a person has an unexpected onset of symptoms or a severe medical condition, accident, or illness that could place a person’s health in jeopardy if not treated with immediate medical attention. Severe, sudden symptoms or conditions that don’t quickly get better such as chest pain, extreme shortness of breath, and bad accidents causing severe pain or bleeding require emergency care.

Colorectal screening recommendations

As medical guidelines evolve, MagnaCare aims to keep you informed and recommend the best course of care for your members.

The American Cancer Society recently released new guidelines regarding colorectal cancer screening for average-risk individuals, lowering the recommended age for screening from age 50 to age 45.

The cost implications of these recommendations are potentially significant. Under the new guidelines, your member population would receive the screening at an earlier age, and therefore get more screenings over their lifetime. Additionally, screenings are not without risk to the patient. For example, colonoscopies can tear the lining of the colon and virtual colonoscopies subject the patient to high levels of radiation.

It’s important to note that other guideline-producing organizations such as the US Multi-Society Task Force on Colorectal Cancer and the U.S. Preventive Services Task Force (USPSTF) have not changed their recommended starting age for colorectal screening, which remains at age 50. Based on these standard guidelines, MagnaCare continues to recommend colorectal screenings starting at age 50 in average-risk people, except for African-Americans in whom evidence supports screening starting at age 45.

We also recommend benefit designs that encourage performing the procedure at a participating doctor’s office or ambulatory surgical facility, not in an outpatient hospital setting which is typically much more expensive without providing any additional benefit.

MagnaCare will keep abreast of this issue as the medical organizations build consensus and make strong, clear, and consistent recommendations, and we will recommend coverage determinations based on their decisions.