in Case Study, Health Insurance

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!

{ 14 comments }

  • Mathieulebrun July 17, 2014, 9:59 AM

    Interesting post. Hope to hear more post from you. Tks.

    Reply
  • Sandra Mercier July 17, 2014, 9:28 AM

    Thank you for your information. It’s very helpful and interesting!

    Reply
  • debt debs July 14, 2014, 4:01 PM

    I think my clock starts from the last purchase, sort of like dental. I wonder if my orthotics work that way too? I need to check that.

    Reply
    • bigcajunman July 14, 2014, 4:33 PM

      Always check before you buy, or you might be out of pocket.

      Reply
  • Denis July 9, 2014, 2:33 AM

    Try getting 3 pairs of glasses and one pair of sunglasses in one year. One time $200 off ONE pair, and each pair was OVER $800one was $960! Multiple appointments, only one covered for 80% after the discount! I got a discount of $15 on the appointment from my health coverage through the province? The reason for the expense is tri-focals, and my prescription changed by +2.00 or it might have been -2.00 from what it had been when I had the appointment and it changed that much during the time I was waiting for the glasses to come in from the place making them, and that was in under 2 weeks! Goth them to honor the 60 day warranty to adjust them. 3 months later it had gone the other way by 1.00 so I was off getting another pair! 6 months later again!

    Be happy it was so little!

    Reply
  • Dan @ Our Big Fat Wallet July 8, 2014, 11:45 PM

    I do this all the time with my work’s benefit plan. We get around $350 vision coverage which resets ever two years, with a year ending June 30th. I will typically call them near the end of June to see how much I have left to spend (if any), and if I do I will spend the full amount allotted. If not, I will wait until July 1 for the new coverage year to begin

    Reply
    • bigcajunman July 9, 2014, 5:36 AM

      I think the moral of the story is to always check your coverage before you use it.

      Reply
  • Brian So July 8, 2014, 7:23 PM

    It’s all a way for employers and/or insurance companies to save money. By basing it on a 2 year rolling period, the insurance company is now off the hook for the claim, although chances are the employee will figure this out and time the claim better next time.

    Reply
  • My Own Advisor July 8, 2014, 6:42 PM

    Sounds like a PITA…

    Mark

    Reply
  • Michael James July 8, 2014, 3:49 PM

    Look into getting glasses at CostCo or ordering them online once you have the specifications — they’re much cheaper that way.

    Reply
    • bigcajunman July 8, 2014, 4:21 PM

      That is where my new glasses came from, just fine.

      Reply
  • Bet Crooks July 8, 2014, 11:55 AM

    We got caught by this one, too, once. It was a “rolling” 2-year for an eye checkup, so we weren’t out as much when they refused to cover. And given how valuable eyesight is, we didn’t really mind paying the $60 ourselves. Still, it was annoying!

    Especially since the appointment was only a few days before the date that the “rolling” limit would have permitted us to get reimbursed. We were never given any way to check the details of the 2-year calculation; I guess we could have phoned and asked before booking the appointment but it never occurred to us.

    Reply
    • bigcajunman July 8, 2014, 11:57 AM

      Most of the time I rebook my eye exam for the next year +n days just to be safe (as I do with my dentist as well).

      Reply

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