Insurance the dreaded 9 letter word

[jediron]

Paula your story was great. But the problem is nine times out of ten most people don't even now who the HR rep is. They might not even know what HR means. We had one man about three months ago with GM insurance and wanted his $129.99 frame with St. Top 28 bifocals with transition for what he pay for in 2001
which was $78.00. I told him GM had changed there policy drastically. He said what do you mean, I told him he would have to pay 215.00 where by which I thought I was going to have to do CPR he almost had a stroke. He still paid but he was not happy.

:bbg: :D

[Paula]

A funny HR story

We had a patient in our office a few months ago, with VSP. She kept insisting that the vsp plan she had covered progressive lenses, the plan said other wise. When we discussed ar coated lenses, again she insisted the plan covered them..it did not. We routinely encourage our patients to go back to their hr people if they are unhappy with their coverage. In this case.. her HR manager was her husband! Needless to say, he was sitting in the reception area and had not a clue as to what was really covered.

[varmint]

Jediron it's not laziness, it's intentional.
The problem is most HR departments in companies, such as your case w\Zerox, are the ones the insurance has negotiated with & these HR folks have not a clue about lenses & frames.
The insurance co tells them they are giving their employees a $100.00 benefit for frames, but never mentions that they will only be paying $45.00 or less to a vision provider.
They do the same with lenses & get away with it because the HR folks aren't edumicated on optical materials.
This leaves the employees with the belief their employer has provided them with a good vision plan and they don't have to pay any more for options, etc. to the vision provider. It makes it easier for the insurance co to sell their plan to the employer and also for the HR dept to sell it to their employees, and leaves it up to the optical professionals to look like the bad guys.
Lets take the power of the Optiboard, band together & create our own insurance plan for eyecare. Then we can all drop all the outside insurance companies and promote vision care as it should be. How bout it Steve?

[jediron]

Chris said:
In this age of hard tough competition and copying and imitation I wonder that not some insurance has picked up the idea of making or coming up with a simpler easier system in the USA.

Apparently you have never delt with US insurance companies. Everyone is different. You may know one inside out and another
comes along with totally different parameters. Here in Rochester
N.Y. we have Xerox with there insurance which pays $100.00 toward a frame purchase, but the kicker is that what your reimbursed for is roughly $45.00 on the frame, the patient thinks he is getting a full $100.00 dollars. On this plan they pay for basic
lenses (S.V., Bifocal, Trifocal) No-Lines are $50.00 up charge and you tell the people there is an up charge for No-lines they almost blow a gasket. They say, I was told I can get a free pair of glasses, for which you have to do the public relations kick because the company is too lazy to do there home work and explain there benefits to them.


:bbg:

[Chris Ryser]

To set the record staright

jediron said:
Chris you may get your payment in a timely manner but that is not the way it is done in the States. Insurance companies in the States don't normally reimburse the consumer they reimburse the
dentist or optician or what ever. Paw is right these are two different animals.

:bbg: :D

Jediron we do have the joice to have the professional reimbursed directly, or pay direct and get re-eimbursed by the insurance.

Different animals for sure

[jediron]

Chris you may get your payment in a timely manner but that is not the way it is done in the States. Insurance companies in the States don't normally reimburse the consumer they reimburse the
dentist or optician or what ever. Paw is right these are two different animals.

:bbg: :D

[varmint]

No Chris, the insurance companies don't want anything to be clear to the providers, insured, or employers. They would have to be honest, and actually pay claims.
I can't tell you how many times I see patients spend more from payroll deductions for vision coverage than what they would spend on buying their eyewear, or spend more in payroll deductions than the insurance pays. Of course the insurance expects the providers to take care of the difference.
:cry:

[Chris Ryser]

yes different.....................

Paw,

In this age of hard tough competition and copying and imitation I wonder that not some insurance has picked up the idea of making or coming up with a simpler easier system in the USA.

[paw]

Insurance in Canada and insurance in the U.S. are 2 different animals.

[Chris Ryser]

Insurance................

Chris, I do believe that you are the exception, in that you understand that you pay up front, and get reimbursed by the insurance company, and that you even know how to contact your insurance company.



Jon 22,

The way we work it in my own company is that we give the insurance with the employement at no cost to the employees.

It covers glasses up to $ 150.00, dentist the full value for normal procedures and 100% of RX prescription.

I can even make the claim to the insurance company on line and get the refund within max of 10 days.

I actually just received my Visa bill today for $ 835.00 of dental work with which I had paid the dentist. I already received the 2 cheques from the the insurance and paid Visa with the money today, at no cost or time loss for me.

I am sure that there are more insurance companies that do work on a similar basis. It is sad to hear that all you guy's are having problems, or is it the public?

[jon 22]

I'm sorry, we don't take your insurance

I started my practice 6 years ago (illinois) and have never "taken" VSP. Some of the other doctors in the area have dropped VSP in the last 2 years. It still is a headache just explaining to patients that we don't "take" their insurance. I now and then have patients offer to help hook me up with VSP, Davis etc so that they can get their eye care from me. As if it would be somehow "illegal" for them to come and pay money for services and glasses out of their network. Often we explain that they can come here for exam and glasses, pay normal price, and get reimbursed what their insurance coverage covers. Some find their reimbursement as unappealing as I do, and are surprised to learn that if I were a provider on their network, I barely get paid anything either. They all believe that insurance is paying full rate and that its a great cash cow for doctors to milk.
I do take Medicare, and for one local factory, will bill BCBS, beyond that, its pay as you go.
When I look at what some of these "insurance" plans cover, it shocks me that any doctor would accept their reimbursements as full payment. For a lot of them, I would be better off paying the patient ten bucks to go elsewhere, than to provide exam and glasses. You can't lose money on each transaction and "make it up on the volume"

Chris, I do believe that you are the exception, in that you understand that you pay up front, and get reimbursed by the insurance company, and that you even know how to contact your insurance company.

There's a major problem in that people don't pay for healthcare, insurance pays, and to further disconnect the process, people don't pay for insurance either, some employer pays. Sometimes its not even my employer, but my spouses employer, and how any employer got stuck paying for some elses' health insurance, I'm still scratching my head on that. I guess its a miracle that employers didn't get stuck with paying auto, home and life insurance too.

I chose to open my practice in an area not dominated by a single employer or insurance plan, where there are still a lot of private pay clients, and I don't have to charge higher fees to them to offset the losses to "insurance" discounts. Am I as busy as the guy down the road that "takes" every plan? No. Do I have to see 25-30 patients a day just to make ends meet? No. Do I still like my profession? yes. Will that last? I don't know. Do my patients understand simple questions like "which is better, one or two?" no, but that's another rant.

[jediron]

optigoddess said:
I am "amazed" when I try to explain to the customer that we, unfortunately, do NOT accept their insurance and they still want to know what they will cover. (oh joy...NOT)

We get the answer, do you know who does take my insurance
if you don't? A DAAAAAAAA, don't you know and 9 times out of 10
they have not a clue.

:bbg: :shiner:

[optigoddess]

I work in a chain and we constantly get asked "do you take my insurance" .... when we ask "what insurance do you have?" , the standard reply is: "I dunno".

I am "amazed" when I try to explain to the customer that we, unfortunately, do NOT accept their insurance and they still want to know what they will cover. (oh joy...NOT)


Karen

[jediron]

Paula said:
Wow! I cant believe there has been no response to this post. I am new to the board, but insurance is the #1 headache in my office in Illinois.

Ya in N.Y. insurance is a nightmare. I agree everybody comes in expecting you to know every single insurance plan and what they pay. The worst one's are the people who come in and say "I only
want what my insurance will pay for and nothing else". Very hard
to get around that angle.

:D :bbg:

[Chris Ryser]

Re: Insurance the dreaded 9 letter word

jediron said:
In your area what type of insurance do you take or don't take?
In western N.Y. I have heard of two plans in the Rochester N.Y.
where they hold 99.5% of all people covered and if you don't accept these plans your almost dead in the water. So where are
you on the insurance matter? Personally I don't like all the plans.
Go back a number of years, where going to see your Doctor was see the Doc and then walk out pay the fee and go on with life.
Now what insurance do you have, fill out this form, now this ect.
Just nauseating. So again where are you on the insurance matter?:D

I have a great company group insurance, paying 100% of dentist, glasses and medication. In each case I pay for the service received directly, go home or the office fill in the forms on line and get the refund cheque from the insurance within 10 days.

Am I an exception?