Some employers and medical insurers choose to offer routine vision-care “insurance”, usually as a distinctly separate plan administered by a different company than one's primary health insurer (e.g. VSP, Davis, BlueView, AnthemVision, Cole, ECPA, EyeMed, Spectera, etc.). On first glance, this sounds attractive and indeed, you’re probably asking: “what’s going on? – this is an eye doctors’ office, right? – why don’t they take vision insurance?”
In addition to being very expensive, medical insurance has unfortunately become complicated & difficult to understand, so it’s helpful to revisit some basic assumptions: Insurance, of any type, is a product you purchase in order to provide financial protection against the risk of unlikely events that might otherwise be unaffordable – e.g. the very high costs of medical care for an injury or chronic illness. Routine health care, on the other hand, typically refers to preventive maintenance most people reasonably expect to encounter as they care for themselves and their families – e.g. vision-care, dental-care, regular physical exams, etc. Consequently, we generally accept the costs of health insurance as protective peace-of-mind, measured against the hope that we won’t need to use it! On the other hand, it makes little practical sense to "insure" ourselves against relatively minor expenses unless there's significant financial benefit to doing so (e.g. guaranteed savings or tax benefits) and/or rational basis for addressing minor problems before they become bigger ones. From an analogous perspective, most of us understand the wisdom of automobile insurance…but we don't expect it to cover the cost of gasoline & oil changes!
Sadly in this context, most vision plans are now simply marketing tools — a.k.a. discount plans that often fail to meet one's expectations. Sadder still, they often provide far less "benefit" as compared to the premiums paid by you and/or your employer…and in most cases, the dollars paid for 'vision coverage' prove far more effective when left in your own pocket to use as necessary. For example:
- Many plans are structured around more frequent examinations than some patients need, and thus, collect premiums for benefits that subsequently go unused (average utilization across the country is barely better than 50%) . . .
- Virtually all vision plans promise discounts that often fail to materialize in reality – e.g. is it really a “discount” if everyone pays 50% of an inflated “full price”? . . .
- Most plans specifically restrict your choice of doctors and materials, such that your “benefit” applies only in department stores or shopping malls, and/or limits your choice of eyeglasses, etc. . . .
- Vision plans generally provide no coverage for medical eye conditions (e.g. cataracts, glaucoma, etc.) and carefully limit their allowances for routine services – i.e. these plans always profit at your expense and never risk unpredictable losses due to unforeseen eye problems (which fall under your medical insurance) . . .
So…you should be your own vision plan administrator! Spend the money as you see fit and keep the profits yourself – it's your money in the first place.
Though we realize our office's philosophy regarding vision plans may present difficulties and misunderstanding, we're nonetheless committed to the high-quality care our patients entrust us with every day. Participating with most of these plans as they presently exist would unfortunately compromise the faith we work to earn from each of you…and in our opinion, misleads the public in general.
We consequently encourage you to consider vision plans very carefully and explore other alternatives such as self-directed defined contribution plans. We genuinely respect the fact that many unique factors contribute to your health care choices, however, so please feel free to inquire if we can help you understand your specific eye-care options or answer any questions. Should you wish to receive care here in our office despite existing vision plan coverage, we will happily provide you necessary paperwork to submit for “out-of-network” reimbursement – an option that virtually all plans allow (but rarely advertise).