Insurance Claims: Timing is everything

I ran into an interesting financial faux pas a few months ago, when Mrs. C8j decided she needed new glasses (her eyes are deteriorating at a high rate it seems). I checked my insurance to see and yes she was allowed to buy glasses this year, so she went out and bought a nice new pair.

Optical Device Glasses

I have replaced these glasses since this photo

Mrs. C8j has her own insurance (which is nice for a full part-time job), so she first submitted her glasses claim to her insurance provider and was told, “No, we won’t pay for these because you already had new glasses, in this time period”. I believe the obscenity yelled by me was similar to #WTF! , I was not well pleased, but from this I learned that timing is everything when it comes to Optical Device Insurance Claims.

The interesting point is that both Insurance Companies claim you can purchase glasses every two years and they will cover an amount for the glasses (with a bunch of riders about styles, types of lenses etc.,) up to a maximum of about $250 (not the real number). In theory then, if Mrs. C8j went and bought $600 worth of glasses, the arithmetic should end up:

  • Insurance Company #1 pays about $250
  • Insurance Company #2 pays about $250
  • We are $100 out-of-pocket on the glasses

Fine and dandy, and that was the (flawed) assumption we went forward with, but the mistake we made was how each insurance company computes 2 years.

How can this be? I will try to elaborate

  • My Insurance company computes two years as a calendar event. If I buy glass on January 1, 2012 or on December 31st, 2012 I can then buy a new set on January 1st 2014. This is a nice way of calculating two years (and it was what I was used to with insurance).
  • My Wife’s insurance computes two years, as two years from the day you last bought glasses. Mrs. C8j had bought glasses in September of 2012, thus she wouldn’t be allowed to buy another pair until September 2014, and that is where the problem arose.

This is where the consternation on my part arose, Mrs. C8j purchased new glasses in March, thus we ended up only being reimbursed by my insurance company for their “cut” of the glasses pay out, only.

I don’t think anyone is “at fault” here except myself for not checking closely with BOTH insurance companies before telling Mrs. C8j about when the insurance might pay out, but remember with Insurance (and all things financial) check dates, riders, provisos, and the fine print closely before acting!

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