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November 1991

Functional Is Distinct From Cosmetic

Author Affiliations

Stuart, Fla

Arch Ophthalmol. 1991;109(11):1493-1494. doi:10.1001/archopht.1991.01080110027011

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


To the Editor.  —The editorial by Anderson and Holds1 in the December 1990 issue of the Archives raises an issue that the Florida Society of Ophthalmology and the state's Medicare carrier, Florida Blue Cross/Blue Shield, have jointly attempted to solve. Unfortunately, the article depicts all providers and carriers as staunch adversaries. With mandates on reimbursement reduction, which the carrier as an intermediary implements but typically does not initiate, a "shoot the messenger" relationship is easy to adopt. All practitioners can produce a list of inconsistent claim handlings by any carrier. An attempt by Anderson and Holds (and recent others) to quantify visual defects in lid droop have already solved the problem for insurers. However, the article cries out not for additional studies on quantifying defects, but for communication with carriers.State ophthalmology societies' third-party reimbursement committees have been successful in dealing with the carriers in Florida, California, Indiana, Virginia, and

Anderson RL, Holds JB.  Does anyone know how to differentiate a 'functional' defect from a cosmetic one? Arch Ophthalmol . 1990;108:1685-1686.Article