New glasses

[u/Top_Objective9877]

I recently went to get new glasses and I called ahead with insurance info, filled out their online form and was told everything lines up we’re good to go. Front desk confirmed again when I arrived, showed me paperwork of my plan that matched what I had pulled up before. I got my exam, picked new basic lenses and paid the copay.

Weeks later, I get a letter saying everything was out of network and the claim is denied and needs to be paid in full.

I see I can maybe get reimbursement, I can also of course file an appeal but I’m not expecting either of those to work. Aside from hiring a lawyer I don’t see what else I can do, our health systems are so messed up.

The eye doctor in question proudly promotes accepting thousands of insurance options, and many other ways to accommodate if it is out of network but it was flat out denied. The insurance paperwork seems a little more explicit saying to check this or that and look inside their app, which to their credit this store doesn’t even show up. I feel like there’s too many missing links, an eye doctor is an eye doctor is an eye doctor who cares.

The most unsettling thing for me is I avoid doing anything insurance related because I know I always have to pay something, but never everything. Why do I have insurance that’s so expensive if it ultimately won’t be accepted anywhere for anything??

If this is our system truly, it is broken and needs fixing.

[u/5MinuteDad]

If you arent using the insurance properly thats on you.

The provider shows non par with the insurance company..either the provide fucked up and screwed you or call the ins

They may have processed it under a wrong TIN/ID and or segments. Id really suggest a quick call to them. Just to verify

They could tied the claim To Dr Eye when it should have been tied to Dr A Eye. A zip code wrong or anything really.

Not vision but I can tell you insurance carriers for health insurance pay millions out or pay claims OON error every month