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Canceling My (Vision) Insurance

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Hi friends! Sorry I didn’t get a post up yesterday. Life, you know?

Today I want to tell you about a horrible experience I’ve had with my vision insurance company. I’m about 2 minutes away from canceling it all together but before I officially make the call I wanted to put it to YOU to see if I’m overlooking something or if there’s some good reason to keep it.

Here’s what I’ve been dealing with yesterday and this morning….

I got vision insurance last July through my employer. It’s through a company called Avesis and I pay $15/month for the insurance.

From July through December I received several vision-related services. I had an eye exam, a contact lens fitting, I purchased new lenses (for my existing frames), and new contacts. I did both because I wear both. Contacts about 30% of the time, glasses about 70% of the time.

All combined, I paid a total of $408.97 for vision-related expenses last year (this was spread across the second half of the year, when I was insured). I paid everything completely out-of-pocket and was told I could submit all my receipts for reimbursement so I did that in early January 2016.

Yesterday I received 3 separate letters from Avesis. Two of them denied my claims. The codes were listed as “conflicting service filed in benefit period”, “benefit maximum for this time period has been reached”, and “receive date prior to service date.”

The only one I agree with is the conflicting service. I submitted the receipts from EVERYTHING and I knew they would only cover EITHER contacts OR frame lenses. Not both. But I submitted everything in the hopes that I could receive maximum reimbursement (because the reimbursement rate varies between lenses and contacts, so my hope was that I could be reimbursed for whichever was higher).

Instead I received a check for a measly $15.

I called to find out what the deal was. First, I have to say I received HORRIBLE and ATROCIOUS customer service!

Regarding the “receive date is prior to service date” error, I was told that the person who received my paperwork mistakenly entered it into the system as January 2015 (instead of January 2016). Simple clerical error, right? Only I was told that I would have to re-do everything because of THEIR error. I asked to speak to a supervisor, as this didn’t seem fair.

Here’s where the customer service really went downhill (and, looking back, I totally believe the person was NOT a supervisor, but was probably a friend or buddy of the original representative).

I was talked down to, given serious attitude, and outright told that I was at fault for the date error (which HAD to be on their end. It doesn’t even make sense that the customer would enter a “received” date. I have no idea when they’d receive it. Depends how long the mail takes!).

I was getting nowhere so I hung up and called back, hoping for a new representative.

This time, I was told that the code “benefit maximum has been reached” is because when I ordered my lenses and contacts through Costco, I was given a 20% discount which is the maximum they allow. They would not reimburse anything because that already “counted” as coverage. This didn’t make sense, though, because I never even showed my insurance card at Costco. I paid in full out-of-pocket.

I had to go to work so I hung up and tried again later.

This time (call #3), I’m told that the doctor who did my eye exam had billed them for his services and already received reimbursement for my eye exam. Again, this makes no sense because I paid fully out-of-pocket. I’m told there’s nothing they can do and that I’d have to handle it privately through the optometrist’s office. I asked how much they had mailed the eye doctor. I’m told he received $40, the maximum amount of reimbursement they provide for vision exams.

So after 3 different calls I’m given 3 different excuses of why I haven’t (and will not) be paid. And if I want to pursue the eye exam reimbursement it will be a huge hassle and take another chunk of time (who knows how long), and may or may not even be viable. All for a pesky forty dollars. My time is more valuable than that.

Then I got to thinking.

I’ve been paying them $15/month for the last 6 months (January excluded, I’m only talking about 2015), so that’s a total of $90.

They only gave me a check for $15 and the vague possibility of an additional $40 if I were to fight. This is a total reimbursement of $55 in exchange for the $90 I’ve given them through 2015.

Makes no sense. Why the heck am I paying this?

After calming down a bit (because I was definitely fired up after the third call, feeling like I’m getting the total run-around and that the customer service is seriously the worst I’ve ever dealt with), I decide that I just simply don’t want to do business with this company. I don’t want to give them another penny. And given their reimbursement structure (or lack thereof), it seems to not even make financial sense to keep my plan.

Luckily, hubs and the kids both have great vision, so none of them even need any coverage for glasses/contacts/etc. I would rather pay out-of-pocket for eye exams (which, apparently, I’ve been forced to do even with my insurance coverage) and not have to deal with the headache and hassle of this company.

Thoughts? Any reason to keep them around?

My only other consideration was that the company does help reimburse some of the expenses related to Lasik eye surgery. I haven’t made definitive plans but was hoping that I might have some money saved up to be able to do Lasik toward the end of this current year (2016). But when I called to find out about it, I discovered that, again, coverage is really limited. They only reimburse a couple hundred dollars and only cover one single surgeon in the entire Tucson area (who, by the way, doesn’t have great reviews online). There are other options up in Phoenix, but that’s definitely not convenient and, given the run-around I’ve received on the reimbursement for simple expenses, I don’t even want to count on actual reimbursement for surgery. I think I’d rather pick whatever surgeon I actually want (rather than being limited to a very restrictive list), save up the cash, and just pay for it myself. And, again, we’re talking about something that may not even occur this year (might be 2017 before I get around to Lasik).

That’s all I got. Very frustrated with this company and with my (lack of) coverage.

Has anyone else experienced similar issues with this or another company? Why are insurance places such a pain to deal with? Ugh!

Ashley

Texan at heart; Arizonan on paper. Lover of running, cheese, camping, and family (fur-family included!). Blogger, motivated to get out of debt YESTERDAY! Follow along with my journey!

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25 Comments

  • Reply Cory |

    I cancelled my vision insurance for essentially the same thing. No need foor vision insurance. Medical, Home, Car insurance all covers potential huge expenses that you cant or dont want to pay for yourself. Vision insurance is more a prepay type of thing and clearly you dont recoup the premiums. I think if you shop carefully you can spend less overall without insurance.

    I think dental is in the middle (in terms of value) between vision and medical. Not as high of a potential expense but a potential high expense does exist.

    • Reply Ashley |

      I think you’re right. For us, the dental is totally worth the monthly rates at this point because hubs has been busy with catch-up (and the girls have used it too). So between all 4 of us, we’re really getting our money’s worth. But vision…not at all. It seems like one of those “self-insured” type of things. We can afford the $400-ish per year so I’ll just do that, rather than waste money paying an insurance company for services they won’t even reimburse.

  • Reply Tamara |

    That company doesn’t sound like a good deal for sure. We have VSP through my husband’s work, and it’s been pretty good. But we both wear glasses and contacts. I’ve done both getting reimbursed and using a doctor who bills them directly, and had no trouble.

    From your description of this company, I’d dump them.

  • Reply Maureen |

    Dump them! Choose your Lasik surgeon based on what you are comfortable with (I had it 10+ yeas ago and one of the best things I have ever done). Are they worse than Navient? 😉

    • Reply Ashley |

      Lol! I thought about that as I was writing the post (like, am I just going to sound like a complainer??). I swear I get along with most people and really don’t have issues with 99% of the people/companies I deal with! I’ve just had bad luck with Navient and Avesis!

  • Reply Theresa |

    I would dump them too. But you said it was offered through work? Take a few minutes and send a letter to your HR department. Let them know how crappy this company is.

    • Reply Ashley |

      I actually spoke directly with the benefits manager from HR. I had to get special approval to cancel since it’s not during the open enrollment period. They waived the open enrollment requirement and took note of the issue. No idea what will happen from there, but it’s been handled on my end.

  • Reply Jason |

    If you signed up via open enrollment, you are unlikely to be able to cancel them until 2016, unless you have a “qualifying event”

    • Reply Ashley |

      No worries, I got out via an Open Enrollment Appeal form, and the help of an HR Benefits manager at my university. : )

  • Reply shana |

    If the vision insurance is offered through work, you will not be able to drop them unless you have a qualified family status change (birth, marriage, loss/gain other coverage, etc). It’s an IRS rule and your employer will be unable to make an exception. If the eye doctor that you went to was in-network, the insurance company is legally obligated to pay them and you will have to get reimbursed from them for the vision exam. Contact fittings are typically not covered by vision insurance so that one will likely be 100% out of pocket.

    Go to your employer’s HR team and they typically that will have someone that can help and can figure out what’s going on and get you any additional reimbursement that you need. (Also $15/month is a lot for vision insurance for 1 person and they need to look at some new options. It should be closer to $9-10/month in total between the employee and employer cost for most vision plans.)

    • Reply Ashley |

      I actually spoke with the head of benefits from HR and had to fill out an Open Enrollment Appeal form (to allow me out of the insurance even though it’s not open-enrollment period). I was told they would retroact it back to December 31st so I’d even get a reimbursement for January’s payment. Maybe since this came up not even a month into 2016 they were able to make this type of exception (I don’t know the laws, but I do know I was able to get out of it).

  • Reply kathryn |

    I’ve had Avesis for almost 3 years, and I’ve never had a bad experience with them. BUT, I’ve always used an “in-network” eye doctor/office and had them run any services or benefits through the insurance. I’ve never had to submit my own claim.
    If I were in your shoes I would definitely be fed up at this point. Could you easily switch to another company? If yes, do it. If they do not, you might want to just cancel your vision and maybe re-enroll with another when you are able. It definitely does not sound that your monthly premium is worth it at this point!

    • Reply Ashley |

      It was definitely an in-network eye doctor (I went to a new person specifically because my old person was NOT in-network). I ended up just canceling for the time being. If it seems like it would be beneficial again at some point in the future I’m probably going to look for alternative options.

  • Reply gmtb |

    No experience with this insurer, but I’ll tell you three things as a Lasik patient:

    1 – Depending on the technology used by your surgeon/clinic, you may also need to buy about 7 boxes of Refresh Optive preservative-free eyedrops, and then about 6 months after the procedure, that number decreases drastically (but still needed, especially in dry climates or offices). I strongly recommend Amazon because $15 a box is much better than $30 retail. This isn’t usually covered in your procedure estimate.

    2 – You’ll definitely want a surgeon in town with admitting privileges or a practice at a reputable eye clinic. I’ve had complications from mine that, thankfully, were tended to almost immediately because my surgeon is in town and my procedure costs covered 1 year of follow-up appointments and corrections. If I had gone to the nearest city to save costs, I’d have been hosed.

    3 – If you’re looking to save a little on the costs, ask the eye clinics and surgeons if there are/will be specials on the procedure when they’re about to phase out old (but perfectly usable) equipment/procedures for new ones. I got $1K off because they were about to get a bladeless setup.

    • Reply Ashley |

      Wow, a thousand dollars is a huge savings! Thanks for the tips, too! Like I said, it will probably be a long while before I seriously start considering/researching options but I’ll definitely file these tips away in the old memory bank ; )

      • Reply Jill |

        You might get lucky. When I had mine done they had an educator’s discount, since I was teaching adjunct at a community college I was able to get this discount. Mainly when you call around make sure you ask if they have a discount for teachers and ask if that includes college.

  • Reply Emily N |

    That sounds totally rotten! Can anyone in your employer’s HR department (maybe the benefits administrator) help you out?

    I have no personal experience with Lasik, but I think the Frugalwoods blog had a writeup on how they found the most frugal way to do it.

  • Reply Consuelo |

    I’m an employee benefits lawyer but not familiar with this insurer. My suggestion is to do two things: first, send a letter and copy your employer’s HR dept.–(they are the “plan sponsor” of your vision plan) on the letter. Describe your awful experience with customer service in the letter and point out that the quality of their service is so bad as to amount to fraud under both federal and Arizona law (if I’m wrong and you live in Texas then mention Texas instead…). Tell them you want to appeal their denial of your two good claims from 2015. They are required to have a free, internal appeal process. Find out how to appeal and devote just a few minutes to filling out the form. Keep copies of everything. Second, I agree with the other commentators; I’d cancel my coverage and save yourself the $15/month. You can cancel and still appeal the denial of your 2015 claims! If anyone from your employer’s HR office follows up with you (and they should) explain that you are deeply disappointed with insurance that is in fact illusive and pays no benefits. A big university should easily be able to provide affordable, decent quality vision coverage. Good luck.

    • Reply Ashley |

      Wow, thank you! I already cancelled but I figured I was just screwed in terms of reimbursement (didn’t think about still appealing even after canceling coverage). Thanks!

  • Reply Sarah |

    Our 17 year old has vision insurance through our PPO (we think til he is 19). I wonder if this is part of ACA. Your girls might be covered.

    • Reply Jen From Boston |

      Part of my annual eye doctor visit is covered by my regular medical insurance, but only the medical part. I think that means the glaucoma test and other screenings are covered, but not the part that checks my prescription. I use my vision plan to get a deep discount on glasses. I don’t get glasses often, but the discount is deep enough the plan is still worth it.

      I don’t know what effect the ACA has on this as I am lucky to work for a large corporation that provides really good benefits.

  • Reply Adam |

    I actually opted out of vision coverage this year too. We decided it wouldn’t cost us any more to just getbour exam and prescription from Walmart or Costco, and then buy glasses at Costco or online. Vision coverage just didn’t add up.

    What I don’t know is if I sacrificed any catastrophic coverage for vision related emergencies. Hope not.

    Regarding LASIK, I had LASIK 10 years ago. I recommend it because it frees me from a lifetime of extremely poor vision. Life changing. But, at the time, there was a wide variety of surgery methods and machines on the market , and the price was widely variable. I’m not sure how things have changed since then, but I’d say to check if your coverage is limited to a certain type of LASIK…and if you want anything different, it may be way more. Just don’t get outdated surgery. Those places pay big money for their machines so they want to get maximum use out of them even if a newer better technology comes to market.

    When I got mine, the advertised price was for $299/eye. But I had a special circumstance that required a different machine and it cost me $1800/eye. After the $299/clinic told me I’m “not a candidate”

    I was happy with results but 10 years later I’m back in glasses (just barely though).

  • Reply Jenna |

    I had a workplace benefit called Health Advocate that sorted out issues like this for me – it was very helpful. Look into whether your work has it!

So, what do you think ?