My wife tells the clerk we have vision insurance. "Oh-- well we can't honor that price with insurance" says the clerk. She goes on to say that insurance is only good towards the RETAIL price of any glasses/frames. My wife looks a little puzzled, and asks what the price would be with insurance. The price using the insurance benefit deducted from the retail price was almost identical to the sales price. How the hell could this be?
As it turns out, this clerk did not submit the order at that time, so this entire issue came up a few days later when my wife called to confirm that the order had been placed (it hadn't yet). Since it had not been ordered, I told my wife to tell them to hold off on ordering for now. I wanted to learn a little bit more about how this price scheme (emphasis on "scheme") works exactly. After all, how can they charge us a near-identical price to their "sale", when they are also collecting an insurance benefit? How the hell does that benefit ME? I am the dumb sonofabitch that is paying for the insurance, yet somehow, WITH that insurance, I am still paying the same damned price as Joe Blow coming in from the street with cash in his pocket. Something stinks here.
I call JCPenneys and pointed out to them "If the price with the insurance benefit deducted is the same as the sales price, then I am getting screwed out of my benefit. Why should I let you collect my insurance benefit AND charge me the same cash price as other customers?" The manager tells me that this is a condition of MY insurance, and that I would have to address such questions to them. And address them I did!
So I call EyeMed Vision and explain the situation. Surely I was about to find out JCPenney was breaking some provider rule or something. Guess again. Turns out they openly admit that individual retailers can apply my "insurance" any way they want, and nearly all will only use it towards full retail price on eyeglasses. The conversation went something like this:
Me: "So basically, they get to collect a benefit AND charge me nearly the identical price they charge other customers?"
Eyemed: "yes sir"
Me: "Then what the hell good is my benefit?"
Eyemed: "Your benefit is good towards retail purchases; we don't control provider pricing sir"
Me: "Fine. What is the benefit reimbursement amount they receive when I get a pair of glasses?"
Eyemed: "That depends on the provider agreement they sign with us sir, but it is a set amount."
Me: "Fine, what is the set amount with JCPenneys?"
Eyemed: "I can't disclose that sir. That's between the Provider and EyeMed."
Me: "Well then just who in the hell are you representing here? It sounds to me like you are more interested in representing the provider than me. That's a conflict of interest, don't you think?"
Eyemed: "No sir, we work with providers to get you the best deal."
Me: "Then why am I getting screwed?"
I found out why I am getting screwed. Tune in to Part 2
Shoutwire - Internet News for the Masses
8 comments:
There are a couple types of EyeMed insurance. One version of this insurance will pay something for the exam to the provider, but won't pay anything for materials. It is a "discount-only" type of coverage. It sounds like that's the one you have. In that case Eyemed doesn't pay anything to the provider for materials. The provider can't give you more than their sale price and make a profit. You sign up and pay for the benefit. Eyemed asks providers to participate which brings folks into their office or store. They agree to a reasonable discount. It's inexpensive insurance - you get a small benefit. Weigh how much you pay, how many members of your family will use vision insurance, how much the same services would cost without vision insurance and decide if it's worth it. It may be worth it for the exam alone with a $10 copay, maybe not. If your family is particular about frames, you will have to pay the value of the frame less a modest discount. Discount-only benefits are really the least valuable as retailers raise their prices in order to offer them. The best benefits are those that allow you to find the best deal and reimburse you a real dollar amount. Also valuable is utilizing a health savings account for eye exams and materials where you use pre-tax dollars to pay for the best deal you can find. They eliminate the need to negotiate and also eliminate the dreaded paperwork at the doctor's office.
My wife and I recently cancelled our vision policy with VSP because it was a waste of money. With the VSP plan, you only get full benefits when going with In-Network providers. These providers jack up their prices so I pretty much end up paying more than I would by purchasing the same service and products out-of-pocket at a retailer.
With VSP, I purchased my first pair of lenses and frames through my In-Network provider. Non-designer frames with polycarbonate lenses and anti-reflective coating came out to about $170. It would have cost an extra $80 for transitions lenses. Designer frames could cost an extra $50. Exam copay was $10. We pay about $200 a year for the policy through my wife's employer.
The following year at Costco I paid $182 for a pair of designer (kenneth Cole) frames with lenses (polycarbonate, Anti-reflective AND transitions). If I had paid for the exam at Costco it would have cost an extra $90.
So here's the cost comparison, assuming that both my wife and I received and standard eye exam and designer frames and full featured lenses in one year.
VSP total = $820
$200 premium per year $200
Exam $10 copay x2 $20
Designer frames/lenses x2 $600
Costco total = $544
Exam x2 $180
Designer frames/lenses x2 $364
This doesn't even take into account the fact that VSP only allows a benefit for frames every 2 years. If I wanted new frames sooner I would have to pay up the wazoo.
Costco comes out way cheaper and I can walk in and get that price whenever I want. So we cancelled our policy and decided to fill our optical needs through Costco and other retailers. Walmart, Target, Sears, JCpenny, etc. We'll just pay cash.
I also checked out our policy with VSP to see if there were any benefits other than standard exam and frames/lense coverage, such as laser eye surgery or additional contact lense benefits. There were no additional benefits. Our policy covers eye exams and glasses OR contacts ONLY. Once exam a year (glasses or contact exam, but not both), Lenses Or Contacts once a year, and frames every 2 years. The only benefit they offer for Laser surgery was "special pre-negotiated pricing with our in-network providers" which means nothing since you still have to pay the entire jacked-up price yourself.
What makes the VSP policy a clear cut scam is that there are no variables at all. The benefit maximum is set. Since VSP has pre-negotiated rates with it's in-network providers, and it's out of network benefit maximum is far less than the premium we pay, we would pay more than market value for services and products provided through VSP and its partners no matter what the scenario.
The game is fixed, and they will NEVER lose money. Aren't there laws against this? Maybe price-fixing laws can apply. Can some lawyer out there set up a class-action lawsuit against these vision providers?
Boy can I relate!. Same thing happened to us. We took EyeMed insurance. Exam was $10. When we went to look at frames, we picked some on sale. We thought with the discount from the insurance, we will do really well. Then the sales lady comes over and tells us that sale price only applies to those without insurance. We could not purchase from that spot. Of course, the rack we could purchase from cost more!
Even this past year, I paid less for my glasses without insurance then I did with insurance!
Boy can I relate!. Same thing happened to us. We took EyeMed insurance. Exam was $10. When we went to look at frames, we picked some on sale. We thought with the discount from the insurance, we will do really well. Then the sales lady comes over and tells us that sale price only applies to those without insurance. We could not purchase from that spot. Of course, the rack we could purchase from cost more!
Even this past year, I paid less for my glasses without insurance then I did with insurance!
Just Who is Luxottica?
How the Public in general and EyeMed Members in particular are Being Deceived
Ray-Ban, Giorgio Armani, Coach, Oliver Peoples, Prada, Oakley, Maui Jim, Chanel, Anne Klein, Brooks Brothers, Bulgari, Burberry, Chaps, Coach, Dolce & Gabbana, DKNY, Paul Smith, Polo, Ralph Lauren, Versace, Persol, and Tiffany & Company. Recognize these names? Well chances are if you’ve shopped for eyewear at Target, Pearle Vision, Sears or many other Optometrist’s offices you’ve seen these brands of eyewear. But did anyone tell you that they are all designed and manufactured by one company? They are all mass produced in the same factories in China and Italy by a very secretive company called Luxottica. Why is this a bad thing? It’s because the consumer doesn’t get to know that the brand Coach has nothing to do with the purses that you love, and when Luxottica puts the name Coach on a frame, the price doubles or even triples! Luxottica not only churns out all of these brands of eyewear at millions of frames a year, they also own the stores that sell them. Lenscrafters, Sunglass Hut, Pearle Vision, Target and Sears Opticals are also all owned by Luxottica. Luxottica owns a company that fabricates prescription eyeglass lenses as well, including progressive multifocal lenses. Their optical stores only sell Luxottica's own progressive brand, passing them off as "just as good" as the high quality lenses that your Doctor might recommend.
If you have EyeMed "insurance", that is also a Luxottica brand that funnels patients to it’s own optical shops, making them believe that is where they must go to use their benefits, or where they should go get the best "deal". Employers and their Human Resources departments are contracting with EyeMed for vision plans without understanding that they are paying premiums to Luxottica for "vision coverage" , just so their employees can use their "benefits" (plus spend more on additional out of pocket copays and options) at Luxottica's optical stores. Luxottica is actually manipulating you into paying them for the privilege of buying their frames and lenses at greatly inflated retail prices from their own stores. Can this really be considered Insurance??
Sure there are private practice Eye Doctors who accept Eyemed, but that may be changing. Eyemed is continually pushing to control Doctors decision-making and cutting reimbursements, and many Doctors are deciding to drop them. Some believe that this is intentional so that Luxottica can further monopolize the industry. Already Luxottica has amassed 35 million members by selling their routine vision insurance to employers and other Medical Health insurance companies like Aetna. As any good monopoly would, Luxottica is doing its best to ensure that Eyemed members use only Luxottica for their eye care needs.
The latest tactic is that EyeMed no longer allows private practice Doctors to choose what optical lab they trust to provide the best quality, most reliable lenses to their patients. Eyemed patients must have their lenses made by a lab that has financial dealings with Luxottica. This lab directly charges the Doctor more for these lenses than a private lab does, and some Doctors are complaining about poor quality coming from this lab. Why should you care? Well, primarily it is because Luxottica's business practices are deceptive in that they appear to provide consumers with many choices for their eye care needs, when really the only choice you have is to give your money to Luxottica, one way or the other.
Copies of this article are available for your personal use, and can be given by you to your employer or Human Resources administrator.
I had the same experience with eyemed. I went to JCpenny and came to know that if I use my insurance I will pay $260 out of pocket for a pair of glasses and without insurance it will cost me $220. I was amazed to see that having insurance was costing me more. I went out of Network and got the pair from Samsclub for $260 and got $140 reimbursed from eyemed. Thats what I am going to from now on with this insurance. I also tried goggles4u.com and got one pair for $50 just to try how they compare with the sams club ones and they came out good. After two years I am going get my glasses from goggles or samsclub (haven't decided yet) and get some part reimbursed from eyemed. They allow reimbursement upto $90 for frame and $50 for lenses.
When you are ready to try a comparative filet verses a ground beef protein, you should try a private Doctor that has access to the finer lenses available in the market. If you like the taste of cheap lenses and enjoy slumming it for life, keep on buying the big box retailers version of eyewear. Good luck, lol.
thank you for your interesting infomation. liability insurance Texas
Post a Comment