Contacts/double cov. insur ?'s

[dreamin_disney]

Hello. My dd will be getting contact for the 1st time next month. We get her eye exam with her optometrist at our medical group. We buy her glasses at another eye place because they have a better selection- the glasses are nicer, more updated and more stylish .

Edit- i found out that the fitting is different and another cost

so does really matter where i get the fitting or just go buy price? I was just thinking if the place i buy glasses is more updated and has nice styles then the medical group office does that mean they will have a more better selection of contact lenses brands?

double coverage questions

My plan coveres the eye exam 100%

Contact coverage
-Elective (Cosmetic/Convenience) up to $100

-Non-Elective (Medically necessary) hard or soft 100% but if its non paticpating provider than only up to $250
so I'll have to see if 1-800 contact or or comp quailify

Well dh just found out his work will provide vision insurance as of July 1st
-I dont have a co pay for exam and its covered 100%, his is $25 copay then covers the rest

-dh's covers
elective conventional lenses=$130 then 15% off any reamianing balance
elective disposable lenses= $130 no additional discounts
Non-elective contacts lenses= covered in full

My dd13 has a stigatism in one eye so she wants disposable ( i think 2 week wear) Dr. mentioned toric? so which of the above is her condition non elective???

Well Her appt is on thursday so my insurance will cover her exam since dh doesnt kick in until the 1st. In our medical insurance he is the primary because of his bday. Does the same apply with vision? if so next year will we have to pay $25 co pay for dh's insur even though mine doesnt have a copay, i only have a $10 copay for the glasses at the other place.

I was planning on paying about $400 for fitting/contacts thats just a guess hopefully it will be less.

oh how many contact to I get a couple month supply or year supply? As you can see we are clueless but need to be a budget and not a go broke

Thanks

 

[Marionnette]

Hello. My dd will be getting contact for the 1st time next month. We get her eye exam with her optometrist at our medical group. We buy her glasses at another eye place because they have a better selection- the glasses are nicer, more updated and more stylish .

Edit- i found out that the fitting is different and another cost

so does really matter where i get the fitting or just go buy price? I was just thinking if the place i buy glasses is more updated and has nice styles then the medical group office does that mean they will have a more better selection of contact lenses brands?

double coverage questions

My plan coveres the eye exam 100%

Contact coverage
-Elective (Cosmetic/Convenience) up to $100

-Non-Elective (Medically necessary) hard or soft 100% but if its non paticpating provider than only up to $250
so I'll have to see if 1-800 contact or or comp quailify

Well dh just found out his work will provide vision insurance as of July 1st
-I dont have a co pay for exam and its covered 100%, his is $25 copay then covers the rest

-dh's covers
elective conventional lenses=$130 then 15% off any reamianing balance
elective disposable lenses= $130 no additional discounts
Non-elective contacts lenses= covered in full

My dd13 has a stigatism in one eye so she wants disposable ( i think 2 week wear) Dr. mentioned toric? so which of the above is her condition non elective???

Well Her appt is on thursday so my insurance will cover her exam since dh doesnt kick in until the 1st. In our medical insurance he is the primary because of his bday. Does the same apply with vision? if so next year will we have to pay $25 co pay for dh's insur even though mine doesnt have a copay, i only have a $10 copay for the glasses at the other place.

I was planning on paying about $400 for fitting/contacts thats just a guess hopefully it will be less.

oh how many contact to I get a couple month supply or year supply? As you can see we are clueless but need to be a budget and not a go broke

Thanks

You can choose which vision insurance to use. It doesn't rely on whose birthday comes first in the calendar year. Are you sure that each policy covers you for annual exams? Some only cover for every 24 months.

The toric lenses are a way of correcting for astigmatism. In your daughter's case, they are considered to be cosmetic (elective) and not medically necessary.

Contact lens fittings in our area run about $45-$50 above the cost of the routine exam. It includes the measurements, instruction sessions, trial lenses and as many follow up visits as are necessary to get the correction comfortable for the patient.

Patients frequently order a 6-month supply unless their insurance covers for more than that amount. It helps to spread the cost out.

 

[Marionnette]

I also want to add that 1800contacts is considered to be "out of network" by most of the major vision insurance plans. That means that you have to pay them upfront and then submit to your insurance company for reimbursement. Something to think about if you don't have the cash to put out initially. You will also lose that "15% of the remaining balance" on your husband's plan if you go out of network since that would be something that the insurance company has negotiated on your behalf with the provider but 1800contacts has no such agreement with them.

Your daughter will also need a back up pair of glasses for those times when she is not wearing her contacts (like in the evening when her eyes are tired, if she has a mild eye infection or abrasion, etc.). You will probably want to look at both insurance plans to see which one has better coverage for frames/lenses and use that one for getting her glasses.

And regarding the fitting - it is done in conjunction with the routine eye exam. You can shop around if you wish, but eye care professionals are not going to do just a contact lens fitting without performing the routine refraction as well. In other words, choose an in-network doctor to do it all.

The prescription that your optometrist gives you does not allow for substitutions. So if he prescribes Air Optics, you can't go someplace else and ask for AcuVue Oasys instead just because they are cheaper. So the "selection" of lenses at another location is inconsequential.

 

[dreamin_disney]

You can choose which vision insurance to use. It doesn't rely on whose birthday comes first in the calendar year. Are you sure that each policy covers you for annual exams? Some only cover for every 24 months.

The toric lenses are a way of correcting for astigmatism. In your daughter's case, they are considered to be cosmetic (elective) and not medically necessary.

Contact lens fittings in our area run about $45-$50 above the cost of the routine exam. It includes the measurements, instruction sessions, trial lenses and as many follow up visits as are necessary to get the correction comfortable for the patient.

Patients frequently order a 6-month supply unless their insurance covers for more than that amount. It helps to spread the cost out.

my insurance covers eye exam every year not sure about dh's. DD needs an exam every year her eye rx have changed every year. She can't see without her glasses. She is near sighted( i think) she cant see far away so would that be medically necessary??? Poor kid has to have glasses on at all times or she can't see. Hopefully her eyes rx didnt change this year but i'm sure it did.

my inusrance covers $90 towards frames every year and dh's is $130 toward frames every 24 months

 

[Marionnette]

my insurance covers eye exam every year not sure about dh's. DD needs an exam every year her eye rx have changed every year. She can't see without her glasses. She is near sighted( i think) she cant see far away so would that be medically necessary??? Poor kid has to have glasses on at all times or she can't see. Hopefully her eyes rx didnt change this year but i'm sure it did.

my inusrance covers $90 towards frames every year and dh's is $130 toward frames every 24 months

"Medically necessary" would be cases where the natural lens has been removed and needs to be replaced such as when a patient has had cataract surgery. However, those patients usually have an artificial lens permanently implanted.

Your daughter's contacts would not be medically necessary since her vision can be corrected with glasses. Contact lenses are a cosmetic choice not a medical necessity in her case.

 

[dreamin_disney]

I also want to add that 1800contacts is considered to be "out of network" by most of the major vision insurance plans. That means that you have to pay them upfront and then submit to your insurance company for reimbursement. Something to think about if you don't have the cash to put out initially. You will also lose that "15% of the remaining balance" on your husband's plan if you go out of network since that would be something that the insurance company has negotiated on your behalf with the provider but 1800contacts has no such agreement with them.

Your daughter will also need a back up pair of glasses for those times when she is not wearing her contacts (like in the evening when her eyes are tired, if she has a mild eye infection or abrasion, etc.). You will probably want to look at both insurance plans to see which one has better coverage for frames/lenses and use that one for getting her glasses.

And regarding the fitting - it is done in conjunction with the routine eye exam. You can shop around if you wish, but eye care professionals are not going to do just a contact lens fitting without performing the routine refraction as well. In other words, choose an in-network doctor to do it all.

The prescription that your optometrist gives you does not allow for substitutions. So if he prescribes Air Optics, you can't go someplace else and ask for AcuVue Oasys instead just because they are cheaper. So the "selection" of lenses at another location is inconsequential.

Thank you so much for taking the time to write all this info.
I thought the vision is like medical and they go by primary which dh would be primary so my thought was
- keep her current glasses and just getting new rx lenses. Dh's insurance only covers frames every 24months and my insur covers frames$90 every 12 months
DD will be in 8th grade so her frames are still good and next year she could pick new frames since she will be going to high school and would like something more updated.

 

[Marionnette]

Thank you so much for taking the time to write all this info.
I thought the vision is like medical and they go by primary which dh would be primary so my thought was
- keep her current glasses and just getting new rx lenses. Dh's insurance only covers frames every 24months and my insur covers frames$90 every 12 months
DD will be in 8th grade so her frames are still good and next year she could pick new frames since she will be going to high school and would like something more updated.

The problem with this approach is that she will be without glasses while the new lenses are ground and inserted into the old frames. Depending on your insurance, your provider may have to send the old frames to a specific lab. Turnaround time could be as long as 2 weeks and you will not be saving that much money since your DH's insurance will cover frames every 24 months.

My advice: Most insurance plans cover either frames + lenses OR contact lenses but not both. Use your insurance for the exam and new glasses since your husband's coverage on the contacts is better. Pay out of pocket for the contact lens fitting since neither insurance will cover that fee. There is usually a 1-week waiting period between the initial fitting and the follow up and her glasses should be ready by then. Your husband's insurance will kick in by the time she returns for her follow up. Then order the contacts using his insurance to pay for them.

 

[dreamin_disney]

"Medically necessary" would be cases where the natural lens has been removed and needs to be replaced such as when a patient has had cataract surgery. However, those patients usually have an artificial lens permanently implanted.

Your daughter's contacts would not be medically necessary since her vision can be corrected with glasses. Contact lenses are a cosmetic choice not a medical necessity in her case.

Oh ok I get it now-lol! I was thinking because theres an rx for glasses its medical but now i get it.

The problem with this approach is that she will be without glasses while the new lenses are ground and inserted into the old frames. Depending on your insurance, your provider may have to send the old frames to a specific lab. Turnaround time could be as long as 2 weeks and you will not be saving that much money since your DH's insurance will cover frames every 24 months.

My advice: Most insurance plans cover either frames + lenses OR contact lenses but not both. Use your insurance for the exam and new glasses since your husband's coverage on the contacts is better. Pay out of pocket for the contact lens fitting since neither insurance will cover that fee. There is usually a 1-week waiting period between the initial fitting and the follow up and her glasses should be ready by then. Your husband's insurance will kick in by the time she returns for her follow up. Then order the contacts using his insurance to pay for them.

I didnt even think about having to turn in her glasses for the new lenses. They do send the glasses out so she would be 2 weeks without glasses. omg! Thankgoodness you posted all this. We will get her new glasses and do as you said, make more sense. Thank you so much for all this advice, you just saved me from a HUGE headach the day of her fitting-lol! I appreciate all your help

 

[dreamin_disney]

Update 6/28/12
dd13 had her appt today. Her rx changed by one click and Dr. recommend toric for her asigitism. He said its a thicker lens and a lil more uncomfortable.

Now if i set up a fitting appt and dd for some reason decides she cant put the lenses in I want to know how much am i looking to lose $$ I know every office is different but what estimate price cost should i be looking at. I'm in so cal, it's dd13 first time getting contacts.

Would like input on people or if your kids/teens have toric what are your thoughts on the toric lenses???

price estimate for a fitting for lense for the 1st time. Thanks


oh is there anyway to prep her for her fitting, I just hope she doesn have a hard time putting lense in or to scared to touch her eye

 

[m2zjj]

Update 6/28/12
dd13 had her appt today. Her rx changed by one click and Dr. recommend toric for her asigitism. He said its a thicker lens and a lil more uncomfortable.

Now if i set up a fitting appt and dd for some reason decides she cant put the lenses in I want to know how much am i looking to lose $$ I know every office is different but what estimate price cost should i be looking at. I'm in so cal, it's dd13 first time getting contacts.

Would like input on people or if your kids/teens have toric what are your thoughts on the toric lenses???

price estimate for a fitting for lense for the 1st time. Thanks


oh is there anyway to prep her for her fitting, I just hope she doesn have a hard time putting lense in or to scared to touch her eye

I've been wearing contact lenses for 17 years now (got them when I was 13 as well) When I got my first pair I only needed a Toric lens for one eye, no astigmatism in the other eye, and I couldn't tell the difference between the toric lens and the regular one. Now I need toric lenses for both eyes. Every place I have ever gone to get my contacts has ordered trial lenses first to make sure the fit and prescription was correct. Some places will already have the trial lenses in stock depending on how common her prescription is. The trials in my case are a set of 5 lenses for each eye but that is because I wear disposable contacts meaning I wear them once and throw them away. I have never been charged for the trial lenses in fact it says right on the trial boxes "not labeled for sale".

If you are looking for contacts for her that you wear clean and then wear again then ask about acuvue oasis for astigmatism, I wore them for a couple years and they are very comfortable. Currently I prefer disposables because I find that the reusable lenses start to shift more easily on my eye and don't seem to fit as well after wearing them a few times and while that isn't a big deal for regular contacts with toric contacts a small shift in the lens means very blurry vision. I wear focus daily toric and love them but they are more expensive simply because they are a disposable lens. I did try to go to a non toric lens a couple years ago because they were cheaper and I was short on money, all I can say about that is don't! A non toric lens for someone with an astigmatism will result in blurry vision and in my case bad headaches from the eye strain.

If you go to a place that does the trial lens first then the only money you would be out if she can't or wont be able to wear them is the charge for the fitting and contact exam. Something else to keep in mind, all the Sears locations in my area have a Sears optical and they price match on their contacts. Last time I brought in the cheapest price I found online and after calling to verify the info they matched their price which saved me over 60% and for a year worth of contacts that equals a lot of money.

I did have a little trouble in the beginning putting mine in and since I get frustrated easily I almost gave up on them. The optician helping me simply kept reminding me that the eye shuts by reflex when something comes to close to it and that with a little practice it would get easier and feel more natural. Tell her that it will feel strange at first and that's normal however there shouldn't be any pain just a strange feeling. Pain means that the contact isn't sitting on the eye properly or that there is something on the lens. An eyelash or a speck of dirt on the lens can cause discomfort or pain. One thing that my help before the fitting would be to make sure her nails are trimmed short, less chance that she will poke or scratch her eye while trying to put them in for the first time.

One last thing depending on how severe her astigmatism is she may notice a small difference in he vision between her glasses and contacts. My contact prescription has been adjusted many times and when just using my contacts I don't notice anything and I see great but when I take my contacts out part way through the day and switch to my glasses I notice for a few minutes, until my eyes adjust, that my vision is a little more clear and crisp with my glasses on. It may be so minor that she wont even notice it or her astigmatism may be mild enough that there wont be a difference at all.

Sorry that this is so long.
Good luck with the fitting and I hope it goes well

 

[dreamin_disney]

I've been wearing contact lenses for 17 years now (got them when I was 13 as well) When I got my first pair I only needed a Toric lens for one eye, no astigmatism in the other eye, and I couldn't tell the difference between the toric lens and the regular one. Now I need toric lenses for both eyes. Every place I have ever gone to get my contacts has ordered trial lenses first to make sure the fit and prescription was correct. Some places will already have the trial lenses in stock depending on how common her prescription is. The trials in my case are a set of 5 lenses for each eye but that is because I wear disposable contacts meaning I wear them once and throw them away. I have never been charged for the trial lenses in fact it says right on the trial boxes "not labeled for sale".

If you are looking for contacts for her that you wear clean and then wear again then ask about acuvue oasis for astigmatism, I wore them for a couple years and they are very comfortable. Currently I prefer disposables because I find that the reusable lenses start to shift more easily on my eye and don't seem to fit as well after wearing them a few times and while that isn't a big deal for regular contacts with toric contacts a small shift in the lens means very blurry vision. I wear focus daily toric and love them but they are more expensive simply because they are a disposable lens. I did try to go to a non toric lens a couple years ago because they were cheaper and I was short on money, all I can say about that is don't! A non toric lens for someone with an astigmatism will result in blurry vision and in my case bad headaches from the eye strain.

If you go to a place that does the trial lens first then the only money you would be out if she can't or wont be able to wear them is the charge for the fitting and contact exam. Something else to keep in mind, all the Sears locations in my area have a Sears optical and they price match on their contacts. Last time I brought in the cheapest price I found online and after calling to verify the info they matched their price which saved me over 60% and for a year worth of contacts that equals a lot of money.

I did have a little trouble in the beginning putting mine in and since I get frustrated easily I almost gave up on them. The optician helping me simply kept reminding me that the eye shuts by reflex when something comes to close to it and that with a little practice it would get easier and feel more natural. Tell her that it will feel strange at first and that's normal however there shouldn't be any pain just a strange feeling. Pain means that the contact isn't sitting on the eye properly or that there is something on the lens. An eyelash or a speck of dirt on the lens can cause discomfort or pain. One thing that my help before the fitting would be to make sure her nails are trimmed short, less chance that she will poke or scratch her eye while trying to put them in for the first time.

One last thing depending on how severe her astigmatism is she may notice a small difference in he vision between her glasses and contacts. My contact prescription has been adjusted many times and when just using my contacts I don't notice anything and I see great but when I take my contacts out part way through the day and switch to my glasses I notice for a few minutes, until my eyes adjust, that my vision is a little more clear and crisp with my glasses on. It may be so minor that she wont even notice it or her astigmatism may be mild enough that there wont be a difference at all.

Sorry that this is so long.
Good luck with the fitting and I hope it goes well

Thank you . Lots of good infomation I will tell dd to cut down her nail because her are natural but long. I'm glad to know they give out trail pairs I thought we were going to have to order then and there. I thought she would try on different pair at the fitting-lol!

 

[Fire14]

I personally feel my vision is better with my contacts. I have acuave osayis and love them. When I had toric lens at one time I found they worked ok but not great for me( I honestly think I didn't need them).