More On Insurance Fraud

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Rob Lister
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More On Insurance Fraud

Post by Rob Lister »

Not really fraud. More like scam. Today's topic, Vision Insurance.

At noon I had an appointment with the eye doctor at National Optometry.

Was he trying to impress me with his speed of his exam? I was not impressed. I did not feel like I was properly attended to. I tried to convey to him some current difficulties but I'm not sure he even acknowledged my concerns.

But he does this all day every day and if his chair side manner was a bit rushed, impersonal, and 'assembly-line-like', it doesn't necessarily mean he doesn't know what he was doing. Still, I left his office with prescription in hand but confidence in it somewhat lacking. We'll return to that briefly.

Next stop is the frame bouquet. The kind lady at the counter told me I was covered up to $140. I quickly picked a mid-range $80 pair.

That's free! she said.

Add $70 for progressive because that's not covered.
Add $30 for light weight because that's not covered.
Add $25 for anti-scratch because that's not covered.
Add $25 for anti-glare because that's not covered.
----$150

:x

I put the frames back on the rack and said, 'No thanks.'

She looked perplexed. I told her gently that they're charging way too much and that I can get them on-line for a fraction of that. She gently told me back, 'I hope nothing goes wrong with that order'.

No really, she said it just like that, kind of under her breath.

"I think it'll be okay," I replied.

"That will be $25 for the exam deductible. We're willing to wave that if you buy your glasses here."

:x :x

I just finished the wizard at zenni optical and everything together is $40.

I almost went to the shopping cart but I remembered that I still had my old prescription scanned somewhere on the computator. I found it and compared.

Whereas before my OS was stronger than my OD, now they are the same. But rather than OD getting stronger, OS got weaker. How the fuck does that happen? My eyes are getting better!? My Cylinder remained the same but the OD axis changed from 70 to 10!? What the hell do I know. Maybe that happens. I just don't feel good about it at all. Not a lot I can do but get another exam somewhere else and pay out of pocket.

:x :x :x

I feel like I wasted my time and $25 deductible. I'm going to let HR-hot-girl at work know how displeased I am with this insurance.
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Re: More On Insurance Fraud

Post by DrMatt »

I have a combination of Davis Vision and BCN (the latter gets involved because of an unusual condition). They've been okay.
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Re: More On Insurance Fraud

Post by Tiosylanyl »

Why blame the insurance? It isn't responsible for your piss poor selection of an optometrist.
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Re: More On Insurance Fraud

Post by WildCat »

You can buy moron insurance?
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Rob Lister
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Re: More On Insurance Fraud

Post by Rob Lister »

Tiosylanyl wrote:Why blame the insurance? It isn't responsible for your piss poor selection of an optometrist.
I could have asked around I suppose. This is the first bad optometrist I've ever visited. But really, that just set the stage for me being in such a foul mood. There's not much I can do about it except gamble that it is correct. I could pay out of pocket for one of my choosing.

My bitch is really that it doesn't pay for my vision care. I can buy the glasses out of pocket 1/3 of the price I'll pay with with the insurance. That is pretty bad insurance. While technically it is free, it is also part of my compensation package at work, so it isn't really free.

The hottie from HR will get a strongly worded email from me. I will CC the whole fucking company 'cause it brightens their day when I get on a rant. 'Cept my boss. I leave him in the dark about everything.
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Re: More On Insurance Fraud

Post by Doctor X »

You need to masturbate more with your other hand.




To balance your vision.

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Re: More On Insurance Fraud

Post by shemp »

WildCat wrote:You can buy moron insurance?
I have some. I've put in several claims against you.
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Re: More On Insurance Fraud

Post by Tiosylanyl »

Rob Lister wrote:
Tiosylanyl wrote:Why blame the insurance? It isn't responsible for your piss poor selection of an optometrist.
I could have asked around I suppose. This is the first bad optometrist I've ever visited. But really, that just set the stage for me being in such a foul mood. There's not much I can do about it except gamble that it is correct. I could pay out of pocket for one of my choosing.

My bitch is really that it doesn't pay for my vision care. I can buy the glasses out of pocket 1/3 of the price I'll pay with with the insurance. That is pretty bad insurance. While technically it is free, it is also part of my compensation package at work, so it isn't really free.

The hottie from HR will get a strongly worded email from me. I will CC the whole fucking company 'cause it brightens their day when I get on a rant. 'Cept my boss. I leave him in the dark about everything.
I'm not sure what your part of the premium is or who your coverage is through, but for me it is ~$9.00 per pay period, which works to $216 per year for my family. For that, we get the following:

Exam fee: Up to $50
Frames: up to $140, plus 20% discount on anything over that amount
Lenses: up to $50, $75, or $100 depending on single, bi-, or tri- focal
Contacts: up to $140

All that includes between a 30-40% discount off the gross charge, and you have to choose between the contacts or lense as you can't have both in the same year.

So, assuming I'm getting glasses alone, I come out ~$24 ahead of what I paid in premiums, just on my own. Add to that a wife and two kids and I'm having trouble understanding how VSP stays in business.

Fact is that all vision insurance sucks. It's basically a discount program.
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Rob Lister
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Re: More On Insurance Fraud

Post by Rob Lister »

Tiosylanyl wrote: I'm not sure what your part of the premium is or who your coverage is through, but for me it is ~$9.00 per pay period, which works to $216 per year for my family. For that, we get the following:

Exam fee: Up to $50
Frames: up to $140, plus 20% discount on anything over that amount
Lenses: up to $50, $75, or $100 depending on single, bi-, or tri- focal
Contacts: up to $140

All that includes between a 30-40% discount off the gross charge, and you have to choose between the contacts or lense as you can't have both in the same year.

So, assuming I'm getting glasses alone, I come out ~$24 ahead of what I paid in premiums, just on my own. Add to that a wife and two kids and I'm having trouble understanding how VSP stays in business.

Fact is that all vision insurance sucks. It's basically a discount program.
It covers my the appointment ($25 deduct), my frames (up to $140) and standard glass lenses. As most anyone older than 50 will tell you, that's ain't shit. It doesn't cover bi/tri/progressive lenses, tempering, anti-glare or lightweight lenses. Say 'transition' and the glass lady behind the counter sez cha-ching. Mention all those things together and she books a vacation to the Bahamas right then and there. IT is a fucking rip off.
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Re: More On Insurance Fraud

Post by Tiosylanyl »

Rob Lister wrote:
It covers my the appointment ($25 deduct), my frames (up to $140) and standard glass lenses. As most anyone older than 50 will tell you, that's ain't shit. It doesn't cover bi/tri/progressive lenses, tempering, anti-glare or lightweight lenses. Say 'transition' and the glass lady behind the counter sez cha-ching. Mention all those things together and she books a vacation to the Bahamas right then and there. IT is a fucking rip off.
The provider is going to charge what they are going to charge. It has nothing to do with the insurance save for any agreements the insurance has with the provider for discounts to their policy holders. As you've discovered, there are alternatives for which you can shop around. The only question is whether those alternatives accept your insurance.

If you are paying any portion of the premiums then I think you've got a legitimate gripe with your employer. If they're paying 100% of your premiums then my opinion is that you're lucky to get what you have. At the end of the day are we really talking about a significant portion of your overall healthcare costs? I'd say that in a year when I buy new frames and lenses (I generally replace them every 2-3 years) in addition to contacts, I'm still not paying more than $400 per year out of pocket. That's far less than the MRI I just had on my knee. If I'm just getting contacts I'm under $200.
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Rob Lister
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Re: More On Insurance Fraud

Post by Rob Lister »

Tiosylanyl wrote:If they're paying 100% of your premiums then my opinion is that you're lucky to get what you have.
I think our opinions part company right there. It is part of my compensation package. It used to cover everything but they changed our plan. This is unacceptable. I will not take this lying down. I'm not going to let them push me around. I'm mad as hell and I'm not going to take it anymore. The will pay or they will PAY. They're going to get it now. The courts will be involved. The Supreme Court. My congressman. Senator. Barrack Obama. John William Ashe at the UN. Official resolution of condemnation. Peacekeeping forces. Police action.

I'm Rob Lister, dammit.
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Re: More On Insurance Fraud

Post by Tiosylanyl »

Rob Lister wrote:
Tiosylanyl wrote:If they're paying 100% of your premiums then my opinion is that you're lucky to get what you have.
I think our opinions part company right there. It is part of my compensation package. It used to cover everything but they changed our plan. This is unacceptable. I will not take this lying down. I'm not going to let them push me around. I'm mad as hell and I'm not going to take it anymore. The will pay or they will PAY. They're going to get it now. The courts will be involved. The Supreme Court. My congressman. Senator. Barrack Obama. John William Ashe at the UN. Official resolution of condemnation. Peacekeeping forces. Police action.

I'm Rob Lister, dammit.
Good luck with that. May the Force be with you...or something. I expect a progress report by COB Friday. Don't forget the goddamn cover sheet either.
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Re: More On Insurance Fraud

Post by Rob Lister »

Tiosylanyl wrote:
Rob Lister wrote:
Tiosylanyl wrote:If they're paying 100% of your premiums then my opinion is that you're lucky to get what you have.
I think our opinions part company right there. It is part of my compensation package. It used to cover everything but they changed our plan. This is unacceptable. I will not take this lying down. I'm not going to let them push me around. I'm mad as hell and I'm not going to take it anymore. The will pay or they will PAY. They're going to get it now. The courts will be involved. The Supreme Court. My congressman. Senator. Barrack Obama. John William Ashe at the UN. Official resolution of condemnation. Peacekeeping forces. Police action.

I'm Rob Lister, dammit.
Good luck with that. May the Force be with you...or something. I expect a progress report by COB Friday. Don't forget the goddamn cover sheet either.
All kidding aside, here's the way it is going to go.

I'm going to email HR-nicebutt and let her know what the scoop is. I'm going to ask to be reimbursed for the full price of what I paid at zenni, $40. She'll reply back that it is out of her hands. I'll reply back CC'ing my boss's boss and asking her to reconsider. She reply again that it is out of her hands. I'll reply back CC'ing my boss's boss and the HMFIC asking her yet again to reconsider. There will be emails back and forth that I won't see. Then she'll reply back to me and tell me to just expense it, as it is cheaper than headache she knows I'm going to create.

Two days later my boss will get word and create an additional string of emails demanding to know why he wasn't in the loop on this. I won't see them because I blocked his email last month.
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Re: More On Insurance Fraud

Post by Anaxagoras »

Tiosylanyl wrote:So, assuming I'm getting glasses alone, I come out ~$24 ahead of what I paid in premiums, just on my own. Add to that a wife and two kids and I'm having trouble understanding how VSP stays in business.
Not everyone needs glasses.

I'm with Rob here. This is probably a great deal for the insurance company. If they give the insurance to all employees, they pay premiums for it even for those who don't need glasses.

And if they won't cover stuff that should be standard like scratch-resistant lenses, you end up paying anyway.

The shitty optometrist getting his script wrong (if that's what happened) is another matter.



Does it cover anything like eye surgery? Why can't it be part of general health insurance?

If the costs it covers are predictable and not likely to be catastrophic, you are probably better without insurance. Because this insurance only seems to cover basics.
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Re: More On Insurance Fraud

Post by Badger »

Rob Lister wrote:
Tiosylanyl wrote:Why blame the insurance? It isn't responsible for your piss poor selection of an optometrist.
I could have asked around I suppose. This is the first bad optometrist I've ever visited. But really, that just set the stage for me being in such a foul mood. There's not much I can do about it except gamble that it is correct. I could pay out of pocket for one of my choosing.

My bitch is really that it doesn't pay for my vision care. I can buy the glasses out of pocket 1/3 of the price I'll pay with with the insurance. That is pretty bad insurance. While technically it is free, it is also part of my compensation package at work, so it isn't really free.

The hottie from HR will get a strongly worded email from me. I will CC the whole fucking company 'cause it brightens their day when I get on a rant. 'Cept my boss. I leave him in the dark about everything.
Must be nice to have an HR rep.

I'm pretty sure we have one, but who the fuck knows where HR is, anymore, or their contact info? Friggin impossible to find even on our corporate intranet.
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Rob Lister
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Re: More On Insurance Fraud

Post by Rob Lister »

Badger wrote:Must be nice to have an HR rep.

I'm pretty sure we have one, but who the fuck knows where HR is, anymore, or their contact info? Friggin impossible to find even on our corporate intranet.
No worries. If you say the right1 thing to the right2 person, the HR rep will find you.




===================
1 For wrong values of right
2 ibid
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Re: More On Insurance Fraud

Post by Pyrrho »

Oh heck, our company just fired our HR rep. We're practically automatons anyway, so who cares?
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Re: More On Insurance Fraud

Post by Cloverlief »

Rob, my recommendation is contact your insurance company and talk to them. They may be willing to wave the f/ u fee for less than a year. I would definitely talk to them.
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Rob Lister
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Re: More On Insurance Fraud

Post by Rob Lister »

Cloverlief wrote:Rob, my recommendation is contact your insurance company and talk to them. They may be willing to wave the f/ u fee for less than a year. I would definitely talk to them.
Thanks for that Clover. But I've already initiated the first in the string of emails. I've also gotten the first "out of my hands" reply.
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Re: More On Insurance Fraud

Post by Tiosylanyl »

Anaxagoras wrote:
Tiosylanyl wrote:So, assuming I'm getting glasses alone, I come out ~$24 ahead of what I paid in premiums, just on my own. Add to that a wife and two kids and I'm having trouble understanding how VSP stays in business.
Not everyone needs glasses.

I'm with Rob here. This is probably a great deal for the insurance company. If they give the insurance to all employees, they pay premiums for it even for those who don't need glasses.
I can't speak for Rob's coverage, but for my own we can opt out if we don't want it, so all those people that don't need glasses don't need the insurance either. You're probably correct in that a fair number probably do opt in because....why not? However, I know of several coworkers that do opt out of it. My point above was meant to illustrate that even with my coverage not being that great, I'm still getting well more out of it for the whole family than I personally am paying in premiums.

Does it cover anything like eye surgery? Why can't it be part of general health insurance?
If you're talking about things like cataract surgery or anything invasive, that would (should) fall under medical coverage, not the vision plan. If you're talking about LASIK, it entirely depends on the vision plan. Mine covers LASIK at about 50%
If the costs it covers are predictable and not likely to be catastrophic, you are probably better without insurance. Because this insurance only seems to cover basics.
It is only intended to cover regular annual check ups and corrective lenses. Anything "catastrophic" or over and above the annual visits would fall under the medical coverage. As I mentioned earlier, vision coverage is effectively not much more than a discount program.