Tri-City Eye-Care Associates

Review: My issue is regarding the billing practices of this office. I have eye care insurance and have a benefit that allows for an annual exam (glasses or contact exam) and eyeglasses or contact lenses every other year. I have never used my benefit prior to this therefore no benefits had been exhausted. I called and confirmed my benefits twice prior to going in for the visit on 12/30/13.

After my contact lens exam and fitting I was told I needed to pay my $20 copay (which goes toward the lenses) and when I came back the following week to make sure everything was ok with my trial pair of lenses I could purchase additional lenses! I tried explaining that is not how my benefit worked and I also advised I came to that office because a co-worker also went there and she stated for contacts (exam and lenses ) I would only need to pay the $20 copay. I was told the lens benefit was being applied to my contact exam and fitting and there would be no amount remaining for additional lenses. I called my benefits department again to review and was told that should not be correct and if I only received the contact lens exam and a trial pair of lenses I should not have paid the $20 copay. I have tried several times to explain this to Melanie at Tri-City and she continues to dispute and actually made me feel like it was just my "tough luck". This is not right, nor is it fair. I now am unable to obtain lenses unless I pay out of pocket and I pay out of pocket every time the money is taken from my check for vision benefits. I think their billing practices need to be investigated and I would appreciate any assistance in obtaining what is owed to me with regard to my benefits.Desired Settlement: I would like the $150 in contact lenses I am entitled to as per my vision benefit.

Business

Response:

We did in fact, talk directly to the patient. It was due to her not completely understanding her insurance benefits and has since been resolved.

Thank you

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

This situation has not been cleared up and the misunderstanding is not mine but theirs. I've also filled a complaint with insurance commission for fraud as well as the optometry association.