KFF Health News: Confusion Over Medical and Vision Insurance Results in Surprise Patient Bill
January 30, 2026
KFF Health News: Blurry Line Between Medical and Vision Insurance Leaves Patient With Unexpected Bill
Barbara Tuszynski, a 70-year-old retiree, was understandably concerned about her vision when she visited an eye clinic last May. Diagnosed with glaucoma in her right eye back in 2019, she had undergone a laser procedure in 2022 and regularly uses medicated drops in both eyes to prevent further damage. Her optometrist reassured her during the appointment that her glaucoma had not worsened.
Living in central Wisconsin, Tuszynski had checked her insurance coverage before the visit. The insurer’s website confirmed that the clinic in nearby Madison was in-network, displaying a green check mark next to the optometrist’s name. Confident her policy would cover the appointment, she was shocked when the bill arrived.
The Medical Procedure
During her visit, the optometrist conducted a vision test and took images of Tuszynski’s optic nerves.
The Final Bill
The total came to $340, which included $120 for vision testing and $100 for optic nerve imaging.
The Billing Problem: Vision Coverage vs. Medical Coverage
To her dismay, Tuszynski’s UnitedHealthcare Medicare Advantage plan denied coverage for her eye appointment. The denial letter stated, “The member has no out of network benefits.” Confused, she wondered how an eye doctor could be both in-network and out-of-network simultaneously. She even sent the insurer a screenshot of its own website confirming the clinic’s in-network status.
After raising her concerns, UnitedHealthcare representatives clarified that while the eye clinic was in-network for her vision plan, it was out-of-network for her medical insurance plan. Since glaucoma treatment is classified as a medical issue, her visit was not covered. Tuszynski was baffled that eye care wouldn’t be included under vision insurance, highlighting the complexities of insurance contracts with eye clinics.
Meg Sergel, a spokesperson for UnitedHealthcare, acknowledged that such arrangements are common, even with non-Medicare insurance plans. “I looked up my eye doctor, and it’s the same thing,” she noted in an interview with KFF Health News. She emphasized the importance of patients confirming whether specific services are in-network before undergoing treatment, as understanding the intricacies of a policy can be daunting.
Leaders at Steinhauer Family Eye Clinic, where Tuszynski received care, declined to comment on the situation.
Casey Schwarz, senior counsel for education and federal policy at the nonprofit Medicare Rights Center, pointed out that such complications are common for Medicare Advantage members seeking care at eye clinics or dental offices. With over half of Medicare beneficiaries opting for private plans that offer additional vision and dental coverage, the lack of transparency can lead to confusion.
The Resolution
After receiving the denial, Tuszynski persistently contacted UnitedHealthcare to challenge the decision and filed an appeal. She also reached out to a Medicare hotline to report her issue and contacted KFF Health News for assistance.
Eventually, UnitedHealthcare agreed to cover the bill as if the service had been in-network, with Sergel stating, “In good faith, we made an exception.” However, she warned Tuszynski that future medical care from the clinic would not be covered, as it remains out-of-network for such services. Unsurprisingly, Tuszynski was not pleased with this outcome.
She expressed frustration over the ordeal, stating that it shouldn’t have taken so much effort to resolve the issue. “It’s just been a horrible, difficult whirlwind,” she lamented.
The Takeaway
Schwarz advocates for clearer communication from insurance companies regarding coverage for different procedures and services under vision, dental, and health plans. “They’re tricky,” she remarked. Ideally, she believes Medicare should consider essential services like dental cleanings, eye checkups, and hearing aids as basic healthcare, ensuring they are covered similarly to other medical care. Until such changes occur, patients are encouraged to verify coverage details with their insurers before seeking services.
When Barbara Tuszynski needed glaucoma testing, she checked UnitedHealthcare’s website to ensure her optometrist’s office was in-network. But after declining to pay the bill, the insurer explained that the clinic was in-network for eyeglasses but out-of-network for medical care. (David Nevala for KFF Health News)
By Tony Leys
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
January 30, 2026
KFF Health News: Blurry Line Between Medical and Vision Insurance Leaves Patient With Unexpected Bill
Barbara Tuszynski, a 70-year-old retiree, was understandably concerned about her vision when she visited an eye clinic last May. Diagnosed with glaucoma in her right eye back in 2019, she had undergone a laser procedure in 2022 and regularly uses medicated drops in both eyes to prevent further damage. Her optometrist reassured her during the appointment that her glaucoma had not worsened.
Living in central Wisconsin, Tuszynski had checked her insurance coverage before the visit. The insurer’s website confirmed that the clinic in nearby Madison was in-network, displaying a green check mark next to the optometrist’s name. Confident her policy would cover the appointment, she was shocked when the bill arrived.
The Medical Procedure
During her visit, the optometrist conducted a vision test and took images of Tuszynski’s optic nerves.
The Final Bill
The total came to $340, which included $120 for vision testing and $100 for optic nerve imaging.
The Billing Problem: Vision Coverage vs. Medical Coverage
To her dismay, Tuszynski’s UnitedHealthcare Medicare Advantage plan denied coverage for her eye appointment. The denial letter stated, “The member has no out of network benefits.” Confused, she wondered how an eye doctor could be both in-network and out-of-network simultaneously. She even sent the insurer a screenshot of its own website confirming the clinic’s in-network status.
After raising her concerns, UnitedHealthcare representatives clarified that while the eye clinic was in-network for her vision plan, it was out-of-network for her medical insurance plan. Since glaucoma treatment is classified as a medical issue, her visit was not covered. Tuszynski was baffled that eye care wouldn’t be included under vision insurance, highlighting the complexities of insurance contracts with eye clinics.
Meg Sergel, a spokesperson for UnitedHealthcare, acknowledged that such arrangements are common, even with non-Medicare insurance plans. “I looked up my eye doctor, and it’s the same thing,” she noted in an interview with KFF Health News. She emphasized the importance of patients confirming whether specific services are in-network before undergoing treatment, as understanding the intricacies of a policy can be daunting.
Leaders at Steinhauer Family Eye Clinic, where Tuszynski received care, declined to comment on the situation.
Casey Schwarz, senior counsel for education and federal policy at the nonprofit Medicare Rights Center, pointed out that such complications are common for Medicare Advantage members seeking care at eye clinics or dental offices. With over half of Medicare beneficiaries opting for private plans that offer additional vision and dental coverage, the lack of transparency can lead to confusion.
The Resolution
After receiving the denial, Tuszynski persistently contacted UnitedHealthcare to challenge the decision and filed an appeal. She also reached out to a Medicare hotline to report her issue and contacted KFF Health News for assistance.
Eventually, UnitedHealthcare agreed to cover the bill as if the service had been in-network, with Sergel stating, “In good faith, we made an exception.” However, she warned Tuszynski that future medical care from the clinic would not be covered, as it remains out-of-network for such services. Unsurprisingly, Tuszynski was not pleased with this outcome.
She expressed frustration over the ordeal, stating that it shouldn’t have taken so much effort to resolve the issue. “It’s just been a horrible, difficult whirlwind,” she lamented.
The Takeaway
Schwarz advocates for clearer communication from insurance companies regarding coverage for different procedures and services under vision, dental, and health plans. “They’re tricky,” she remarked. Ideally, she believes Medicare should consider essential services like dental cleanings, eye checkups, and hearing aids as basic healthcare, ensuring they are covered similarly to other medical care. Until such changes occur, patients are encouraged to verify coverage details with their insurers before seeking services.
When Barbara Tuszynski needed glaucoma testing, she checked UnitedHealthcare’s website to ensure her optometrist’s office was in-network. But after declining to pay the bill, the insurer explained that the clinic was in-network for eyeglasses but out-of-network for medical care. (David Nevala for KFF Health News)
By Tony Leys
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
