Insurance Won't Pay for Progressives

[TPL]

For future referance,most insurances will consider a progressive bifocal to be classified as the same as a trifocal if the add is 2.25 or higher;will pay the same dollar amount

[shellrob]

Like Jubilee said, the office should've billed the base price with an add on progressive code. I hope you switch offices, sounds like they were too lazy to service you correctly.

[beach57]

Their reason for not billing it as a trifocal with a progressive code was because they felt it was "insurance fraud." I just switched to this office, so I will make sure in the future that they agree to bill it this way so I can get reimbursed.

I am extremely impressed with the optometrist and he comes highly recommended. The person who works in the on-site lab is also very knowledgeable and helpful. The optometrist's support staff, on the other hand, needs some improvement.

[pauly47]

You mention a $10 week deduction from my paycheck for insurance. My BC/BS plan costs our family $1.50 per week. So our vision plan costs us $78 per year. For that, all three of us each get reimbursed $36 for eye exams, $100 for progressive lenses (husband and myself), $97 for contact lenses (daughter), and $45 for frames. That comes to a total of $540 in vision benefits for a $78/year premium. I don't think that is a bad investment of our money. I'm just frustrated that my optometrist won't bill my progressive lenses properly so I can get reimbursed as I have in the past.

But the Optometrist DID bill correctly for a progressive. It's your old optometrist who didn't bill correctly. That's why they created the CPT codes to specifically identify procedures, products, etc...A progressive lens is not a trifocal lens so it shouldn't be billed that way.

[Bill West]

You mention a $10 week deduction from my paycheck for insurance. My BC/BS plan costs our family $1.50 per week. So our vision plan costs us $78 per year. For that, all three of us each get reimbursed $36 for eye exams, $100 for progressive lenses (husband and myself), $97 for contact lenses (daughter), and $45 for frames. That comes to a total of $540 in vision benefits for a $78/year premium. I don't think that is a bad investment of our money. I'm just frustrated that my optometrist won't bill my progressive lenses properly so I can get reimbursed as I have in the past.

Weird math: So if 100,000 people get the deal you got, they pay out 46,200,00 and lose $462.00 on each one. No wonder my premiums are so high.:hammer:

[shellrob]

But the Optometrist DID bill correctly for a progressive. It's your old optometrist who didn't bill correctly. That's why they created the CPT codes to specifically identify procedures, products, etc...A progressive lens is not a trifocal lens so it shouldn't be billed that way.

Not true. You're supposed to bill the cpt code for a bifocal AND the the code for a progressive with the progressive having the non-covered modifier. Same goes when you bill a polycarbonate lens or anything other than cr39. Although some insurances now pay for polycarbonate.

[Jim Stone]

I have had progressive lenses (Hoya ECP) for several years. My optometrist always billed them as CPT code V2300 (trifocal lenses) and my insurance company (Carefirst Blue Cross Blue Shield of MD) always paid the claims. I switched to a new optometrist this year. His office used a different CPT code V2781 (progressive lenses) and the claim was rejected. Our insurance plan does not specifically cover progressive lenses. They cover single vision, bifocal, and trifocal lenses. My new optometrist will not resubmit the claim as trifocal lenses because he said it would be "insurance fraud." Aren't progressive lenses essentially no-line bifocals or trifocals? Varilux lenses have been around since the late 50's. Wouldn't you think my insurance company would be paying for them by now?? I think it is just a matter of how the claim is coded as to whether they will pay. They said if my optometrist agrees to provide additional information to them, then they will reconsider the claim. They said the code V2781 is "too generic." Any suggestions on how to get Blue Cross to pay this claim?

They know that MOST people are wearing progressives now. Just another way ins co get out of paying claims. You are making the mistake of thinking that ins co are here to help you with your med bills. No, they want money..

[beach57]

They know that MOST people are wearing progressives now. Just another way ins co get out of paying claims. You are making the mistake of thinking that ins co are here to help you with your med bills. No, they want money..

I was fortunate to get a BC/BS customer service rep who was willing to go the extra mile. She called my optometrist and got it straightened out so that I will get the reimbursement that I am entitled to.

[Jade Sky]

Insurance companies are only going to pay for what you need to get by, if you need the add power and would much rather have a progressive that is a want not a need, you could get by just fine with the bifocal dont get me wrong i really do wish that everything could get covered cause it is much better to be using a progressive which is a much more natural vision, but in my work i have noticed that every so often a customer comes in and says the one they always went to would do it for them, it is fraud though and its something that the business will do at their own risk. Even though you would have to invest quite a bit of money in your glasses I think it would be better knowing that the customer service you are getting is top notch and that the company will continue to help you should anything happen to your glasses, my theroy is that top notch customer service will leave you knowing you made the best possible decision for your vision, and will bring you back when its time for an update.

[Chris Ryser]

I
They cover single vision, bifocal, and trifocal lenses. My new optometrist will not resubmit the claim as trifocal lenses because he said it would be "insurance fraud." Aren't progressive lenses essentially no-line bifocals or trifocals?

Actually they are multifocal lenses. Now that that the new wave of progressives is making an entry into the market they are soon to be cheaper tha regular bifocals.

[chip anderson]

You takes what you can git when you leave your care to someone else whether it's the government or the insurance company. Will people ever learn to take care of themselves again?

I just cringe when an old patient of mine comes in and says: "My insurance makes me go there now!"

I may be the last but no one makes me do anything.

[gunner05]

Ugh, I hate dealing with insurance. Pt came in today with a very bad insurance (didn't pay for anything more than the bare minimum) and got a premium product (ovation, AR, trans, flexon frame). We're at the end of a 50% off sale and it was actually cheaper for us to do the 50% off than file with his insurance since it would only pay for CR39 trifocals and $100 on the frame. For us to file, the pt would have paid 360ish while it was 340 with the sale. Pt then got upset that they would probably only get about 50-80 bucks back after filing on their own since they have a "$100 frame allowance." I really wanted to just pound my head into a wall. Shouldn't have mentioned the stupid sale and just filed their insurance for them, but noooooo I have to try to save people money. I did make a good commission on the sale, but still, I hate dealing with stupid people.

Sorry, rant over.

[orangezero]

You takes what you can git when you leave your care to someone else whether it's the government or the insurance company. Will people ever learn to take care of themselves again?

I just cringe when an old patient of mine comes in and says: "My insurance makes me go there now!"

I may be the last but no one makes me do anything.

Couldn't agree more on this point. Do you think its just a general feeling of lack of self determination? Is it simply that they are misinformed that many times they can actually go out of network? Somewhere in between?

[Barry Santini]

I still can't get over paying $747 for one pair of glasses! It's truly outrageous how high the markup is on lenses and frames. I hope you don't expect me to feel sorry for my "poor" optometrist.

Your Pharmacutical insurance insulates you from the true and actual/customary cost of your drug prescriptions. If you knew how much your insurance company is paying, you wouldn't complain about the glasses.

Glasses are custom..and less expensive than a custom suit!

Barry