A Friendly Reminder To Check Your Benefits

Today we’re keeping $225 in our pockets because I clicked on a link in the member portal of Mr PoP’s vision insurance and checked Mr PoP’s benefits even though I was 99% sure a bill wouldn’t be covered.

Mr PoP has risk factors for glaucoma that means he should have been getting regular visual field tests after he passed age 30. Getting Mr PoP to the doctor for something non-urgent is a challenge, so I finally got him to an appointment last month for this exam. A year later than he really should have gone. =P

Everything we’d been told about this test, by the eye doctor and by Mama PoP who has had many of these tests herself over the years, was that these tests are always billed through medical insurance, not through vision insurance. Mr PoP has a high deductible health plan, so we *knew* going in that we’d be footing the bill to pay for the entire exam since he’s never been anywhere near his medical deductible.

Specialists can be pricey on Mr PoP’s HDHP, but the $250 the exam was going to cost wasn’t a reason to not get it done. If Mr PoP was headed down the road to glaucoma, it’s better to find out as early as possible. So we scheduled the appointment, and Mr PoP went last month. His results were great, so no worries there. =)

But Mr PoP didn’t pay the full balance like I thought he would the day of the procedure, just 10%. So I *knew* we’d have to pay more. Fast forward to the end of the month and we get the EOB (explanation of benefits) from his medical insurance company that the eye doctor ran the exam through. I wasn’t surprise it said we’d need to cover the entire amount, and have just waiting on the bill from the eye doctor for the rest.

Instead, something else happened. We bought Mr PoP those $950 glasses.

And since those were an out-of-network purchase, I logged into VSP (our vision insurance provider) to fill out the online out-of-pocket reimbursement for our purchase. (We’ll get ~$100 from VSP toward the lenses and frames.) It was the first time I had ever logged in to the VSP portal, but wanted to try doing it online rather than mailing or faxing the claim form since I was told by a coworker it was much quicker online.

Turns out, the claim form for the glasses was quick and easy online. So much so, that while on the VSP site I started clicking around a little – looking up Mr PoP’s benefits to see exactly how much we’d be getting for the lenses and frames. And then another link caught my eye. There was a menu of “Specialty Services” that are covered under Mr PoP’s plan.

Since he had just gotten this visual field test, I clicked. “Surely the test won’t be covered,” I thought. “Our eye doctor would have billed VSP as they have for other WellVision exams rather than going through the medical insurance if that were the case.”

But I clicked. And read:

VSPCovered

“For the treatment and diagnosis of eye conditions like…glaucoma.” That sure as anything sounds like the exam that Mr PoP just had done. Is it possible it’s covered, even with the caveats about limitations and coordination with medical covered?

I Called The Eye Doctor’s Office

“Those exams are medical. We NEVER run them through anything but medical insurance. VSP won’t cover them.” said the office manager at our in-VSP’s-network eye clinic.

“Well,” I said, “This really reads like it might be covered under his vision insurance. Can you try to run it through VSP and see what happens?”

“If I do, it’ll force him to lose eligibility for his next WellVision appointment which is three weeks from now.”

“Really? That seems weird since they have different copays and the benefits read like they’re not mutually exclusive.  How about you send me the detailed list of the billing codes for this exam and I’ll call VSP myself?”

(In actuality this conversation was much longer with the office manager not listening to what I was asking and being very dismissive. But after 5 painful minutes she agreed to fax me a statement that showed Mr PoP’s diagnosis code and the billing codes for the various exams that Mr PoP had as part of his visual field test appointment.)

Fax In Hand, I Called VSP (The Vision Insurer)

After making my way through the automated phone maze, I finally reached a person – Katherine! I explained to her that I was just reading my husband’s benefits and it looked like a vision exam he recently had might be covered under VSP even though our eye doctor was insisting it be run through his medical coverage (where the entire cost was being pushed through to us since his deductible hadn’t been met there).

She looked up Mr PoP’s exact benefits, and I filled her in on the billing codes and the diagnosis codes. “This should be covered, but you do have a $20 copay.”

“I’ll gladly take $20 over $250! And will using this benefit for the appointment he had last month prevent his from using the benefit for his WellVision appointment in a few weeks?”

“Absolutely not. You just can’t use them on the same day.”

“That’s weird, but okay.”

“Yeah, it’s a requirement.”

Katherine then called our eye doctor and spoke with the same office manager who was giving me a hard time and told her to run it through VSP since it was covered under Mr PoP’s plan. Apparently the office manager was tough to convince since Katherine was on the phone with her for 15 minutes while I waited on hold. But when she came back, she assured me that they eye doctor would run it through VSP and the only amount due would be a $20 copay.

And since Mr PoP had already paid $25, we’ll actually have a small credit on the account.

All VSP Plans Are Not Equal

Now curious, I logged in and checked the benefits on my own VSP plan. (We have the same vision insurer, but get our benefits as individuals through our respective employers.) There, it looks like I would have coverage for this stuff if I have a diagnosis of glaucoma, but doesn’t include services relating to the diagnosis itself. So for me, the eye doctor would have been totally correct to not run it through our vision insurer.

There are apparently so many different tiers of benefit plans that not even the doctor’s office can keep track of them these days. It’s hard to fault the office manager who really did think she was right for not using the VSP benefits for the visual field test since I’m guessing Mr PoP’s plan is in the minority, though I think she could have been a bit less dismissive of me asking.

But the 30 minutes I spent on this (and 20 of those minutes were spent on hold), were well worth it. Not only will we avoid paying an extra $205 this year, this is a test that Mr PoP should really be getting done regularly, so we’ll avoid paying it going into the future as long as Mr PoP has this vision insurance plan as well.

So let this be a friendly reminder. When in doubt about insurance benefits, it doesn’t hurt to check with your insurer. And it makes the call go much easier if you can do it with the diagnosis codes and billing codes in hand.

Now I just need to figure out how to get Mr PoP to show up for two different eye doctor appointments each year since they can’t be on the same day!

* I’ve tried scheduling our appointments together, especially now that we are a one car household [LINK to One Car], but that hasn’t always worked to get him there either and just ends up with us canceling or re-scheduling appointments at the last minute.

 

When was the last time you checked your benefits? Does your employer provide benefits that you’re not aware of and aren’t taking advantage of?

44 comments to A Friendly Reminder To Check Your Benefits

  • I’ve had VSP insurance before and have run into the same issue with the office I used for exams. They really didn’t understand the coverage available. I had to call VSP to confirm my coverage and save my family so money in the long run. It pays to read the fine print or do your homework when it comes to benefits.
    Brian @DebtDiscipline recently posted..Sunshine Blogger AwardMy Profile

  • Sweet! Good job Mrs. PoP. I love saving money on services I need anyway. Health insurance is a huge ripoff, but we really need it. We switched over to a high deductible plan also, and deposit the difference in premium (about $400/month between the two plans) in our HSA. Once we accumulate $7 or $8k we’ll stop, but for now it’s providing a great cushion for our future…..or more likely, prepaying for our next child.

    Have a great week!
    -Bryan
    Income Surfer recently posted..The Oil GlutMy Profile

    • Switching to a HDHP and pocketing the premium difference in your HSA seems like a great plan. I’d consider switching to a HDHP like Mr PoP, too, but my employer would pocket 90% of the difference so I wouldn’t really benefit. Granted that’s because they cover 90% of my premiums, so I can’t complain too much… =)

  • Wow, it’s annoying how dismissive the office manager was being of you (I’d probably have folded out of sheer lack of patience). Kudos to you on getting it all sorted out and saving a cool $200 in the process!
    Taylor Lee @ Engineer Cents recently posted..The Quest For The Perfect CouchMy Profile

    • Yeah, she clearly had other things she wanted to be doing right then, which is annoying. Like you, I might have given up if the $-amount was lower, but to bring a $250 bill down to $20, I’m willing to spend a little time.

  • lucas

    Way to be persistent. Not to sound to pessimistic but my guess is that if the eye doctor billed correctly through VSP they they would get less money as VSP probably has some “defined” rate for services. So there is an incentive for them to make mistakes and discourage proper billing.

    • To be optimistic here, it might also be the billing office trying to save time. Why bother to fill out paperwork for something that is rejected 9 times out of 10 (or more)?
      Leah recently posted..Time and seasonsMy Profile

      • This definitely could have been the case. I didn’t know it at the time, but in order to run it through VSP, they also have to reverse what they ran through Mr PoP’s health insurance. So if I was wrong, I was asking her to do the job 3 more times when she had already done it once. =P

    • I really hope that’s not the case, but I guess we’ll see when the VSP EOB comes through since I know what they were allowed to charge under Mr PoP’s health insurance.

  • Yes, always important to keep pushing. I’ve run into that before with dismissive billing officers. Also good to go to multiple sources for help. In our most recent case, we were being billed an extra $1k for our little one’s birth that I didn’t agree with (“newborn resuscitation” by the pedi’s office, when the pedi wasn’t there and my newborn wasn’t resuscitated). I mentioned it to my doc, and she said to keep pushing. The pedi ultimately spent a good chunk of her own time calling and getting everything cleared up. So grateful!

    The worst part was that I kept asking the billing lady on our case for a manager, and she wouldn’t give me one. If I tried to call at another time, every other person who picked up would look at our chart and say “woah, you have to talk to X here.” She must have written one heck of a note about me. That made it extra gratifying to success, tho it was also frustrating to have to do this with a tiny infant and starting back to work.
    Leah recently posted..Time and seasonsMy Profile

    • An extra $1K! Definitely good on you for following up and pushing back on that, and I’m glad your pediatrician was helpful there. Good to know you have them on your side.

      • It was crazy. My OB had twins, and she said she was charged differently for them (based on an age-related charge) even though they were the same age. She’s the one who first encouraged me to pursue the overcharge. Again, always good to go through doc bills and insurance coverage with a fine tooth comb. I’ve read ours so well that I often answer questions for our colleagues, especially since our HR lady takes her husband’s coverage instead of ours.
        Leah recently posted..Time and seasonsMy Profile

  • I check my benefits before any non-regular medical appointment (basically anything besides a teeth cleaning and a physical) to see what should be covered. I find that doctors often don’t really understand various health insurance programs that well, and I have wound up paying a lot more than expected in the past because a doctor mis-interpreted my coverage. Now I rely on myself, so I have no one but me to blame if I’m wrong in my estimations!
    Ali @ Anything You Want recently posted..Guest Post on Embracing Simple – Your Free Credit ReportMy Profile

    • Very impressive! Our non-regular medical appointments are mostly because we’re sick or injured, so I don’t think we’ll be checking benefits before going to those. But you’re right that we probably should!

  • With my new job, my medical, dental, and vision insurance are all through the same company with one card and one website! I love it! It makes it so much easier to figure out what’s covered where and also easier to withdraw money from my HSA for dental/vision claims.

    I once went to the doctor for an issue and they basically told me I was crazy AND gave me false information about how to resolve the issue (aka didn’t). A few days later, I went to a different doctor and got the same issue actually resolved. So when I got a bill in the mail for the first doctor, I was PISSED! I did manage to get them to reverse the bill, which I was very happy about!

    I learned this year that vision benefits can be used for non-prescription sunglasses! I never would have thought about that before.
    Leigh recently posted..Budgeting: always stay a month aheadMy Profile

    • Whoa! All through one provider! I am impressed. Between the two of us, we have 2 health insurers, 2 dental insurers, 1 vision provider (but 2 different plans and logins), and 2 different “health $ account” logins where we are eligible for reimbursements from Flex and HSA. I would love to have it all under one roof.

      • Yeah and the company is the exact same network as my previous job had! And the HSA was through the same login! So all my doctors are definitely covered! I basically have the same plan, but with different premiums and a different amount going into my HSA :) That made the transition pretty convenient. (I had three different providers at my last job and never figured out how the dental plan worked other than the two free check-ups a year OR how to log into the vision website from not at work…)
        Leigh recently posted..Budgeting: always stay a month aheadMy Profile

  • I have trouble convincing staff to pay attention to all the things our company offers. We made changes to the medical insurance last year (to save money), but staff haven’t had their premiums go up in about 5 years! The changes made were little things like generic drugs over brand (you pay the difference if you want the brand name), slightly higer co-pay for appts (from $15 to $20) and a higher co-pay at specialists (from $15 to $40).

    It is amazing how many ways there are to adjust the insurance benefits (I realize I am writing form the point of view of the employer instead of the employee). In many cases we can save money and not have to increase premiums by making small changes that are barely noticed or only used by a small percentage of staff (I think of it as mostly a win-win).
    Vawt recently posted..The Homemade Laundry Soap ExperimentMy Profile

    • Way to go in managing health insurance costs so well for your employees! I was part of a team that led to changes and cost savings for health insurance for our company a couple of years ago and it’s definitely a complicated equation of how to keep premium costs low while also taking into account out-of-pocket costs, particularly for the “heavier users”.

  • I also want to add something about medical/dental coding. It is a good idea to try to understand the CPT codes on your EOB’s. I manage a team of 14 professional coders and sometimes providers use a higher code than needed (usually not on purpose). Coding can be very complicated, you can look up the 99213 and see it is an office visit code, etc.

    I am sure with smaller practices, the provider may try to code to get the highest reimbursement possible, this may not be a good thing for you (the codes may be borderline or just plain false). It is good to pay attention so you don’t get charged for services that didn’t occur.
    Vawt recently posted..The Homemade Laundry Soap ExperimentMy Profile

    • Is there a good online resource that you can recommend for translating CPT codes for people to understand? I’ve heard of some providers using a higher CPT code before – one smarmy dentist was billing my friend for a very extensive dental checkup that cost her and her insurance co more when she kept her teeth so clean the hygienist barely had to spend any time with her. She didn’t know the difference until we started comparing costs and she had a heck of a time figuring out what the difference was!

      • I usually just ask one of my 13 certified coders! Alas, not everyone can do that. I think if you google the code, you can usually find enough info about it to see if something does not make sense.

        Dental codes are very specific, so it is realyl easy to see if they are billing as an emergency or adding extra codes on to your visit!
        Vawt recently posted..The Homemade Laundry Soap ExperimentMy Profile

  • That’s the first time I’ve ever seen something associated with insurance claims described as “quick and easy.” Good for you doing all that legwork and research! I sure hope Mr. POP appreciates that you did all this work on his behalf!
    Norm recently posted..But Seriously, Folks, A Tracfone Is The Only Cell Phone Anyone NeedsMy Profile

    • Maybe we’re lucky, but we generally have pretty good luck with insurance being fairly quick and easy. Submitting a claim for a cracked windshield earlier this year took maybe 3 minutes on the phone and $0. The mobile windshield replacement folks then met Mr PoP to install the new windshield at their appointed time a couple days later. Easy peasy.

  • Too often people don’t fully take advantage of all the benefits that employers provide us with. That has definitely happened to me in the past. So good job for getting on it. And also thanks for the reminder…I’m a “glaucoma suspect” and I haven’t gone for my annual visual field test in a while. I really need to make an appointment…and my insurance covers it and I only have a small co-pay. I really have no excuse.
    Andrew@LivingRichCheaply recently posted..Frugal Dating GuideMy Profile

    • Yup – don’t put off your visual field test like Mr PoP did! Though do call and make sure you don’t have any weird restrictions like Mr PoP on the coverage for it like it can’t be the same day as a well-vision appointment. (‘Cause that would be too convenient for users of the benefit!)

  • Wow – I think I’d prefer to just pay up front and submit the claim to the insurer myself in some cases! I hate not knowing how much something will cost when we go to the doctor – and the doctor generally doesn’t know half the time either. Especially with prescriptions – the doctors want us to name a pharmacy up front to electronically send prescriptions to – but if you’re paying for them yourself, how do you know ahead of time which pharmacy has the better price?!
    Mom @ Three is Plenty recently posted..First DIY Building – Ever – Starting Our Swing SetMy Profile

    • This frustrates me so much. My vet and dentist can tell me how much every procedure will cost. Wish my doc’s office could do the same.
      Leah recently posted..Time and seasonsMy Profile

    • And pharmacy prices can vary pretty dramatically! If it’s a non-urgent Rx, we try and get them to write it on paper to call around. Most are okay with this, though the eye doctor always invites you to look at their glasses for sale while you wait 10 minutes for the receptionist to print out your Rx and get the Dr to sign it. =/

      Urgent ones we generally just send to Publix since their prices are usually pretty good and they are right on the way home from the doctor for us to pick them up when we are feeling crappy. When sick we’re not super cost-sensitive.

  • That’s awesome that you followed through on all of that so well! And that’s a LOT of money to get covered on a recurring basis instead of having to pay out of pocket. We had a slightly similar experience in that right before Kyle left his last job we suddenly remembered that we had FSA money to spend or we would lose it (we didn’t contribute anything, but his employer did a bit per year for each of us), so we went on a bit of a vision spending spree as well.

    Kyle’s new health insurance hasn’t kicked in yet and I, at least, haven’t seen any documents about what it covers and doesn’t, but I’m sure we’ll pore through them for everything that seems relevant for us. One plus side of being on the same plan is that we only have one set of benefits to try to understand instead of two. :)
    Emily @ evolvingPF recently posted..Apartment Search in SeattleMy Profile

    • It sure is… he’s supposed to get this test done yearly (if I can make him go to the appointments!), so it’s an extra $200 or so we get to keep every year as long as his plan doesn’t change!

      I’m jealous that you’ll be down to one set of benefits… I like the cost savings of having our employers pick up the tabs, but sometimes it’s annoying having separate benefits.

  • I almost got burned by our two dependent care FSA plans. They look identical and are run by the same company–but mine has a grace period, and Mr. FP’s doesn’t. Oops! His year ended and we had several hundred dollars unused and no receipts left to submit. I had to call my plan and have them reject my last couple of claims so I could re-file them on his.

    I’m just glad it was a fixable problem! At first, I really thought we had forfeited it at first. I did have to call twice–I don’t the think the first person totally understood what I wanted and she didn’t think she could do it, but the second person got it right away.
    Frugal Paragon recently posted..I’m Making a Skirt! Phase 3: Caught in the ZipperMy Profile

    • Yikes – glad you got that one worked out. We try to be pretty conservative with the FSA plan so we don’t lose any money – because ours doesn’t allow a carryover even though the federal govt has now said plans are permitted to let employers rollover $500… but they don’t have to. Ours doesn’t.

    • Do you both take the full amount for dependent care? We were told that only one of us could take the $5.5k (or whatever it is). We do both work at the same place, so maybe that’s the difference.

      In the end, what we do is have one of us do the dependent care FSA and one do the HSA.
      Leah recently posted..Time and seasonsMy Profile

  • That’s awesome. We don’t have any vision or supplemental insurance such as Aflac. Just health insurance but I really need to get up to speed on what’s now covered under the new health care laws.
    Mrs. Crackin’ the Whip recently posted..This Financial Independence ThingMy Profile

  • Becky

    I’m weirded out that they shared Mr. PoP’s medical information with you! It sounds like the office manager was frustrating to you for not being very flexible, but she’s frustrating to me for violating HIPAA!

    • Did she? We’re both each other’s list of “people you can talk to and leave messages with” about care and billing issues, so I would have thought there wouldn’t be a problem. I call for all of our medical stuff since Mr PoP can’t be bothered.

    • I do all my husband’s stuff too. I’m pretty sure you can have a list of “people okay to talk with” for that kind of thing.
      Leah recently posted..Time and seasonsMy Profile

  • Another interesting health care thing: know your plan year and tax stuff. Our plan year is different than the tax year (we go by the school’s fiscal year). When our HR gal does withholdings for things like the HSA, she goes by the plan year. This has led to us not maximizing our tax-advantaged stuff because we didn’t withdraw enough for the calendar year max. I just went in and filled out a form to make sure I hit the max this year.

  • Q+2

    Nice job Mrs PoP!

    Our employer makes small changes to all our benefits each year to try and keep costs low and coverage high. As such, we have a benefits review meeting every June. Most employees just use it as an excuse to gripe about health rates going up, but I like to use it as a yearly reminder to recheck ALL my health, dental, vision, HSA, and IRA accounts to make sure I’m not missing any new benefits or had any weird changes pop up.
    Q+2 recently posted..Build Update 1: Girl’s Got LegsMy Profile

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