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Dr. Chan
Dr. Chan, Ophthalmologist
Category: Eye
Satisfied Customers: 356
Experience:  Board Certified in ophthalmology
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A couple of years after getting cattaract surgery on both

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A couple of years after getting cattaract surgery on both eyes, my wife was told that she would require "yag" procedures on both eyes to correct the vison problems very common after such surgery. The problems were sufficiently severe in one of her eyes that she was able to get the "yag" done right away and have it covered by her health insurance. She was told to return in several months when the problems in the other eye would probably be severe enough to meet the insurance criteria so that the "yag" could be performed. Well, today (five months later and after one visit where she was told he problems weren't bad enough to qualify) she came back and was told she can now get get the "yag" on her other eye. However, rather than have it done then and there as was done on the first eye, she must now take 24 hours to digest a very general statement on patients rights and responsibilities and then return for the procedure. WHY? Some kind of new state (Texas) or federal law?
Submitted: 8 years ago.
Category: Eye
Expert:  Dr. Chan replied 8 years ago.


I'm sorry to take so long to get to you. There are no such federal laws. I have done some research and did not find any such Texas law either. The only thing I can gather is that Medicare ruling requires that 24 hours must pass between a visit and a procedure in order for a physician to be paid for both. If he performs a procedure on the same day (or within 24 hours) of an examination, he would most likely not be paid for the examination. This is not a new law, but whether a physician "eats" the examination and just performs the procedure depends on many factors (ease for patient, economic climate, etc.).

Hope this helps and thank you.

Customer: replied 8 years ago.
Thank you..but my wife is not on Medicare. Might the same 24-hour "waiting period" apply to some private insurance ? Her carrier is Aetna; she has the "TRS Care" plan that all retired Texas teachers are on. Appreciate a follow-up. Thaks again.
Customer: replied 8 years ago.

Still waiting for a reply to my reply!

Customer: replied 8 years ago.

I sent you two replies so far..this makes three. In my first reply, I said my wife is not on Medicare (she's only 56), so your answer would not apply to her. I asked if maybe the same 24-hour requirement might be imposed by private insurers, such as the one she's with, Aetna. She has Aetna's "TRS Care" policy, which all Texas teachers get when they retire. (In my second reply, I merely said that I was still waiting for your reply.)

I don't know why you're not getting my replies, but I haven't yet accepted your answer because so far it is incomplete!

I continue to wait for you to complete your answer.

Sorry for the confusion.

Expert:  Dr. Chan replied 8 years ago.

I apologize for the delay in getting back with you. I have been at a meeting. The 24 hours apply to all insurances.
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