Understanding logic of medical insurance

Deborah Mitchell - Contributing Columnist

Deborah Mitchell

Contributing Columnist


I can’t remember the last time I had a good time getting my eyes checked.

It’s not so pleasant, sitting in dim light, wearing those giant goggles, trying to see impossibly small letters that are a football field away (or so it seems), finding out that I still can’t see really well and that I still need glasses. Then I suffer through having yellow dye placed in my eyes that eventually runs down my face and turns my previously pink blush a tawdry orange color. Finally, there’s the dreaded dilation of my eyes, rendering me unable to see or drive or do anything for hours.

How surprised I was this past week to discover that, with apologies to Aldous Huxley, a “Brave New World” of technology has come to the optometrist’s office, and having an eye exam is actually getting closer to fun! Oh, I still have to show that I still can’t see very well, but I was treated to a photograph of my eye – not one that I might take with my iPhone (pardon the pun), but a big, 3-D image of the entire interior of my eye. This photo takes the place of my having to deal with dilating my eyes. And it was in color!

According to the information in my patient file, which I received the next day via email, the “Optomap” is “digital retinal imaging technology.” It takes a “wide 180 degree computer-generated image of the eye,” and it allows the doctor to show me the parts of my eye I learned about in fifth grade science – the retina, the blood vessels, where the rods and cones are most concentrated, even my eyelashes. And the picture of my eyelashes showed that the mascara that is supposed to make them thick and luscious is working.

It looks as if my blood vessels are healthy and doing their jobs; they show no signs of hypertension or other dreaded conditions. I show no signs of macular degeneration; my retina is in one piece, and everything else looks good. We saw a couple of “floaters,” which sounds as if I have a couple of small people on life rafts drifting around in the ocean of my eye, but my eyes are doing their jobs well, for the most part.

This 3-D imaging technology is really intriguing. Earlier this year, I had the opportunity to have a 3-D mammogram, which was not quite as fascinating as the Optomap image; it wasn’t in color, so I couldn’t really see the rotation of the image. However, the 3-D mammography is supposed to be much better than the traditional form, because the image does rotate, and radiologists can better find little abnormalities that might be hiding in previously unseen areas. This form of mammogram will be helpful to a vast number of women.

So why, oh why, won’t my insurance pay for it?

That’s right. My health insurance will not pay for the 3-D mammogram, and my vision insurance will not pay for the Optomap image, both of which procedures are more likely to show problems at earlier stages, and both of which are technologies designed to benefit patients. But the insurance companies don’t have to pay, and so they don’t. My 3-D mammogram cost me $134. The Optomap was more affordable, coming in at $37.

I have had few personal complaints about the health care or insurance industries, except for a few years when we paid $750/month and had a $5,000 deductible – and no claims. But we have been generally healthy. Emily had serious migraine problems the year she moved from Savannah to Little Rock to work for a company that did not provide health insurance, but the Affordable Care Act, thank goodness, allowed us to keep her on our insurance because she was under 26.

Why won’t an insurance company pay for procedures that are designed to advance the quality of health care to people who need it? We are told we need to have our eyes checked every year and that a mammogram is a test most women should have annually. Insurance companies should facilitate people’s getting those tests and pay for technology that makes them better.

Deborah Mitchell is a a local attorney and a Municipal Court Judge.

Deborah Mitchell is a a local attorney and a Municipal Court Judge.

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