Navigating Out-Of-Network Glasses Insurance: A Comprehensive Guide To Billing And Benefits

If you have an out-of-network vision insurance plan, you can still apply for reimbursement on prescription glasses, sunglasses, and eye exams. To do this, you will need to complete an out-of-network claim form, which you can usually download from your insurance company's website. You will also need to attach an itemized receipt to your claim form. Once you have submitted the form and receipt to your insurance company, you will typically be reimbursed within 2-3 weeks, depending on your provider. It is worth noting that some companies, such as Glasses.com, accept out-of-network plans and can guide you through the process of using your out-of-network benefits.

Online retailers that allow out-of-network billing

Glasses.com is a good option for those looking to use their insurance for out-of-network billing. The website accepts most vision insurance plans, including EyeMed, Davis Vision, and Superior Vision. It also accepts out-of-network plans, allowing customers to submit a claim form directly to their insurance company.

Glasses.com offers a simple process for using your insurance. Your applied benefits will be displayed during the lens configuration or when you access them in the cart during checkout. The website also provides a Live Chat option and a customer service phone number to discuss options for using your out-of-network benefits.

Other online eyewear retailers that accept out-of-network billing include:

• LensCrafters: Accepts EyeMed, Aetna, Humana, Blue View Vision, and more.
• Ray-Ban: Accepts Eyemed, Aetna Vision Preferred, Blue View Vision, Humana Vision, UniView Vision, and more.
• Target Optical: Accepts EyeMed, Aetna, Humana, Blue View Vision, and more.
• Eyeconic: Accepts VSP, MetLife, and Cigna Vision.
• ContactsDirect: Accepts EyeMed, Aetna, Humana, Blue View Vision, and more.
• 1-800-Contacts: Accepts Davis Vision, Superior Vision (Versant Health), and Blue View Vision/Anthem BCBS.

In-store retailers that allow out-of-network billing

If you're looking to purchase glasses in-store and want to use your insurance, there are a few retailers that offer out-of-network billing. Here are some options:

Glasses.com

Glasses.com accepts most vision insurance plans, including EyeMed, Davis Vision, and Superior Vision. They also accept out-of-network plans and offer a reimbursement option for out-of-network benefits. You can easily use your insurance on their website or give them a call to discuss your specific plan. They also have a live chat option to answer any questions you may have.

Target Optical

Target Optical is another great option for in-store shopping and out-of-network billing. They offer a wide variety of name brands like Ray-Ban, Coach, and Armani Exchange, as well as more affordable in-house brands. They accept most major insurance plans, including out-of-network benefits for an array of vision insurance companies such as VSP and Spectera. You can also use your FSA or HSA account for purchases.

LensCrafters

LensCrafters is another popular option for glasses shoppers. They have a wide range of designer frames from brands like Armani Exchange, Vogue Eyewear, and Versace. They also offer frame and lens packages starting at $99. While they do not specifically mention out-of-network billing, they accept a large variety of insurance plans and you can always contact them to inquire about your specific plan.

Eyeglass World

Eyeglass World accepts most vision insurance plans and is an out-of-network provider for VSP. They also accept HSA/FSA funds for purchases, including glasses, prescription sunglasses, sports goggles, contacts, and solutions. They offer comprehensive eye exams and have board-certified optometrists.

Warby Parker

Warby Parker is a well-known glasses retailer with both online and in-store options. They offer stylish frames starting at $95, including prescription lenses. They also have physical stores where you can schedule eye exams and browse frames. While they do not specifically mention out-of-network billing, they accept insurance plans and you can contact them to discuss your specific plan.

Remember to always verify with the retailer and your insurance provider to ensure that your plan is accepted and understand the reimbursement process. Each insurance plan is different, so it's important to know what your plan covers before making a purchase.

How to apply for reimbursement

To apply for reimbursement for out-of-network glasses insurance, follow these steps:

Step 1: Check your out-of-network benefits

Check your Summary of Benefits, which is included in your member information packet or on your insurance company's website. Look out for terms like "out-of-network deductible", which is the amount you must pay before being eligible for reimbursement. For example, if your out-of-network deductible is $1000 and your insurance company pays 100% of services after you meet that amount, you will have to pay $1000 out of pocket.

Step 2: Call your insurance company to verify your benefits

Clarify your benefits with your insurance company member services line. You can find their phone number on the back of your insurance card or through your online insurance platform. Ask questions such as:

• How much of my deductible has been met this year?
• What is my out-of-network deductible for outpatient mental health?
• What is my out-of-network coinsurance for outpatient mental health?
• Do I need a referral from an in-network provider to see an out-of-network provider?
• How do I submit claim forms for reimbursement?

Step 3: Ask your optometrist for a Superbill

A Superbill is a document that details how many sessions you've had and the total fee. You will send this directly to your insurance company at the end of each month.

Step 4: Submit a claim for reimbursement

Complete an out-of-network claim form and attach your itemized receipt. You can download the form from your insurance company's website. Submit the form and receipt to your vision insurance company. Most major insurance providers will split the charge 50/50 between frames and lenses.

Step 5: Collect your reimbursement

After submitting your claim, you will typically be reimbursed within 2-3 weeks, depending on your provider.

How to submit an out-of-network claim

If you have an out-of-network benefit included in your insurance plan, you can apply for reimbursement on prescription glasses or sunglasses and eye exams. To do this, you will need to submit an out-of-network claim request.

Firstly, you will need to complete an out-of-network claim form. If you cannot find your provider, you can download a form from your insurance company's website. You will then need to attach your itemized receipt to the form. You can then submit the claim form and receipt to your insurance company. You may be able to do this online, by mail, or by following any other specific instructions from your insurance provider.

Make sure you submit the form promptly, as forms must typically be submitted within a certain timeframe of the date of service to receive reimbursement. For example, one source mentions that forms must be submitted within 15 months of the date of service to receive reimbursement, but out-of-network form submission deadlines may vary by plan.

After submitting your claim, you will usually be reimbursed within 2-3 weeks, depending on your provider.

Vision insurance providers that are out-of-network

When it comes to vision insurance, there are a variety of providers and plans to choose from. Some of the major companies offering vision insurance include:

• Blue Cross Blue Shield (BCBS): BCBS is one of the largest healthcare systems in the country, providing coverage for one in three Americans. Vision insurance plans vary depending on location, but they typically offer coverage for routine eye exams and allowances for prescription eyewear, including contacts and eyeglasses.
• Vision Service Plan (VSP): VSP is one of the largest providers of vision insurance in the US, serving over 88 million members worldwide. They offer plans for both individuals and groups, usually through employers, and are a not-for-profit organisation. VSP plans often include low copays for services like annual eye exams, eyeglass frames, prescription lenses, and contact lenses, as well as discounts on premium frames and specialised lenses.
• EyeMed: EyeMed is another large vision insurance provider, serving over 50 million Americans. They offer a wide network of retail vision care providers and independent doctors, including Target Optical, LensCrafters, and Pearle Vision. EyeMed plans range from $5 to $30 a month and typically include an annual eye exam, discounts on brand-name eyeglass frames, specialised prescription lenses and contacts, and discounts on LASIK and PRK corrective surgeries.
• Humana: Humana is a vision insurance provider that offers low monthly premiums and high annual savings. Their plans include allowances for eyeglass lenses, standard contact lenses, and eyeglass frames, as well as specialty lens options and possible discounts on corrective refractive error surgery.
• United Healthcare: United Healthcare offers vision insurance as a standalone plan or as a rider to regular health insurance. Their plans provide coverage for routine eye exams, allowances for prescription glasses and contacts, and discounts on other vision services. They have a large network of eye care providers and also offer the option of using out-of-network providers for a higher cost.

When choosing a vision insurance provider, it's important to consider factors such as the cost of premiums, copays, allowances, and the network of providers available. It's also worth comparing different plans to find the one that best suits your coverage needs and budget.

Frequently asked questions