Superior Vision Services, Inc.

I am rejecting this response because: The release of information consent was providedI have provided it to Superior again in an email directly to *** *** at Superior. I have also attached it to this reply

Regarding *** ***:
A review of our records indicates Superior Vision received Ms
*** out-of-network claim on December 6, 2017. Her claim was
processed within timely filing deadlines however due to an unforeseen error the
check sent was not able to be cashed by Ms
***’ bank. Superior has
since reissued the check for her claim and is working with our finance
department currently to process her overdraft fees.
Ms***’ benefits were not impacted due to this error and
the repayment of her overdraft fee is being handled by the Customer Service
Supervisory team now. Once they have confirmed the overdraft has been
refunded, a representative of Superior Vision will contact Ms***
directly

According to our records, Miss *** has called Superior Vision a number of times for reimbursement for materials she states she purchased 12/21/The documentation sent by the member did not include a date of purchase confirmation; however, it did confirm an expected arrival date for her
purchase of January 29, or thereafterAs her order confirmation was not a valid receipt, it caused a delay in the processing of her out-of-network claimNone of the phone calls recorded and reviewed reflect that Superior Vision’s staff used foul language or disconnected the member as stated in the complaintOur records now indicate Miss ***’s claim has been processed and her check will be mailedApril 27, A Supervisor from Superior Vision will follow up with Miss *** to confirm receipt

I am rejecting this response because: The business relationship with *** didn't change until 1/1/2018. The claim for service was submitted in August well within the coverage time

After visiting with the optician at the optometrist’s office I secured the details of Mr***’s vision needs. Our policies are designed as a wellness product for employers to offer vision benefitsThe policies contain a comprehensive eye exam to determine vision correction, and the materials for that correction. On occasion, an employee's needs will exceed the policy limits and it may be to their advantage to seek vision correction through different avenues. Because the policyholder/owner is Mr***'s employer it was necessary to seek his permission to terminate coverage. I have spoken with the owner of the company and he is willing to terminate coverage back to the original effective date. The credit to the employer will appear on their October invoice which will then trigger a refund to Mr***. A direct refund will not come from Superior as it is a matter of adding deducted premiums back onto the paycheck and deducting payroll taxes, etc. *** ***Sr Vice President, Operations

***,*** moved from being a self-funded group to a fully insured group on 02/01/Funding arrangements changed at that time*** made arrangements to run out claims for months from 02/01/This arrangement ended on 08/01/The claims for your dependents were submitted on 08/25/This was outside the agreed timeframeSuperior Vision communicated claim information to the broker which was sent to the group for processingOne of our Strategic Account Managers has confirmed with HR Advisor *** *** that she has reached out to you to confirm the claims would be processed and reimbursement would be sent to you directly

Hello,Just wanted to let you know that I have received the payment I was requesting. As of now, I have no other issues or concerns regarding the complaint I submitted against Superior Vision.[redacted]

I reached out to member [redacted] to address her concerns. I will work directly with her to resolve this issue. There seems to be a misunderstanding between the provider of services and the payments sent from Superior Vision. Our records indicate second services were approved...

and paid. Payments went to our contracted provider.

Due to a change in the business relationship with employer group [redacted], claims submitted by member [redacted] for dependents [redacted] and [redacted] have fallen outside an agreed upon claim run out period. We are working with the broker to resolve this issue as reimbursement should be issued by the...

group.

Thank you for bringing this matter to our attention. Because claims were filed outside timely filing window of 12 months from the date of service, we will need to make an exception to payout the out of network benefits. We will work directly with the member on a...

resolution.

Your account (through [redacted]) has been paid and updated through 9/30/15.  Ms. [redacted] from Customer Service left a voice mail for you and indicated as such on 9/25.  If you are unable to secure appointments prior to 10/1 you may contact me personally at [redacted] to request...

an extension.  Please note payments received via USPS mail and signed for by our mailroom staff require time to be sorted and sent to Finance where they are part of a intake and posting process.  Thank you for your inquiry.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.
To avoid issues in the future we will be using only in-network optometrists.  Thank you so much for your help.

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Thank you for sharing with me the concerns raised by this enrolled member.  With regret, privacy and confidentiality regulations prevent us from responding to a third party that we have not been authorized to communicate with regarding employee benefits, insurance coverage, and healthcare claims.  We will reach out to the member to advise him of contractual rights.[redacted]Senior Vice President, Operations

We will resolve this issue directly with the member. He will receive a $20 payment because of the incomplete information he received on the initial call.  Is there anything else you need on this incident? Thank you and have a great day! [redacted]Customer Service ManagerSuperior...

Vision Services, Inc.

Thank you for sharing with me the concerns raised by this enrolled member.  With regret, privacy and confidentiality regulations prevent us from responding to a third party that we have not been authorized to communicate with regarding employee benefits, insurance coverage, and healthcare...

claims.  We will reach out to the member to advise him of contractual rights.[redacted]Senior Vice President, Operations

Review: I paid for [redacted] services. Usps says my payment was delivered 9/18/15 at 11.3am. Superior vision as refused to activate my vision program for me my husband and son. [redacted]Desired Settlement: Provide vision coverage. Because we had to cancel appointments today I would like coverage extended into october until we have all three ad eye exams.

Business

Response:

Your account (through [redacted]) has been paid and updated through 9/30/15. Ms. [redacted] from Customer Service left a voice mail for you and indicated as such on 9/25. If you are unable to secure appointments prior to 10/1 you may contact me personally at [redacted] to request an extension. Please note payments received via USPS mail and signed for by our mailroom staff require time to be sorted and sent to Finance where they are part of a intake and posting process. Thank you for your inquiry.

This insurance is a joke. They don't cover a singe penny for my eye condition (keraroconus). My last insurance covered 100% of the vision side of it. They have 1 option within a 30 mile radius of my town, which is [redacted]. I called all the other well known optometrist in town and not a singe one had anything nice to say about this company. It's literally pointless for me to pay them.

I paid for vision coverage for 9 months this year, then retired on Sept 30, 2015. When I needed new glasses on Dec 5th I was told I had no coverage, my benefit terminated when I retired. Obviously if I had known this I woul have oredered my glasses in September, but I never received any information that you can pay in most of the year and they will pocket that money and you will be out of luck when you retire. I called customer service and they just said "sorry". To me this is a lack of plan disclosure of information.

Review: I obtained Superior Vision through [redacted] in Martinsville VA and pay through payroll deduction. The insurance is useless as it won't even pay an amount equal to the premium. It leaves me with a balance on my lenses I cannot pay. I requested termination of the policy since it won't pay a reasonable amount on my script. They refused. Therefore I now want a refund as well as termination of the policy.Desired Settlement: I now want a refund as well as termination of the policy since they refused to cancel the policy.

Business

Response:

Thank you for sharing with me the concerns raised by this enrolled member. With regret, privacy and confidentiality regulations prevent us from responding to a third party that we have not been authorized to communicate with regarding employee benefits, insurance coverage, and healthcare claims. We will reach out to the member to advise him of contractual rights.[redacted]Senior Vice President, Operations

Business

Response:

Thank you for sharing with me the concerns raised by this enrolled member. With regret, privacy and confidentiality regulations prevent us from responding to a third party that we have not been authorized to communicate with regarding employee benefits, insurance coverage, and healthcare claims. We will reach out to the member to advise him of contractual rights.[redacted]Senior Vice President, Operations

Consumer

Response:

I am rejecting this response because: The release of information consent was provided. I have provided it to Superior again in an email directly to [redacted] at Superior. I have also attached it to this reply.

Consumer

Response:

I am rejecting this response because: The release of information consent was provided. I have provided it to Superior again in an email directly to [redacted] at Superior. I have also attached it to this reply.

Business

Response:

After visiting with the optician at the optometrist’s office I secured the details of Mr. [redacted]’s vision needs. Our policies are designed as a wellness product for employers to offer vision benefits. The policies contain a comprehensive eye exam to determine vision correction, and the materials for that correction. On occasion, an employee's needs will exceed the policy limits and it may be to their advantage to seek vision correction through different avenues. Because the policyholder/owner is Mr. [redacted]'s employer it was necessary to seek his permission to terminate coverage. I have spoken with the owner of the company and he is willing to terminate coverage back to the original effective date. The credit to the employer will appear on their October invoice which will then trigger a refund to Mr. [redacted]. A direct refund will not come from Superior as it is a matter of adding deducted premiums back onto the paycheck and deducting payroll taxes, etc. [redacted]Sr Vice President, Operations

Business

Response:

After visiting with the optician at the optometrist’s office I secured the details of Mr. [redacted]’s vision needs. Our policies are designed as a wellness product for employers to offer vision benefits. The policies contain a comprehensive eye exam to determine vision correction, and the materials for that correction. On occasion, an employee's needs will exceed the policy limits and it may be to their advantage to seek vision correction through different avenues. Because the policyholder/owner is Mr. [redacted]'s employer it was necessary to seek his permission to terminate coverage. I have spoken with the owner of the company and he is willing to terminate coverage back to the original effective date. The credit to the employer will appear on their October invoice which will then trigger a refund to Mr. [redacted]. A direct refund will not come from Superior as it is a matter of adding deducted premiums back onto the paycheck and deducting payroll taxes, etc. [redacted]Sr Vice President, Operations

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.