Can't locate your insurance benefits information?
Hesitant to call your insurance company because you're not really sure what to ask?
Lost your insurance card and don't even know what company you are with right now?
Confused about coinsurance/co-pays/deductibles, etc?
You are not alone. Here are a few tips to navigate through the system.
First of all, YOU are responsible for knowing your insurance benefits. We can verify benefits but it isn't unusual to be quoted the wrong information. That is why YOU also should check your benefits. When we call we are always told "This is not a guarantee of payment."
1. I'm scared to call. I have no idea what to ask. It's a giant maze I don't wish to enter.
Well, maybe you don't have to call. You should have insurance information available to you either on paper or an online portal. If that fails to produce information that you are looking for then take a look at your insurance card.
2. OK so I found my insurance card, now what?
Vision plans may or may not have a card if it is a separate entity from you medical insurance.
Your separate entity vision plan may or may not be printed directly on the medical card.
If your vision benefits are through your medical insurance, your card will not indicate that information.
The good news is that all medical cards will have a phone # on the back for you to call.
3. What in the world do I ask when I call?
First of all, have your card handy because you will probably be entering your ID into an automated system and then press buttons to get to the benefit information you want to know about.
If there isn't a vision category and you are able to speak to a "representative", use the verbage "routine vision." Do I have benefits for routine vision with an optometrist?
Are there hardware benefits?(That would include contact lenses or eyeglasses)
Are these benefits through you or is there an outside vendor?
Are my benefits still available at this time?
Do I need to submit for the hardware myself or does the Dr. do that for me?
Is Dr. Mead an IN NETWORK provider for my plan?
4. I have medicare and something else. I don't think it covers anything though.
GET OUT THE INSURANCE CARD. LOOK AT THE BACK.
If it says to send the claim to medicare FIRST, then you have a supplemental plan.
If it says to send the claim to the insurance first (like BCBS or Medica) you have an Advantage Plan
Nearly all Advantage Plans have routine vision benefits. Look at your information from your insurance company. The Vision information is in that information - guaranteed!
Medicare supplements often pick up routine benefits that are denied by medicare. Again - check your manual.
Medicare by itself has medical only benefits for eye exams if you have Part B. Our Dr.'s perform medical eye exams also but the coding cannot be determined ahead of time.
Hope this helps. Good Luck on your Insurance Journey.