Points to Consider
If you are thinking of purchasing vision insurance, then there are some things that you will need to keep in mind for optimal coverage. When shopping for vision insurance, consider the following:
- The services the policy covers
- Optometrists and clinics included on the network provider list
- Quality assurance mechanisms, if any.
The right plan to buy depends on the services you need, location of network providers, etc. Look for an insurer that gives you access to multiple eye doctors, and never assume a provider is available in your area. Check the insurer’s list of network providers before buying a plan!
Vision Benefits and Discounts
The ideal plan will be one that covers the services you need, such as eye exams and the cost of glasses and prescription lenses, and that places the highest limits on its coverage of these services. To compare different plans, consider the following:
- Amount of the deductible, or the amount you will need to pay every year before your coverage kicks in.
- Co-payment for services, or the amount you pay out of pocket every time you use a covered service. Generally, the higher the copayment, the less you’ll pay in premiums.
- Limits or caps on covered services. For example, your plan might cover only one vision exam per year, or only one change in prescription lenses per year.
- Rate of discount for each service
- Who receives the discount amounts — insurance company or care provider or both
- Payment for services: Will your provider be able to bill the insurer, or will you have to pay for services upfront and file a claim for reimbursement?
- Look for a plan that allows a coverage allowance for using out-of-network providers.
- Check whether the plan requires preapproval before it will pay charges from an out-of-network provider.
- What do you need to do to obtain reimbursements for services from an out-of-network provider?
- Amount the plan reimburses out-of-network providers for each service.
For surgical procedures, such as LASIK or PRK refractive surgery, you want the most experienced eye surgeon available. Therefore, you should select your provider based on experience rather than whether he or she is in- or out-of-network or has the lowest rates in town.
Going for an Eye Exam
When you arrive for your exam, someone on the doctor’s staff will ask you the name of your vision insurance company, your insurance plan, and your I.D. number. Some medical providers will submit your claim to the insurer and then bill you for the difference, which is why they need this information.
If you were given an I.D. card, then you will be asked to supply it at the time of your appointment. Depending upon your vision plan, you also may be asked to pay a deductible, and/or a co-payment for the services you receive. You may receive a discounted rate, thanks to the insurer’s negotiating power.
For out-of-network providers, you will be paying in full for dental services at the time you get them. If your plan allows for reimbursement, you will need to submit all your receipts to your vision insurance company.
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