Fidelis and Refraction

Approximately 2 months ago, Fidelis suddenly stopped paying for refraction (CPT 92015). Refraction is when an eye doctor measures how the eye puts things into focus and then figures out what to glasses prescribe (if any). This is very important for children younger than 8 years, as they can permanently lose vision (amblyopia) without the proper glasses. Nearly all insurance companies pay for refraction, at least for children. We have been trying to explain to Fidelis why this is so important for children, and we will keep trying, but until the insurance covers the fee we will be collecting it from our patients. Refraction is necessary at the first visit, and then periodically; sometimes once a year or so, sometimes every few years. We only charge for refraction once every 12 months. For what it’s worth, we think healthcare is human right and all people should have essential coverage. Until then, we have to work the system we are stuck with.