No, you CAN'T use your insurance ....

[KnitShoni]

and still use the retailer's 50% sale.

We get a lot of these calls. People want to know if they can use their vision insurance and still take advantage of the provider's sale. Most people are fine with, "The benefits apply to retail prices only." The long explanation is that if we were to allow that, we would eventually have no doctors for members to choose from, as they would opt our of our plans before they went out of business. They have an issue giving away free glasses to roughly 75% of their customers.

Some people, though, think that because they're paying for coverage, they can use it however they want. Sorry, $10.00 a month does not give you the right to put people out of business.

[Dave1982]

Um......can't say I get this one.

How would insurance paying LESS money for glasses because they are on sale put anyone out of business?

And if people are using insurance benefits to pay for them, why do they care what the cost is if it's free to them anyway? Do they have to pay up front and get reimbursed?

[Broomjockey]

The only way the "putting out of business" makes sense is if insurance somehow isn't paying the company for the glasses, which is...probably wrong.
Also, many insurance companies won't pay 100%, or will cap out what they're willing to pay, so a 50% sale would let you get better frames for the same price.

I don't really get it. I think we're going to need clarification.

[Banrion]

Insurance companies don't pay full retail price. They have contractual agreements with the providers for discounts already. So while the patient's benefit may be "Frames up to $100" the insurance company is probably only paying $50-$60 back to the store. If the store allowed their sale on top of the insurance benefit then they would be selling $300.00 frames and only get reimbursed the $50.00.

[KnitShoni]

Exactly. Guess I should have explained better. The providers want to make a profit as well as provide services. They can't do that if, by doube discounting, they are forced to sell their product at a price less than it cost to make.

[Broomjockey]

Ah, interesting. So insurance doesn't just "pay"... *files that away*

Yeah, people do love to try and double stack discounts, don't they? Forget the business! I wants my cheap stuff! I mean, I like cheap stuff too, but still, some people do get quite ridiculous about it.

[Banrion]

Ah, interesting. So insurance doesn't just "pay"... *files that away*

Yeah, people do love to try and double stack discounts, don't they? Forget the business! I wants my cheap stuff! I mean, I like cheap stuff too, but still, some people do get quite ridiculous about it.

Yep, I don't know how it is up in Canadaland, but my insurance actually sends me what they call an explanation of benefits, and that delineates exactly what they were billed, vs what they have contractually agreed to pay for a good or service and then breaks down what portion of the contract they paid and what portion I am responsible for.

[Broomjockey]

Yep, I don't know how it is up in Canadaland,

Well, as I'm on my parents' insurance, I don't know exactly how it works in total, but the way it goes on my end is if the place can bill insurance directly, I get a recipt that says the total, how much insurance covers, and what I owe the place, from them. If they can't pre-bill, I pay the total, send the recipt in, and they send my parents a cheque for the covered portion. Any additional paperwork about breakdowns would go to them.