I just went to the optometrist the other day and I was wondering how exactly eye care works. I go at the same time every year and I pay the same price every year. I figured if it would be cheaper to simply pay out of pocket for eye exams so I asked my mom how much she pays and she told me $24 a month, and thats for the 5 people in my family 4 of which wear glasses. At that price and with the price of glasses how do the Insurance companys make money?
Here’s a few things, assuming you’re asking about how it works in the U.S.
First, the base fees for your typical, annual eye checkup are somewhat inflated thanks in large part to the federal government.
If you have insurance, which you pay a premium, then the optometrist will have a set limit for the services offered. That means the insurance company doesn’t always pay the amount you’d get billed if you didn’t have insurance. Insurance typically covers one annual eye appointment, with the exception of a deductible. So in the end, the optometrist will get something like $90 from the insurance company and $20 from the patient. Your family of five provides the optometrist with $550 before getting into any other services - services where the expenses kick in.
One of the secrets about eye care is that a lot of people who pay for eye care insurance don’t take advantage of the service. Eye care and dental care tend to be ignored by healthy people, who’ll wait for a problem before going. This is probably why the insurance rates are low with respect to other medical services.
When it comes time for the patient to require corrective care (glasses, contacts, surgery, etc.), this is where the money kicks in. Optometrists will usually charge fitting fees, consultation fees, and other charges to the bill. Insurance will cover this up to a plan maximum.
Glasses and contacts, which the optometrist typically sells attached to his office, is another area of income. These products are typically marked up and the optometrist can get products at lower cost. Based on my own experience, I’d say this is where an optometrist makes his money. It’s kind of like the movie theater business in that they don’t make money at the box office, but make it at the concession stand. Most insurance plans have an allowance for glasses and contacts, so there’s a consumer incentive to pay for something up to this amount. Plus, selling glasses has the benefit of consumers overpaying for products that look good.
Are there insurances which deal with eye surgery? That’s an aesthetic surgery. “I” (it was actually a gift) paid $4,200.
My optometrist told me that some of the insurance companies now cover the Lasik eye surgery. I believe the surgeries associated to treat glaucoma along with other surgeries have been covered, as these are necessary medical procedures.
I just recently did PRK surgery about a month ago and paid around that amount ($4,800). They told me I could use my current insurance if I pay it all up-front for and that would have knocked off around $750. Not sure if there are any that would give much more of a discount. What I ended up doing was signing up for “Care Credit” a credit card from GE Money and I could load the entire balance on the card. The reason I did this was because I could pay off the balance in payments for up to 24 months without paying any interest so long as I make all my payments on time. I used my online banking to schedule payments to pay it off completely in 23 months, came around $190/mo. I love technology.