In-Network vs. Out-of-Network Vision Benefits

Your Vision Benefits, Explained: In-Network vs. Out-of-Network

You have vision insurance – that's great! But do you know the difference between "in-network" and "out-of-network"? Understanding this one simple concept can save you a lot of money and make your visit to our office even easier.

Let's take a look at what these terms mean, and what they mean for you.

What Does "In-Network" Mean?

When we are "in-network" with your vision insurance company, it means we have a contract with them. We've agreed to a set price for our services, and your insurance company has agreed to pay a certain portion of that price.

Think of it like being a member of a club. Because we're in the "club," you get special pricing and benefits when you visit us.

The Advantages of Staying In-Network

  • Lower Costs: This is the biggest advantage of staying in-network. Because we have a contract with your insurance company, you'll pay a lower price for your eye exam, glasses, and contacts. You'll usually just have to pay a small "copay" for your exam, and you'll get a generous allowance for your glasses or contacts.

  • Less Paperwork: When you visit an in-network provider, we do all the work for you. We'll bill your insurance company directly, so you don't have to worry about filling out forms or submitting claims. It's a hassle-free experience.

  • Easy to Understand: Your in-network benefits are usually very clear and easy to understand. You'll know exactly what's covered and what you'll have to pay before you even come in for your appointment.

What Does "Out-of-Network" Mean?

If we are "out-of-network" with your insurance company, it simply means we don't have a contract with them. You can still visit us for your eye care needs, but the process is a little different.

How Out-of-Network Benefits Work

  • You Pay Upfront: When you visit an out-of-network provider, you'll pay for your services in full at the time of your visit.

  • You Submit the Claim: We'll give you a detailed receipt, and you'll submit it to your insurance company for reimbursement.

  • Reimbursement Varies: Your insurance company will then send you a check for a portion of what you paid. The amount you get back will depend on your specific plan. It's usually less than what you would get if you visited an in-network provider.

An Example: In-Network vs. Out-of-Network

Let's say you have a vision plan with a $20 copay for an eye exam and a $150 allowance for frames.

  • In-Network: You come to our office for your exam and to pick out new frames. You pay your $20 copay for the exam. You choose a pair of frames that costs $175. Your insurance covers the first $150, and you pay the remaining $25. Your total out-of-pocket cost is $45.

  • Out-of-Network: You go to an out-of-network doctor for your exam and frames. Let's say their full price for an exam is $100 and the frames are $175. You pay the full $275 at your visit. You then submit your receipt to your insurance company. They might reimburse you for $50 for the exam and $100 for the frames. You'll get a check for $150 in the mail. Your total out-of-pocket cost is $125.

As you can see, staying in-network can save you a significant amount of money.

How to Find Out if We Are In-Network With Your Plan

The easiest way to find out if we are in-network with your vision insurance plan is to give us a call. Our friendly and knowledgeable staff will be happy to look up your plan and let you know what your benefits are.

You can also check your insurance company's website. They will have a list of in-network providers in your area.

What if We Are Out-of-Network?

Even if we are out-of-network with your plan, we would still love to be your eye care provider. Many of our patients choose to see us even if we are out-of-network because they trust us with their eyes. We are happy to provide you with a detailed receipt that you can submit to your insurance company for reimbursement.

Using Your FSA or HSA

Don't forget that you can use your Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for your eye exam, glasses, and contact lenses. This is a great way to use your pre-tax dollars to pay for your eye care needs.

We're Here to Help

We know that insurance can be confusing, but we're here to help you make sense of it all. Our goal is to make your visit to our office as easy and affordable as possible. If you have any questions about your insurance benefits, please don't hesitate to give us a call. We look forward to seeing you soon!