Eyemed: medically necessary AND out-of-network

[orangezero]

I believe I know the answer to this, but thought I'd get some other opinions just to be clear. "Have them check their benefits on eyemed.com is the correct answer."

We just went out-of-network with all 141 eyemed plans our former owner signed up for or we were forced to take at some point. Based on talking with others, these plans have to be some of the worst. Our state, city, schools, and most large businesses give their employees the lowball eyemed plans in almost every single case. There are times the medically necessary contact lens option is really beneficial on the patient end. And there were times I felt we got screwed because of how much the contacts cost us (which have all gone up), so that larger reimbursement isn't always a great thing for us.

My assumption is now that we are out-of-network the patient who saw us would not be eligible for the same amount of medically necessary contacts. They would just get the standard $xxx amount for their CL benefit. Does this seem correct?

Thanks

[drk]

Pretty technical question. I'd call EyeMed three times and average the different responses.

[orangezero]

I had one OD respond elsewhere that they had seen one patient who had a $200 out-of-network medically necessary contact lens benefit.

I'd call them three times, but will likely retire before I get in touch with a live human.

[mervinek]

If you are out of network, then I assume the patient has to send in the claim for reimbursement. I would give the patient an itemized invoice and use a medical diagnosis along with a signed letter from the OD. Unfortunately for the patient, it is their problem to deal with. They can call eyemed 3 times and average the responses. Of course, then they'll understand why you dropped eyemed.

[jefe]

Pretty technical question. I'd call EyeMed three times and average the different responses.

Funny...but probably the right approach