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The Vision "Insurance" Myth


What is Vision "Insurance"?


Vision "Insurance" is not actually insurance at all. It does not insure you against anything. Other real insurance policies such as medical or health, auto, home owners, liability, etc. always insure you against large or "catastrophic" loss. The benefit of having these insurance policies is that in the case of a major loss or accident, you are covered and will not have an expense which you might be unable to financially manage.


So called "vision insurance" does not actually insure you against any catastrophic loss at all. They are simply offering you a prepaid benefit towards getting your eyes examined and purchasing eyewear such as eyeglasses or contact lenses.


If you develop a medical problem with your eyes, any treatments, doctor visits, and testing are already covered under your medical insurance plan. These conditions are not covered under vision insurance anyway and are strictly considered medical in nature. Your eye doctor will bill your medical insurance for treating any of these medical visits or procedures related to your eyes.


Generally, "vision insurance" policies come in two forms: a vision benefits package or a discount vision plan.




With a vision benefits package there is a monthly or annual premium or membership fee that is paid either by your employer or yourself or both. In exchange for this fee, you will receive an eye examination and benefits towards purchasing eyewear such as eyeglass frames, lenses, or contact lenses.


You typically will have yearly deductibles and copays which must be paid before your benefits are received. These copays and deductibles are designed to force you into sharing in the cost of using your benefits in order to keep the costs of the "insurance" down.


These types of plans will normally cover examinations and benefits only once per year (sometimes only once every two years for some benefits such as eyeglass frames).




Discount vision plans are designed so that for a relatively low cost an employer can say that you have vision benefits even though those benefits are actually just a discount given to you from your eye care provider. The "insurance" plan or company does not actually pay the doctor anything when you have your eyes examined or purchase eyewear. The doctor's office just gives you a discount (sometimes as little as $5.00 off an eye exam and a percentage discount such as 10% or 20% off eyewear).


In these plans, the "insurance" company does not pay any costs. They just collect their fees from either you or from your employer and the eye doctors office gives you a pre-arranged discount.


Why do "Vision Insurance" plans exist?


In order to understand why there are "vision insurance" plans, you need to know the history of "vision insurance".


Health insurance dates back to the 1800's. For a long time, medical or health insurance plans were the only benefits available and were only for medical conditions and diseases. As these insurance plans became more widespread, medical insurance became to be considered a necessary part of everyone's life in order to protect you from catastrophic events and monetary loss.


Employers and especially large companies began including health insurance as part of the benefits of working for them in order to attract better employees. In this way they were able to compete with other rival companies for workers.


Eventually, health benefits became an expected bonus of having a job. In order to make their companies even more attractive to prospective employees, additional benefits such as dental and "vision insurance" were later added and vision insurance was born.


Today, "vision insurance" has evolved to the point where most plans force the doctor to accept far less than his or her normal fees in order to be able to take care of the patients who have that particular insurance. The doctors often have no choice but to accept these reduced fees when the insurance "pool" is so large that not accepting would mean a loss of too many patients for the doctor to be able to make a living. Because they are forced to accept reduced fees, the doctors are also forced to try to examine a greater number of patients to make up for reduced income. Unfortunately, this can often result in less time spent with patients and more hurried health care.


Complimentary Insurance Billing


The doctor's staff, in most cases, provide complimentary billing for all insurances their office chooses to accept. The office staff spends a lot of time looking up what the particular benefit package consists of and what coverage exists for the patient. This includes finding out what copayments, deductibles, dates of coverage, maximum benefits towards examinations, frames, lenses, and contact lenses are available for the patient.


In many cases, the office staff must "play detective" in order to try to figure out what insurance plan the patient actually has through their company. Often, the insurances can be so confusing that the patient has no idea what coverage plan they have or they believe they have one plan and actually have some entirely different coverage.


Again, the doctor's office will often choose to provide this service complimentary with no added cost to the patient. However, your insurance is "your insurance". The payment for services and products received always rests upon the patient. If a particular insurance company does not pay or says it is going to pay a certain amount and then pays less, the patient is responsible for paying for the services in all cases.


A doctor's office may try to get the correct information from a given insurance company about your insurance coverage, but ultimately their office is doing this as a service for the patient and your insurance is your own responsibility. If you actually do not have insurance or if the insurance is not going to pay what was expected, the cost of the services rendered will always be the patient's responsibility to pay.


Do I need "Vision Insurance"?


This is the ultimate question. The simple answer is "no". Again, "vision insurance" is never responsible for any catastrophic loss like other "real" insurances.


Medical problems concerning your eyes including diseases as well as emergencies and injuries are already covered under your health insurance and not your vision insurance anyway. In all cases the amount of fees paid every year for your "vision insurance"--taken out of your paycheck each month and paid by your employer--will be far more than the benefits you receive towards eye care.


Lets repeat that: With "vision insurance", in all cases, you will pay much more each year to the insurance company than the benefits you will receive. That's every year, even if you use the benefits to their maximum value every year.


This is very different than other real insurance policies. When you have auto insurance and there is an accident and your car is "totaled" or someone is injured, the insurance company will pay for a new car or pay for the medical care of the persons who were injured. That is what your insurance premiums are for--they protect you in case something catastrophic occurs.


With "vision insurance" there are never any catastrophic payments. We know how much an eye exam will be every year and how much benefits you will receive towards an eyeglass frame and lenses and when we do the math--you will always have paid more to the insurance company each year than the benefits or savings you will receive.


So why should you have "vision insurance"? Well, in many cases, you may have no choice. Often, your "vision insurance" is part of a package of benefits provided by your employer. In these cases, a certain fee is taken out of your paycheck every week which pays for a portion of your health benefits and includes vision.


So if you have "vision insurance" make sure you use it every year. Otherwise the benefits go unused and you have wasted all the money paid to the insurance company for that year.


But make no mistake, even if your employer is paying a portion or all of your "vision insurance" premiums, the amount paid is always more than the benefits received. After all, that is how the insurance companies make money.


So the bottom line is: If you have "vision insurance", make sure you use it to receive all of your paid benefits every year. If you do not have "vision insurance" you are ultimately paying less for your vision care anyway.















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