Glaucoma care uncovered limits in vision insurance coverage

A Medicare Advantage enrollee received a $340 bill for glaucoma tests after her insurer said the clinic was in-network for vision (glasses) but out-of-network for medical care; UnitedHealthcare later paid the bill as an exception.

Barbara Tuszynski, a 70-year-old retiree with glaucoma, went to an eye clinic last May for routine testing. She checked UnitedHealthcare's website beforehand and saw the optometrist listed as in-network, so she expected her plan to cover the visit. After the appointment she received a $340 bill for vision testing and optic nerve imaging, and her Medicare Advantage plan initially denied payment. The insurer explained the clinic was in-network for vision (glasses) benefits but out-of-network for medical care, and classified glaucoma treatment as medical. Key facts: - UnitedHealthcare told Tuszynski the clinic was in-network under its vision plan but out-of-network for the medical services related to glaucoma, and it denied the claim on that basis. - Tuszynski filed an appeal with the insurer, contacted a Medicare hotline, and raised the issue with the Bill of the Month project. - UnitedHealthcare later agreed to pay the $340 bill as if the service had been in-network, while saying the clinic remains out-of-network for medical care. - For 2026, Tuszynski left her Medicare Advantage plan and enrolled in traditional Medicare with a supplemental plan; she no longer has the vision coverage she used to buy glasses. Summary: The case shows that separate contracts for vision benefits and medical benefits can result in surprise bills even when a provider appears listed as in-network. Insurer representatives said such arrangements are common and recommended verifying network status for specific services. In this instance the insurer reversed the denial and paid the bill as an exception, and the enrollee switched to traditional Medicare for 2026.