Prosthetic eyes. Australian health insurance item numbers.

We’ve just come back from another interesting meeting of the Ocularist Association of Australia.

At the meeting we discussed the development of a universal item number for artificial eyes. With the current system in Australia artificial eyes are covered by most health insurance companies as an ancillary benefit. This is similar to dental and optical claims.

The issue that causes confusion and makes it hard to make a claim is the multitude of loosely defined item numbers for artificial eyes.

With Medibank private the item number for a new eye prosthesis is EP 13 and is covered under some policies but not all with their super extras policies.

HBF use the number A802 under ancillary benefits

HIF uses item number F-A0244

Many of the smaller insurance companies there is no item number at all and payments are made add hock as ex-gratia payments.

Because there are no clearly defined item numbers the insurance companies create their own policies which results with artificial eyes being bunched in with insurance sub categories such as External prostheses. The system is so confusing that the insurance front desk staff are often unable to calculate benefits and claims need to be sent in the head office to sort out the mess.  

The Ocularists Association of Australia is implementing a set of item numbers that we hope will be adopted by all the insurance companies with clear definitions for all items. We are working with the Australian Health Insurance Association (AHIA) to adopt a set of numbers that are suitable for them.

The new item numbers will not affect the rebates people are receiving at the moment but hopefully this will provide some clarity and uniformity across health insurers. With the universal item numbers, when you talk with your insurance company or wish to compare health insurers everyone will be talking about the same thing.

3 Comments

  1. Avatar for medical bills reduced medical bills reduced on April 29, 2010 at 10:05 pm

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  2. Avatar for dental clinics north sydney dental clinics north sydney on July 5, 2010 at 7:21 pm

    Useful information. Prosthetic eyes. Australian health insurance item numbers the multitude of loosely defined item numbers for artificial eyes.
    Hope to see more good posts in the future.

  3. Avatar for Insured in Melbourne Insured in Melbourne on March 30, 2015 at 7:48 pm

    Just wondering if there has ever been an update to this, or even better; a list which has every insurance company thats pays out for fake eyes listed?

    I know defence health pay out, in which there are 2 versions. 1) closed to new members ($1,000), (2) The current “top top extras” (can’t remember name, but still new) which pays $1,500 ish.

    Would love it if there are some updates 🙂

    Especially since the prices go up next month!

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