Problems with Eye Med and Emblem Health (medical, plan, hospital)

[Winu]

Hello, I am having a problem with my vision care insurance and thought maybe someone here can help me.

I have the Emblem Health Silver Value plan with vision and dental. I need to buy some contact lenses, so I went to eye doctor but they wouldn't take my insurance. So I called Eye Med and Emblem, to solve the problem. Long story short, they gave me really really seriously hard time, for 3 weeks, but finally I was able to update my plan info.

However, the updated vision plan on Emblem and Eye Med do not match. On Emblem, it says $0 copay for eye exam and $0 copay for standard contact lenses. On Eye Med, it says $0 copy for eye exam and $0 copay with $80 allowance for contact lenses.

$0 copay, and $0 copay with $80 allowance has a huge difference on how much I have to pay.

Also, it seems like I still have to pay around $125 for the contact lens fitting, although I managed to make the eye exam $0 copay.

Is this normal that the insurance company states one thing and vision care insurance states another?

Is there anyone else who has this same plan and have used the Eye Med vision care? What does your plan say?

Thanks in advance!

[bigbear99]

I don't do vision "insurance" because it's not true insurance. It's more like pre-pay for some services, with lots of limitations, as you're finding out, and poor value for the money.

I think "vision insurance" is a product designed for the benefit of providers (and insurers' profits), not patients, unless your employer pays all the cost, or you're in a high tax bracket, so you save by paying with pre-tax $. Of course high tax folks are high income, so they don't need the savings.

[Winu]

Oh I see... I knew medical cost in America is crazy high but I didn't know using insurance in America is so difficult... Thanks for your advice!

[bigbear99]

Insurance is incredibly difficult here, what with in/out of network, co-pays, co-insurance, deductibles, payment caps, medical necessity (or not...). Did I miss any? Worse is the unbundling - your hospital care, medical care, pharmaceuticals, dental care, vision care, hearing care and mental health care are each subject to separate rules, different benefit managers, and sometimes different insurance.

[Jamessuper]

Maybe! But you should take insurance. And you take treatment at a well-recognized hospital. Because eyes are the most important part of our life.