What is BEST?
BEST provides free vision screenings and financial assistance to Texas residents for medically urgent eye treatment with a referral from your ophthalmologist.
How Do I Qualify for the Treatment Program?
To be eligible for the program, you must:
- Be at least 18 years of age
- A Texas resident
- Not have insurance or any other resource in which to pay for treatment
- Not be legally blind
- Have recommendation from your ophthalmologist
What Services Are Available?
The BEST program provides 3 services:
- Blindness prevention education/resources
- Vision screenings to identify conditions that may cause blindness
- Urgent eye medical treatment to prevent blindness
Blindness Prevention Education/Resources
If you do not qualify for financial assistance for BEST treatment, the BEST program specialist can provide other resources that may meet your needs.
What is a vision screening?
Vision screenings are a non-diagnostic tool that asses a person's risk of vision loss and eye disease. Vision screenings are provided by certified vision screeners with the results of the screening discussed with each participant. Participants whose results indicate a possible vision problem will be recommended for a follow-up eye exam with the participant's health care provider. Participants without health coverage will be provided referral resources and related information to obtain a follow-up eye exam or eye treatment.
Vision screenings occur throughout the state of Texas at specifically scheduled locations. Please contact BESTprogram@hhsc.state.tx.us for the latest vision screening schedule. Vision screenings are conducted throughout the year.
In order to prevent blindness, an ophthalmologist may recommend various treatment and/or surgical procedures for those who have a medically urgent eye condition. If an applicant is determined eligible for BEST, financial assistance will be provided to cover the cost of the recommended eye treatment and/or surgery. Please see below on possible qualifications for eligibility.
What is Medically Urgent?
A medically urgent condition is an eye condition that an eye care physician has recommended treatment/surgery that left untreated, could lead to blindness. Common conditions are:
- Diabetic retinopathy
- Detached retina
Any other medical condition must be determined to be medically urgent by both the referring ophthalmologist and the BEST program specialist or the HHS medical consultant or his or her designee.
Note: The BEST Program is unable to cover the cost of cataract surgery.
How Do I Apply for Eye Medical Treatment Services?
The BEST Treatment application can be found below. We recommend you complete and sign the first page. Your ophthalmologist must complete the rest of the application to determine treatments needs. Once the application is complete, the eye doctor's office may fax the application directly to the BEST program specialist, as directed on the application. Once the completed treatment application is received, the application will be reviewed to determine if you meet eligibility criteria and it will be processed. When funds are available, the BEST program specialist contacts your ophthalmologist’s office to approve treatment and obtain date(s) of treatment service.
Should the Ophthalmologist Submit the Application?
Yes. Form 6499, Application for Treatment, includes information to calculate individual costs for requested medical treatment(s). The most common procedures are provided; however, the ophthalmologist may use the blank lines to enter a procedure code that is not listed. The BEST program specialist may be contacted to obtain the correct fee for unlisted procedures.
Make sure to include the total cost for each provider in the respective billing information section:
- Physician fee
- Anesthesiology fee
- Facility fee
Instructions for providing the required billing information about physician-prescribed drugs are contained in that section.
- All completed applications must be legibly printed or typed.
- The treatment application must be signed by the applicant, the treating physician and/or the anesthesiologist and facility, if required.
- If a treatment application is incorrect (i.e., total fees, missing information missing, etc.), the BEST program specialist will ask for the application to be corrected and resubmitted before the treatment application can be processed.
The treating physician can submit the application by faxing it to 512-438-4370. Please mark it to the attention of the BEST program specialist.
The BEST application and accompanying instructions are routinely updated to reflect programmatic changes. The effective date is indicated in the upper left-hand corner of each page. Only the most updated application will be considered accurate and complete. All others will need to be resubmitted using the most current application.
Frequently Asked Questions
What is the Payment Rate for Treatment Services?
Payment for eye-related medical services is based on the Maximum Affordable Payment Schedule. For your convenience, a list of commonly requested treatment services and the maximum allowable payment for each procedure is included on the application form.
Are There any Restrictions on Payment for Eye Examinations?
The BEST Program does not pay for routine eye examinations that are unrelated to requested medical treatment. However, the program will pay for diagnostics and testing that are submitted with a treatment request. An application for diagnostics only must be made on behalf of an applicant with 20/25 vision or worse in the better eye with best correction, or for an applicant who the treating physician suspects may need treatment. Follow-up eye examinations covered by a global treatment period are the responsibility of the treating physician.
When Can Treatment Services Be Provided?
The following are processes that must be completed before treatments services can be provided:
- Receipt of a current and complete Form 6499, Application for Treatment
- When funds are available for treatment services, the first person on the wait list will be contacted. People will be served according to the order in which they are on the wait list.
- When a person has been determined eligible, the treating physician’s office will be notified that funds are available to proceed. The BEST program specialist will ask for the date of the surgery before a purchase order will be processed.
- When the date of surgery is known, a purchase order will be processed and faxed to the appropriate parties (i.e., treating physician, facility fee or anesthesiologist).
How do I Submit an Invoice for Payment?
To process payment for treatment services, the BEST Program must have 3 required documents.
- An invoice detailing the date of service, service provided and dollar amount
- A report from the treating physician that includes:
- A summary of the treatment services provided
- Post-treatment corrected visual acuity (Snellen equivalent, right eye/left eye)
- Post-treatment visual field restrictions if relevant (right eye/left eye)
- Future prognosis
- A copy of the operative report for surgical procedures and/or a copy of the treating physician's written interpretation and report when applicable as indicated in the CPT code description.
Once all three documents are received, a warrant will be issued for services received.
Does BEST pay for prescription drugs?
The BEST Program does not cover over-the-counter and/or nonprescription drugs. BEST only will pay for ophthalmic prescription drugs needed to prevent blindness. Payment for the cost of covered prescription drugs is limited to the number of refills prescribed by the treating physician or optometrist or one year, whichever is less. The BEST Program will not pay for a name-brand drug if a generic alternative is available.
The following are the procedures for payment for prescription drugs:
- Before authorization is granted for the payment of prescription drugs, the applicant must obtain pre-approval from the BEST Program Specialist by having their physician submit a completed BEST Application for Treatment.
- The physician must provide a copy of the applicant's prescription with the completed application.
- The applicant must designate the pharmacy they will use on the application and must obtain prior approval from the pharmacy that they will agree to participate in the program.
- All billing information in the “Physician-Prescribed Drug Treatment” section of the application must be completed by the applicant's chosen pharmacy. The pharmacy must fax a price quote for the requested prescription drugs along with their completed portion of the application.
- Payments for approved prescription drugs shall be made only to the applicant's pharmacy of choice.
- Upon approval, the BEST Program Specialist will contact the applicant to inform them, if they are eligible and will issue a voucher to the designated pharmacy to order the prescription drug.
How is a Claim Processed?
Only claims for services approved in advance by Texas Health and Human Services will be paid. Payment claims for BEST treatment services must be received within 90 days from the date of each service. Claims lacking the information necessary for processing shall be denied as incomplete claims. The program must receive the resubmission of the corrected claim within 60 days from the last denial date or payment will be declined.
What Else do I Need to Know?
The program does not pay cancellation charges, charges for missed appointments, consultation fees or any other charge incurred other than for the actual provision of treatment services.
May I use BEST Treatment Services More Than Once?
The BEST Program often has a greater demand then there are funds available; therefore, treatment services can only be provided 1 year from the date of your last treatment. You may reapply 1 year from your last treatment.
How is BEST Funded?
The BEST Program receives donations from Texas Residents who choose to donate $1 when they renew their driver's license or ID at the Texas Department of Public Safety.
Who Should I Contact for Questions?
To contact a BEST Program Specialist email BESTprogram@hhsc.state.tx.us. Our goal is to provide services across the state in order to help Texans see their BEST!