So I have BCBS of Michigan and it’s a student plan provided by my university.
I looked at the full terms and conditions of my plan and I found this for vision coverage:
Routine adult vision exam performed by an optometrist, ophthalmologist or other provider and covered through the medical benefit: $20 copay per visit in-network; 20% coinsurance of the approved amount out-of-network. Routine adult vision exams are limited to 2 vision exams per member per benefit year; and 1 office visit for the fitting of prescription contact lenses per member per benefit year. For routine adult vision coverage information contact BCN customer service 1-800-662-6667. Pediatric Vision is covered in full for an eye exam and prescription glasses, once per calendar year for members up to the age of 19. Frames are chosen from a select collection. For additional pediatric vision coverage information, contact VSP customer service 1-800-877-7195.
I am over 19. According to this, as long as I get my eye exam at an in-network optometrist, it will only cost me $20. My deductible is $100.
- Does this mean I’ll have to pay the $100 to meet my deductible and then the $20 copay?
However, when I called BCBS they first told me that they don’t provide vision coverage and it’s through VSP which covers exams for members up to the age of 19 only. I had to really press the phone rep. to get the right information and it took her a while to find the same terms that I had found but she did confirm in the end that my finding is correct. But then I called the optometrist’s office and they asked for my insurance information and they said they could only see on their end discounts for eye exam and contacts fitting but not full coverage. So I told them that they would have to bill it as medical to BCBS as the medical component of the plan would cover it but not the vision component and they said they could do that but they can’t confirm that it will go through.
So I am very confused as to how this works.
My understanding is that the plan from BCBS provides several separate components: medical, vision, and dental. The vision coverage is provided by a third party (VSP) but the medical component also provides vision coverage. Is this correct?
Based on the terms above, will I be paying separately for the eye exam and the contact lens fitting, as I understand they are two different things even though they are done at the same time? Or will it just cost me the $20 copay?
Thank you to anybody reading this and offering their help. This is so confusing to me and I can’t seem to get a straight answer from neither BCBS nor the optometrist’s office.
submitted by /u/KevinKZ
[link] [comments]
So I have BCBS of Michigan and it’s a student plan provided by my university. I looked at the full terms and conditions of my plan and I found this for vision coverage: Routine adult vision exam performed by an optometrist, ophthalmologist or other provider and covered through the medical benefit: $20 copay per visit in-network; 20% coinsurance of the approved amount out-of-network. Routine adult vision exams are limited to 2 vision exams per member per benefit year; and 1 office visit for the fitting of prescription contact lenses per member per benefit year. For routine adult vision coverage information contact BCN customer service 1-800-662-6667. Pediatric Vision is covered in full for an eye exam and prescription glasses, once per calendar year for members up to the age of 19. Frames are chosen from a select collection. For additional pediatric vision coverage information, contact VSP customer service 1-800-877-7195. I am over 19. According to this, as long as I get my eye exam at an in-network optometrist, it will only cost me $20. My deductible is $100.
Does this mean I’ll have to pay the $100 to meet my deductible and then the $20 copay?
However, when I called BCBS they first told me that they don’t provide vision coverage and it’s through VSP which covers exams for members up to the age of 19 only. I had to really press the phone rep. to get the right information and it took her a while to find the same terms that I had found but she did confirm in the end that my finding is correct. But then I called the optometrist’s office and they asked for my insurance information and they said they could only see on their end discounts for eye exam and contacts fitting but not full coverage. So I told them that they would have to bill it as medical to BCBS as the medical component of the plan would cover it but not the vision component and they said they could do that but they can’t confirm that it will go through. So I am very confused as to how this works. My understanding is that the plan from BCBS provides several separate components: medical, vision, and dental. The vision coverage is provided by a third party (VSP) but the medical component also provides vision coverage. Is this correct? Based on the terms above, will I be paying separately for the eye exam and the contact lens fitting, as I understand they are two different things even though they are done at the same time? Or will it just cost me the $20 copay? Thank you to anybody reading this and offering their help. This is so confusing to me and I can’t seem to get a straight answer from neither BCBS nor the optometrist’s office.
submitted by /u/KevinKZ [link] [comments]Read Morer/HealthInsurance