What is coordination of benefits and why do you want a vision plan that DOESN’T do it?

Coordination of Benefits OKC
March 8, 2022
James Ashford

The vision care industry is more complex than ever and one component that most are unfamiliar with is coordination of benefits. As a broker, we know you take your role to assist clients in making informed decisions very seriously. Those employers, and their employees, need to understand the concept of coordination of benefits so they are better equipped to choose a vision plan that doesn’t not coordinate benefits.

What is coordination of benefits?

Sometimes when an individual has a claim, two different insurance plans actually cover their issue. In this case, a process called coordination of benefits resolves which company will be responsible for the payment.

Some vision plan providers also utilize coordination of benefits. When a patient sees their optometrist for a routine eye exam but is then diagnosed with a medical eye issue, vision plan carriers will let the health insurance company cover the cost leaving the employee to pay additional fees they did not expect.

This practice can result in paying for overlapping coverage. Since the vision plan provider will never cover certain costs, that coverage has essentially no value for the plan participant. This can lead to upset employees who feel that they weren’t given a clear understanding of their coverage.

To avoid this loss of value and dissatisfaction, consider offering a vision plan that doesn’t coordinate benefits, and educating your clients on why this is an important feature. Doing so can ensure that all employees receive full value for their monthly premiums.

Routine eye care vs. medical eye care

When a patient schedules an appointment with their eye doctor in OKC, or anywhere else for that matter, they usually expect to pay the copay described in their vision plan. Until after their visit with the doctor, they may have no idea their eye issue is actually a medical issue.

This discrepancy may not be clear to either the doctor’s staff or the patient until check-out. More often than not, this is when the patient learns the cost of their visit. The testing and examination have already been done and fees have been processed. Awkward situations can develop since the services have already been provided.

To the patient, this may feel like a “bait and switch.” They visit their eye doctor for a covered or discounted exam and new glasses, but then they discover that they have financial responsibility for a medical eye problem. Many eye technicians express frustration at dealing with this on a daily basis because it is not their fault, it is the law that all medical issues are coded as such, and the fact that most vision plans coordinate coverage and refuse to pay in these cases.

In most cases, the doctor will have the patient return for another visit to complete the routine eye exam. The two separate visits will allow both claims to be filed. This is very frustrating to patients. Vision Care Direct of Oklahoma and beyond provides an alternative to coordination of benefits by using flex exams. If the visit results in filing with the medical insurance provider, we do not coordinate benefits which means the office can file with both the health carrier and Vision Care Direct on the same day. Instead, Vision Care Direct gives the patient a credit for the exam that can be applied toward other services whether they are paying for the co-pay of the health insurance provider or getting eyeglasses or contact lenses.

Vision plans vs. health insurance

Vision plans cover Routine Eye Exams and Health Plans offer Medical Eye Exams. The difference is if the Optometrist finds a medical issue that is not related to vision correction.

Vision care plans do not cover most common medical conditions of the eyes, such as:

  • Dry Eye Syndrome, which affects nearly 20 million Americans.
  • Floaters, which are usually benign but can lead to retinal issues.
  • Allergies, which can cause itchy, watery eyes.
  • Infections such as conjunctivitis.
  • Cataracts, which cause impaired vision, are not usually improved with glasses. Patients are referred to an eye surgeon.
  • Diabetes, which can lead to diabetic eye complications.

Also, if the patient needs eye drops, these prescriptions are considered medical and are not covered by vision plans. Coverage for eye drops would require filing a claim with the health insurance provider.

Let Vision Care Direct help you help your clients

Helping your employer clients understand the many facets of vision plans is essential. Vision Care Direct of Oklahoma offers multiple advantages to help you meet your clients’ needs for a vision care plan.

Unexpected costs are a burden for anyone. In these unprecedented times, why not choose a plan that is transparent? Vision Care Direct of Oklahoma and VCD nationwide offer straightforward programs which individuals can rely upon.

Not sure where to get started with recommending self-funded plans? Vision Care Direct of Oklahoma is pre-paid plan provider with and extensive of specialists who deliver eye care in Tulsa and nationwide with excellent value for employers and plan recipients.

Find out more about our self-funded plans and other flexible options.

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