Day 5.5 - Filing Insurance

Insurance Filing

The Optical Insurance Manual is linked in the 'dock' on SVE Macintosh computers and in the "Common Bookmarks" folder in Chrome.

Here are some things to pay attention to when checking benefits:

1. Make sure he or she is eligible by looking at the eligibility date.
2. Look at the last time the customer got glasses OR contacts.  ONLY 1 allowed per calendar year.  Frames every 2 years, Lenses yearly.
3. If you get an authorization that is NOT a guarantee of payment (which is why we remind the customer that they are responsible for costs if their claim is denied).
4. Inform the customer of any charges NOT COVERED under their vision plan, and/or items that have a limited benefit.
5. Members are covered for “standard” lens upgrades only.  Higher-end or brand-name lens upgrades are NOT covered.
6. Apply the “standard” retail cost toward the more expensive upgrade and charge the customer the difference.
7. Discount Plans apply AFTER the member uses the insured benefits.
8. 2 pair specials must be entered into File Maker as 2 separate sales.  Insurance & None.

Note the necessary information needed:

• Authorization number.  
• Coverage, Plan & Effective & Term Dates.  
• Benefits.  
• Co-Pays & Frame Allowance
• Confirm Name, DOB, Date of Last Exam, Lenses, Frames and/or Contacts.  

Be sure to COLLECT any co-payment or amount due from the customer AT THIS TIME!