Insurance

Do Not Underestimate Out Of Network Vision Insurance Coverage

Cleverdude_glassespic

A particular frame style grabbed my wife’s attention as she walked by the optometrist section at Costco. She stopped, put the frames on her face and admired how she looked in the mirror. As she changed the angle at which she was facing the mirror she commented on how much she liked them.

My wife had her yearly eye exam a few months ago, but due to a bad experience with the exam, she didn’t buy any eye wear. She took her prescription with her to buy glasses somewhere else, but she still hasn’t purchased eye wear to replace her current scratched up glasses.

“Costco isn’t in our provider network,” I said.

“So I couldn’t get them?” she asked.

“Well, you could. But insurance wouldn’t cover any of it.” I stated.

Each year when I prepare to have my family’s eyes checked and eye wear replaced I do what most people with vision insurance do. I get a list of optometrists that accept my vision insurance to utilize my benefits and minimize cost. There’s something that I’ve been neglecting to do in this process, however, that may not only limiting my selection but actually costing me money.

I’ve never investigated the use of out of network benefits.

I’ve assumed that the only way to utilize my insurance is to use an in network provider. I had always thought that if I used an out of network provider I would get zero insurance coverage. It turns out that assumption was incorrect.

Many vision insurance plans will provide some coverage when an out of network provider is used.

Vision plans are going to vary widely, but just as an example, here are some data point comparisons between in network and out of network coverage with my vision insurance.

Vision Exam:

  • In Network: Fully covered
  • Out Of Network: $35 allowance

Eyeglass Frames:

  • In Network: $120 allowance, 20% off remaining balance
  • Out Of Network: $35 allowance

Eyeglass Lenses (Standard plastic single vision):

  • In network: Fully covered
  • Out Of Network: $25 allowance

Contact Lenses:

  • In network: $120 allowance, 15% off remaining balance
  • Out Of Network: $105 allowance

While the benefits for frames and lenses is substantially less, the coverage for contact lenses is fairly close. Here’s what we need to do next:

  • Have my wife visit both our favored optometrist, Costco, and other locations and select frames she likes.
  • Have all locations give us a price estimate for new frames and lenses
  • Compare the out of pocket cost applying in network or out of network benefits as appropriate.

THEN we can decide which option gives my wife a set of glasses she likes with the least amount of out of pocket expense.

How about you, Clever Friends, do you have vision insurance? Do you know if you have out of network coverage and have you ever investigated if it would be cost effective to use it?

Brought to you courtesy of Brock

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About the author

Brock Kernin

8 Comments

  • I do have vision insurance (free from my employer even!) and I have used the out of network benefits, which are very similar to the what you listed. It required a bit of paperwork – I had to fill out a form and send in copies of receipts – but all in all, it wasn’t too painful. You can also use any medical flex spending account funds you might have to pay for the glasses as well.

    • I’m glad you brought up the paperwork…..when I use my out of network coverage I also have to submit a form for re-reimbursement as the optometrist would not submit the bill to insurance. I think that’s going to be the usual process for out of network. Thanks for sharing!

  • Pairing out of network reimbursement along with an inexpensive pair of glasses is the way to go for my husband and I. We purchased glasses and lenses from zennioptical.com with a lot of upgrades that would’ve been very expensive from our regular eye doctor. But because Zenni is more affordable we didn’t pay much out of pocket once we were reimbursed for part of the cost. It’s all about taking the time to read what your actual benefits are but unfortunately many people don’t ever think about it. Great article! 🙂

    • Glad to hear you found a way to leverage your out of network coverage to find the best deal for you, Rosy! Thanks for showing us how it can be done!

  • I’ve used my vision insurance out of network at Sam’s Club. Even with the lower amount that they cover, the out of pocket cost was much lower. It cost me approx $130, for everything where my last comparable pair of glasses purchased at an in-network location was almost $400 after insurance.

    • I have a feeling that we’re going to find (as we investigate and compare) that prices at the club store optometrist are going to be cheaper. Sounds like a followup article might be appropriate. 🙂 Thanks for your comment, Jennifer!

  • I have vision coverage insurance thru work. I use my own ophthalmologist as I really like him and the few in-network do not provide the services, so I use out of network benefits for the exam. Once I get the new prescription, I got pricing from the ophthalmologist’s service next door for new lenses/frames and a few other places. My husband used them, they did a horrible job took them back 2 times and all they did was give him grief. Asked for $ back, on advice of a friend went to Costco, got excellent service, they did an excellent job, and the price was so much cheaper than other places my husband ended up getting regular glasses and sun glasses for the same price. My husband cannot see much without his glasses so it is crucial he have good lenses. Costco provided a really good service and product. My next trial will be getting glasses online. Keep you posted when I do that.

    • My wife ended up getting her glasses from Costco, and had a GREAT experience – good to hear you did as well. I’d definitely be interested in knowing how your online experience goes…..come back and let all the clever friends know!

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