Why did UnitedHealthcare deny Barbara Tuszynski's glaucoma testing bill?

UnitedHealthcare denied the bill because the eye clinic was considered out-of-network for medical care, even though it was listed as in-network for vision services like eyeglasses.

What is the difference between vision and medical insurance for eye care?

Vision insurance typically covers services related to glasses or contact lenses, while medical insurance covers treatments for eye conditions such as glaucoma.

What did Barbara Tuszynski do after her claim was denied?

Tuszynski appealed the decision with UnitedHealthcare, contacted federal Medicare officials, and eventually received coverage for the bill as an exception.

Home / Health / Patient Baffled: In-Network Eye Clinic Denies Medical Care

Patient Baffled: In-Network Eye Clinic Denies Medical Care

30 Jan

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Summary

An insurer listed an eye clinic as in-network, but denied care for glaucoma.
The clinic was only in-network for vision care, not medical eye treatments.
UnitedHealthcare made an exception, but warned future medical care won't be covered.

Patient Baffled: In-Network Eye Clinic Denies Medical Care

Barbara Tuszynski faced confusion when UnitedHealthcare denied her $340 glaucoma testing bill, despite her verifying the clinic was in-network. The insurer clarified the clinic was only contracted for vision services like glasses, not for medical care such as glaucoma treatment.

This distinction highlights a common issue where insurance plans have separate networks for vision and medical services. UnitedHealthcare noted such arrangements are frequent and recommended patients inquire about network status for specific treatments beforehand.

After Tuszynski appealed and contacted Medicare officials, UnitedHealthcare covered her bill as a one-time exception. She was cautioned that future medical care at the clinic would not be covered. For 2026, Tuszynski switched to traditional Medicare and a supplemental plan, ensuring her glaucoma treatment at the clinic is covered, though she lost vision plan benefits.