So with a new year, comes new insurance plans, for both?MEDICAL?as well as?VISION. ?Many do not realize these are 2 different kinds of insurance. ?I am going to try to explain what the differences are, how you can be more informed of your own plans, and how to make your exam visits flow more efficiently for you and for the clinics across the board.
Most of us have insurance benefits through our employer or we pay for our plans privately. ?Some employers offer Medical, vision, dental, and other types of insurance. ?They are typically optional plans. ?Here is the general differences of these types of insurances.
Medical Insurance plans
Medical insurance generally covers toward medical care, i.e., you go to the doctor for a problem or emergency. ?So for a general medical visit, this may consist of an ache or pain, rash, infection, or fever, just to name a few. ?Not ALL physicians are on ALL medical insurances. ?You should have been provided information regarding providers in your area, or the insurance website can be very helpful to search for one.?
Vision Insurance plans
Vision insurance generally covers?(or ?provides a benefit?)?towards eye exams and medical devices such as prescription eyewear and prescription contact lenses. ?They usually do NOT cover problem visits like, eye infections, red eyes, or other acute eye issues. ?These types of issues would be more of a medical visit and can usually be filed with your medical plan, if your eye clinic provides insurance?filing and?are providers on your plan. ?There are usually copays for most vision plans?as well as medical plans?that are due upon the time services are rendered.
Also, there are not any vision plans out?there?(that I am aware of) that will cover 100% of your vision care needs. ?Most only pay a very small percentage of your eye exam, glasses or contact lens supplies. ?Please note that most of the time, you will be responsible for overages at the time services are rendered in most eye clinics.
Dental Insurance plans
Dental plans generally covers various dental procedures. ?I am not as savvy on this particular type of plan, but I know through my personal experience, they are similar to vision plans?only cover?some things?and most expensive procedures are not billable to the dental plans OR medical plans. ?The best way to find out more about your particular dental plan is to contact your dental insurance.
Premiums, Deductibles and Co-pays
Ugh!!! ?Don?t we pay enough to these insurance companies already?! ?Most insurance plans are NOT free!! ?Someone has to pay ? the members and providers. ? Most employers offer various medical, vision, and dental benefits of some kind, at a less expensive premium (supposedly). ?You should be aware of how much is being deducted from your check monthly and know what your coverage and deductibles are. ?It may be more cost effective for you to be on your own independant insurance plan(s)?or put those premiums toward a Health Savings Account. ?These premiums that are deducted from your pay, should be pre-tax funds.
Once your coverage is activated, then you will likely owe the insurance more money before they start paying for your exams or office visits. ?This is called a deductible. ?It varies from one insurance plan to the next and they typically start over year to year. There may be an individual deductible and a family deductible. ?Either way, be aware of what your deductibles are. ?If you are not aware of them, please contact your HR department or your insurance company.
At your office visits, you may ?have a co-pay that may or may not go toward your deductible. ?This is something else you need to be aware of prior to your visits. ?Be prepared to pay your co-pays at the time the services are rendered.
How do I make life easier and my office visits more efficient?
Regardless of how you have insurance coverage, either through an employer or independantly, here are some helpful pointers to note.
- Find out the full name and contact information of the Human Resource Department and keep on file as you may need to call them a few times.
- Have ALL your insurance information available when you call to make your appointments. ?This includes subscriber/member name that is on the insurance (not nicknames), DOB (date of birth) of the member and the patient, subscriber/member ID number and patient ID number if different, Group number, insurance address and phone number.
- Be aware of your benefits. ?This can be a challenge sometimes, but you should have been provided a manual of your benefits, or have access to their website. ?If you do not have this information, it is likely that your doctor?s office does not have it either. ?Please call your HR department or call your insurance company. ?The number for members/subscribers is on the back of the card. ?Please note,?that most medical clinics do NOT have a direct line to any of the insurance companies either, so the wait time is just as long on the phone.
- Be aware if you have met your deductible or not. ?This is something your doctor?s office will definitely NOT know, so please contact your insurance company.
- Be aware of your copays or expect to pay some sort of copay. ?Most range from $10 to $50 depending on the insurance. ?Often times it will be on your card as well. ?Various clinics may be a ?specialty? clinic. ?You can call that clinic to find out what they are considered.
- Be prepared to pay 100% of the services rendered when you go to any of your doctor?s visits unless you prearranged something. ?Meaning, you called prior to your appointment and discussed this with the billing/accounting department at your doctor?s office.
Insurance myths
1. The doctor?s office gets paid by the insurance companies the difference of what I pay.
This is ABSOLUTELY FALSE. ?Most of the time, providers/physicians, take a significant?cut to be a provider listed on an insurance. ?And most of the time they don?t receive payment for 2-6 weeks after the claim is filed?sometimes longer. ?So, as you can likely imagine, the medical offices have bills to pay as well. ?In order to pay them in a timely fashion, they have to see MORE patients?(which can often times equate to less time per patient)?meaning more volume, less time/patient. ?No medical office can really afford to spend more time with patients individually since the insurance companies don?t reimburse very much, these offices have to see more patients. ?It is a sad and vicious cyle. ?This is the reason why Uptown Eyes has decided to be providers for only a few of the most common insurances plans. Our goal is to never allow insurance to dictate our time with the patient, our treatment plan, or our quality of the product we provide.??
Source: http://uptowneyesnwa.com/2013/01/29/vision-insurance-and-medical-insurance-huh/
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