Case Studies

Managing complications of diabetes


Examination

A.L.’s private insurance includes 80% coverage for one eye examination every 2 years, up to a maximum of $110. His exam fees were $119 for a dilated fundus examination with optical coherence tomography (OCT) in each year: 
Year 1: $119 x 80% = $95.20 paid by insurance; $23.80 paid by A.L.
Year 2: $119 x 0% = $0 paid by insurance; $119.00 paid by A.L. 

In year 2, an additional $49 was incurred to monitor a small hemorrhage to determine risk to vision and whether to refer A.L. for treatment. $49 x 0%= $0 paid by insurance; $49.00 paid by A.L.

Frames and Lenses

A.L.’s insurance includes 80% coverage for frames and lenses, up to a maximum of $220 per 24-month period. A.L. was developing cataracts (common for patients with diabetes), so his prescription was changing and new eyeglasses were needed within the 24-month period. A.L. chose frames from the economy line for $119 and scratch-coated progressive lenses were needed with a non-glare coat (since he drives for work) for a total lens cost of $309.

Total Cost: $428 = $180 paid by insurance; $248 paid by A.L. 

Out-of-pocket costs

For exams, supplemental tests (not covered in NB) and frames and lenses, A.L. incurred $715 in total costs: $275 (38.5%) paid by insurance; $440 (61.5%) paid by A.L. 

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About

A.L. is a bus driver living in New Brunswick with type 2 diabetes. As a condition of his Class 1 license, he must undergo an annual eye examination. A full dilated fundus exam and refractive assessment is carried out yearly to ensure he has not had diabetes-related changes in the blood vessels at the back of his eyes (diabetic retinopathy) and that he is seeing properly.