Received a question from a provider regarding Harvard Pilgrim

Problem:
"I have the same problem! I just saw the first patients that I have on
this plan. The patient has harvard with "routine vision coverage" and
deductible for medical. They also have eyemed. Harvard rejects the
92015 and discounts the 92024 by 50%. And because its not a medical
diagnosis we cant do COB with eyemed for the refraction(or so I am told)"

ANSWER:
This is actually not a "problem". Harvard Pilgrim follows Medicare guidelines In this area. Medicare does not pay for a refraction because they consider it to be part of an exam. Therefore, it is acceptable to bill all Harvard pilgrim and Medicare patients for a refraction and either NOT bill insurance for the refraction or include a -GY modifier when billing ( which MAY NOT be accepted by Harvard Pilgrim).

If these patients ALSO have EyeMed of VSP you can bill them INSTEAD of Harvard pilgrim but I do not recommend this as it can sometimes cause a patient to lose their annual exam benefit depending on their plan.

Hope this is helpful to everyone. As always, talk back to us or ask anything you want related to optometric billing!