Barbara Tuszynski did everything she thought she was supposed to do.

She checked her insurance.
She confirmed her eye clinic was “in-network.”
She went in for a routine glaucoma check to make sure her vision hadn’t worsened.

And then she received a $340 bill she wasn’t expecting.

In an interview with The Washington Post, Barbara, a 70-year-old retiree living with glaucoma, shared a confusing reality many patients don’t learn until it’s too late: vision insurance and medical insurance are not the same thing—even when it comes to your eyes.

What Happened

Barbara has glaucoma and requires regular monitoring, including eye exams and optic nerve imaging. Before her appointment, she checked her insurer’s website and saw her optometrist listed as “in-network.” That gave her confidence her visit would be covered.

After the appointment, UnitedHealthcare denied the claim.

The reason?
Her eye clinic was in-network for vision services (like glasses and contacts), but out-of-network for medical eye care — and glaucoma is considered a medical condition, not a vision benefit.

In other words, the same clinic was:

• ✅ In-network for vision benefits
• ❌ Out-of-network for medical treatment

Yes, at the same time.

Why This Happens (and Why It’s So Confusing)

Many Medicare Advantage plans — and employer plans too — split eye care into two separate buckets:

• Vision benefits: eye exams for glasses or contacts
• Medical benefits: treatment and monitoring of eye diseases like glaucoma

A provider may contract with your insurer for one but not the other.

Even insurance representatives acknowledge this is confusing. As one spokesperson explained, patients often assume “vision insurance covers eye care,” when in reality it may only cover eyewear-related services.

Why Glaucoma Patients Are Especially at Risk

Glaucoma requires:

• Regular eye pressure checks
• Optic nerve imaging
• Ongoing medication management
• Sometimes laser or surgical procedures

All of these are considered medical care, not routine vision care.

That means coverage depends on your medical plan network, not just your vision plan — even if you’re seeing an eye doctor you’ve gone to for years.

How This Case Was Resolved

After multiple calls, an appeal, and a complaint to Medicare, UnitedHealthcare agreed to cover Barbara’s bill as a one-time exception.

However, she was warned that future glaucoma-related care at the same clinic would not be covered unless she switched to an in-network medical provider.

What You Can Do to Protect Yourself

If you live with glaucoma, these steps can help you avoid surprise bills:

Before your appointment, ask two questions:

1. Is this provider in-network for my vision plan?
2. Is this provider in-network for my medical insurance for glaucoma care?

Be specific about services
Ask whether tests like optic nerve imaging, visual field tests, or laser procedures are covered.

Call your insurer — not just the provider
Insurance websites can be outdated or unclear. A quick phone call can save hundreds of dollars.

Document everything
Take screenshots, write down names, dates, and reference numbers.

Know that you can appeal
If coverage is denied, you have the right to appeal — and sometimes, as in Barbara’s case, persistence matters.

Help Paying for Glaucoma Care

If the cost of glaucoma care ever feels overwhelming, you’re not alone—and help may be available. There are programs that can assist with eye exams, medications, procedures, and other glaucoma-related medical needs, especially for people on Medicare or those facing financial hardship. Learning what your insurance covers and knowing where to turn for extra support can make a real difference in staying on track with care. Explore these trusted resources to see what options may be available to you:

• Medicare and Eye Health: https://glaucoma.responsumhealth.com/medicare-and-eye-health
• Prevent Blindness Financial Assistance Programs: https://preventblindness.org/glaucoma-financial-assistance-information/
• Free and Low-Cost Eye Care Resources: https://glaucoma.responsumhealth.com/free-eye-care-resources
• AGS Cares Patient Assistance Program: https://glaucoma.responsumhealth.com/supporting-vision-the-ags-cares-program

*The Washington Post (January 30, 2026). “She has glaucoma. Her ‘vision insurance’ didn’t always cover eye care.” washingtonpost.com

The information provided by The Glaucoma Community is for educational purposes only and does not replace professional medical advice. Always talk with your healthcare provider before making changes to your treatment or care. The Glaucoma Community does not endorse specific treatments, providers, or products.