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Insurance Claims: Timing is everything

A few months ago, I faced a surprising money misstep. My wife, let’s call her Mrs. C8j, required new eyeglasses because of rapidly failing eyesight. We looked at our insurance coverage and found that she could buy eyeglasses that year. So off she went to make the purchase.

Optical Device Glasses
I have replaced these glasses since this photo

She has a separate insurance policy through her part-time job. She tried to claim the cost of the glasses from them but was told, “Sorry, we can’t cover these as you’ve already bought glasses during this timeframe”. To say I was fuming would be an understatement! This incident taught me that timing is crucial when dealing with Optical Device Insurance claims.

Here’s the odd part. Both insurances agree to cover the cost of eyeglasses every two years up to about $250 (this isn’t the exact amount though). When it did come down to specifics like styles, types of lenses and such, they had several conditions. Now theoretically speaking, if Mrs. C8j chose glasses priced at $600, the math should look somethin’ like:

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

This should have been simple. But where we faltered was in understanding how each company calculated two years.

So how exactly did this happen? Allow me to explain

  • 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 an excellent 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.

The issue arose because Mrs. C8j bought her glasses in March thus we ended up getting reimbursed only for what my insurance was willing to pay for the glasses.

I don’t believe anyone is to blame here except me for not doing more research with both insurance providers before telling Mrs. C8j about potential payouts. Always remember in matters of finances and especially insurance – check dates, riders and small print in detail before making a move!

The glasses for Mrs. C8j, featured in this photo, have been swapped out recently.

Feel Free to Comment

  1. 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.

  2. 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!

  3. Dan @ Our Big Fat Wallet

    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

  4. 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.

  5. 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.

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