Not covering what exactly>?

Plaquenil can cause eye problems , but is far from experimental. It was designed for malaria but works - and yes they aren't sure how exactly- but it should not be an issue.

You just need a 6 month eye exam. Your insurance shouldn't even care.

They cover eye exams. As for covering the cost of plaquenil they should cover that too to what ever percentage it does cover.

Are they rejecting the eye exam or the field vision test?

Some insurance companies have people who you can talk to about the coverage to make sure you do what you need to do before you go for the exam. If yours offers this take advantage of it.
When I went in for my "plaquinil" visit I specifically stated I did not want any vision testing only the examination necessary for plaquinal because I knew my medical insurance would cover that alone. The ophthalmologist office billed for an eye exam anyway. Their error but they claimed they never do eye exams without vision testing. Lucklily I had written down on the forms filled out upon arrival that I did not want a vision test only the exam necessary to rule out complications associated with plaquinal. So they could not make me pay for the vision test. Needless to say I won't go back to that doctor!

Thank you all. My insurance coverage is top notch The drug is covered & so are eye exams. This this particular retina exam, I think it is just a matter of proper coding. The treatment code was "drug interaction" which is not covered. However there is a similar code pertaining to long term drug usage which should cover it. I also have small cysts of no consequence in my eyes and there also is a code for that. So I am going to contact the office and request that they resubmit with either of these codes which is totally on the up and up.

You may want to check and see if you actually have a diagnosis of sjogren's syndrom of sicca on your eye doctor exams. I don't have vision insurance, but do have medical. My vision exams at an optometrist for glasses etc are not covered, but my biannual exams at the ophthamologist for the overall health of my eyes from the SS is covered. So the problem may be either the diagnosis they use or the type of eye care professional that you use. Hope this helps and that you get some results soon.

I found the ICD code for monitoring drug side-effects. It is
ICD V58.69

The ICD code for Sjogren's is 710.2

I hope this helps in getting your insurance to cover necessary vision screening tests.

Thank you all again. I also found this code and it is covered by my insurance company. However the full description is "long term use of medications (high risk medications for retinopathy or neuropathy) which may not fit the situation.

I don't know if you have both vision and medical insurance and I don't know if you went to an optometrist or an opthomologist (Sp?). You could have problems with vision insurance, but if you go to an opthamologist because of an illness that should go under your medical insurance. At least that is the way it works for me and I have no problems.

I went to my MD opthomologist and everything else was covered. Again I believe it to be a coding mistake.