We get a lot of questions about vision insurance at Annapolis Opticians! Let’s take a moment to address some frequently asked questions about insurance.
1. Do you take my insurance?
More likely than not, we are considered an out-of-network provider by your insurance. We are an in-network provider for a few plans (for instance, some Anne Arundel County Public School employees). In most cases we will need to submit a claim to your insurance for them to reimburse you directly, although some plans, like VSP for instance, won't allow us to submit paperwork on your behalf. For those plans, you will have to send it in yourself.
2. Why aren’t you in-network?
Two main reasons, and the first one is easy: most insurance plans require that your store be owned by an optometrist or ophthalmologist, and we have been proudly optician-owned and -operated since 1967.
The other reason is that your insurance company wants your glasses to be made as cheaply as possible at an in-network lab. They have arrangements with in-network shops to provide certain glasses to patients that are very inexpensive for them to make. If we were to be in-network for those plans, we would be restricted in the frame and lens options we could offer to patients, and we would have to outsource our lab work to an insurance lab. They are high-volume labs and just don’t have the time or expertise to make glasses to our same standards.
We are in the business of offering the best products, and taking our time to make everything perfectly. In order to do that, we have to make the glasses on site. If we were to become an insurance shop, we just wouldn’t be the same Annapolis Opticians that Annapolitans and clients from all over Maryland, D.C., and Virginia have known and loved for over 50 years.
3. What is the difference between in-network and out?
In-network means you are a preferred provider for a specific insurance company, and have a deal worked out with them to offer certain frames and certain lens options to patients that the insurance company is willing to pay for. Usually these are more cheaply made products than what we care to offer.
Out-of-network means you have no affiliation with an insurance company, but we can submit paperwork to your insurance company for them to reimburse you directly. Most of the time, the out-of-network reimbursement covers a small portion of your out-of-pocket expenses. We are an out-of-network provider for nearly all insurance plans.
If you need to know exactly how much your insurance company will reimburse you when you get glasses from us, you will need to call the customer service number on your card and speak to them directly. Since we are not in-network, they won’t talk to us at all if we call. We always want to help you as much as possible, but they just won’t tell us anything about your plan when we try to talk to them.
4. How are your glasses different from glasses from an in-network shop?
We only carry frames from well-made, independent, and reputable manufacturers. We offer only the best lenses. Because we aren’t in the business of making things cheaply, we think it’s important to have well-educated, highly trained staff and we are all board-certified opticians—that isn’t a requirement in the state of Maryland, but to us it’s important to go above and beyond requirement. We strive to not carry frames made in China or countries with similar lack of regulation. We find the products to be of inconsistent quality, and we can’t trust that the labeling of materials is accurate or that durable materials were used. We would rather carry frames made in countries where we have more peace of mind that the people who made the glasses were treated fairly and the production process was more respectful of the environment. Ultimately, that also means a higher quality, more durable product for you as well.
In short, we prioritize quality over quantity, because we know our customers share these values.
5. How do I submit for out-of-network reimbursement?
Once your glasses have been paid for in full, you’re good to go to submit paperwork to your insurance company to request reimbursement. We are happy to help you with this process insomuch as we are able. If you prefer to handle the paperwork yourself, that’s okay too! You’ll need to complete and sign the proper out-of-network claim form, and mail it to your insurance company along with a copy of your itemized receipt and insurance card. Some insurance companies now allow you to submit everything online. Most insurance companies take around a month to process the claim, and then mail a reimbursement check straight to you. We can always take care of this for you, but you will need to know ahead of time which insurance plan you have, and be sure to bring the card with you. If you aren’t the primary policyholder for your plan, you’ll need some basic information on the person who is—name, date of birth, address, and sometimes social security number.
We hope this gives you a better understanding of how vision insurance works, and why we choose to be an out-of-network provider for most plans. As always, our goal is to provide the best glasses possible, tailored to your needs and preferences. If you have any questions we haven’t answered above, please don’t hesitate to contact us and ask.
We hope to see you in the shop soon! Keep an eye out over the coming months for new styles and exciting events—we’ll be selecting a lot of new frames for the shop in New York City in a few weeks, and we’re planning a few trunk shows for 2018.