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by Ashley

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!

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