How To Use Vision Insurance

By Madeleine Vessel

As soon as you purchase or enroll in a vision insurance plan, obtain a copy of your plan brochure or find out how to access it online. Study the brochure carefully to determine what your benefits include, what costs are involved, and who is on your network provider list. Look also for answers to the following questions:

General Questions:

• What services am I entitled to under my vision plan?
• Who is on the network provider list?
• How do I schedule an appointment with an eye care provider?
• What quality assurance mechanisms are in place?
• What is the process for settling grievances?

Questions About Vision Benefit Packages:

• Do I need an I.D. card? If so, how do I obtain one?
• How much is the deductible I must pay before the insurance company begins to pay its share of the expenses?
• How much is my co-pay for each service?
• Are there limits to what the plan will pay for any of the services?

Questions About Discount Vision Plans:

• How much is the deductible I must pay before discounts apply?
• What discounted rate can I expect to pay out-of-pocket for each service?
• To whom do I pay the discount amounts? The vision insurance company? A primary care provider? Each provider separately?
• How do I pay for services? Do I use a pre-paid discount card, pre-paid coupons, cash, check, or credit card?
  

Questions About Out-of-Network Providers:

• Does the plan allow out-of-network providers?
• Do out-of-network providers need to be approved by the vision insurance company in order for me to receive reimbursements?
• How do I request reimbursements for out-of-network services?
• What amounts can I expect to be reimbursed for each service?

Using Your Vision Insurance for an Eye Exam

After you understand your benefits and know which providers you can use, you are ready to make an appointment for an eye examination. When you make your appointment, be prepared to supply the optometrist or ophthalmologist with the name of your vision insurance company, the name of the plan under which you are covered, and your I.D. number. This is because they usually need pre-authorization from your vision insurance company before they can render a service.

At the time of your appointment, you will be asked to show your vision insurance I.D. card or give some other proof of vision insurance coverage. Depending upon your vision plan, you also may be asked to pay a deductible, and/or a co-pay or discounted prices for the services you receive.

If you require a prescription for vision correction, your optometrist or ophthalmologist, who is also your primary care provider, may help you pick out eyeglasses or contact lenses if these services are available on site. Typically, the primary care provider also will arrange with a laboratory to have your eyewear prescription filled then contact you when your lenses are ready to be fitted.

If you select an out-of-network provider, you can expect to pay the full retail price for the services you want at the time of service. Typically, you must submit a request for reimbursement and an itemized copy of all your receipts to your vision insurance company to receive reimbursement.

How Do I Know When Not To Use My Vision Insurance Benefits?

You may choose not to use your vision insurance when you are restricted to using network providers only, or when...

• The optometrist or ophthalmologist you are comfortable using is not on your vision plan's list of preferred providers.
• The closest network provider is located farther away than you are willing to travel.
• It takes too long or is impossible to obtain a convenient appointment with a network provider.
• The selection of eyeglass frames offered by your preferred provider isn't what you want. Eyeglass frames need to suit the shape of your face and should match the fashion statement you want to make.
• When the eyeglass lenses you prefer aren't covered by the vision plan.
• When you can obtain a service cheaper by going outside the provider network. For example, some online eyeglass and contact lens services can be obtained very inexpensively.

You may have other considerations when you are planning to undergo LASIK or PRK refractive surgery. Because this is an elective surgical procedure for vision correction, you should choose the most qualified and experienced eye surgeon available. This should be your priority above shopping for the lowest cost or accepting only a provider approved by your vision plan.

[Page updated March 2009]