How much can an optometrist overcharge before you can file a claim?
T L asked:
I recently visited my optometrist for my yearly exam and walked out the door paying $160 for 6 months of Proclear Toric lenses (in addition to numerous other fees). I am insured through VSP.
I recently visited my optometrist for my yearly exam and walked out the door paying $160 for 6 months of Proclear Toric lenses (in addition to numerous other fees). I am insured through VSP.
I found the same lenses selling at numerous online retailers for $45-$50/box (so a 6-month supply would cost $100).
Shouldnt my insurance have covered some of this cost? Can I make a fuss next time over this obvious overhead?
Its always more expensive to buy from the doc.
now you know.
VSP is one of the worst insurances around, basically it covers a basic eye exam. The doctor, can then charge for a contact lens exam, fitting, etc.
The cost that you paid him is about the going rate. You can go back to his office and ask for a copy of your prescription and buy the contacts from online retailers, BUT…..
In Texas, the doctor doesnt have to give you a copy of your contact lens prescription. I dont know where you are and the laws in your state.
In addition I wouldnt trust an online retailer for contacts, and if I was the doctor, I sure would not examine you if you had purchased the contacts elsewhere, because of medical liability.
I don’t think there is any control on the price of optical appliances. However, if your ask, your optometrist has to give you a copy of your prescription after an eye examination. You can shop around and get different quotes from other optometrists and optical dispensers.
You can find the names of Optometrical Associations in the phone book, ring and ask them any questions you may have.
Be careful buying online, you must know the brands and quality of what is offering.
I’m not familiar with VSP insurance, but with my vision insurance, all I get is a discount…and when I had ordered my last contacts, the gal at the front desk didn’t figure my discount correctly…at all! I ended up canceling the order (the contact price was not out of reason itself).
After trying to add it all up after I got home and had my copy of my vision benefits, I called, spoke with my optometrist and HE refigured it…I canceled the contact order and only had the copay for the exam and fitting…saving me nearly $200!! which my optometrist then reimbursed me.
1. You might want to sit down with a copy of your benefits and try to calculate with your itemized bill from your optometrist’s office. Also make sure your optometrist is able to accept your insurance…sometimes they do change from year to year.
2. Look for any discrepancies from what your vision insurance will and will not cover compared to your charges.
3. Take that difference AND your benefits schedule to your optometrist’s office. Most of them will then refigure.
I have purchased contacts online in the past, but had a bad shipping experience and started taking my prescription to Walmart.
Actually, I did just look up your Proclear Toric lenses online…and am seeing a price of $185 for a four box (one year supply) BEFORE the mail-in rebate of $40 for four boxes.
Call some of the discount optical places, Walmart, Pearle, Eyeglass World and get price quotes on your prescription…and if they come in under what your optometrist charged…cancel that order…perhaps they will honor any discount on your contacts that your optometrist’s office might not.
I would go in asking questions and getting some answers with specific regard to your insurance coverage/discount for the lenses themselves, then the best way you can deal with this in the future, if the office isn’t helpful, is to go there for your exams…and take your prescriptions elsewhere.
Is your doctor a participating provider for VSP? Here in PA where in the are where I live, only 1 place accepts VSP as payment. I’ve heard its not very good coverage and I’ve heard that its hard for the doctor to get their claims paid by VSP. So, if where you went is not an actual provider, perhaps that is why they didn’t cover more.
As for the pricing of the contacts, your doctor’s office is pretty much charging at the competitive rate, which is about what we charge in the optometrist office that I work at. Online places are always cheaper, and sometimes we actually match their prices, if possible. Online places buy in bulk and get discounts and it eliminates the “middle men” so it can keep costs down. And because its not your doctor supplying the lenses, they are absolved from a lot of the liability.
So, you really cannot file a claim because of what your doctor’s office charges for your contacts. They have their prices – you agreed to pay that price. If you’re that unhappy, tell them to cancel the order, get your money back, and a copy of your Rx and get them online for less.