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In Network vs. Out of Network

Many benefit plans will allow you to see the provider of your “choice” and may pay you – the patient – directly for the amounts that are their responsibility. This does create more “work” for the patient (sending in receipts and waiting on the benefit plan for reimbursement) but it also allows you to maintain the high level of quality service you have experienced with the doctor of your choice.

The amount that the benefit plan will reimburse a patient seeing an “out of network” doctor will vary from case-to-case, employer-to-employer and plan-to-plan. What follows below is our best estimate of what should occur in the situation that is most pertinent for 2018 Vision plan patients who choose to remain under our care when we are “out of network.” Again, we cannot guarantee any of the amounts in the “Vision” column, but the amounts there are consistent with the employee manuals/explanations that we have seen.

EXAMINATION

*= patient responsibility includes a 15% “Self-Pay Discount” we provide all patients who are not using insurance products or are submitting to those insurances themselves.
**= vision plan reimburses you after you submit invoices according to their fee schedules.

The provision of eyewear / prescription glasses will VARY WIDELY depending on materials used and frame style(s) chosen etc., but here is a comparison of what have been our most typical situations:

PROGRESSIVE LENSES

The difference between what you would pay when using an “in network” versus using us (in 2018) as “out of network” is about $60.

For contact lens patients there will be no difference in the provision of services and/or materials by using us as “out of network” (regular exam difference – above) will still apply and patients will have to submit invoices to the vision plan and wait to be reimbursed).

CONTACT LENSES

***= the discount on lens product is for an “annual supply” and varies with type of lenses: this is for Daily disposable lenses worn every day.

These three tables provide us with the estimate that our patients can expect to pay (NET – AFTER they submit to the vision plan and receive the out-of-network allowances) about $60 to $120 more using us as “out of network” at their annual visit.

For details on the Fresno Unified Vision Plan – effective January 1, 2013 through 2017 (no news on whether they are staying with MES-Vision for 2018) = click here

From information we have seen, the “reimbursement” when using an out-of-network provider for employees of the City of Fresno is less for examination ($40 instead of $45) and more for contact lenses ($200 instead of $130).