Price of ‘essential’ vision
By Sheila Hagar, Walla Walla Union-Bulletin, Wash. | |
McClatchy-Tribune Information Services |
Most children who need glasses are well served with single-vision lenses and good-quality, impact-resistant frames, said
Such eyewear can be had for
As the price increases, so does the craftsmanship and quality of materials used on eyewear frames.
"It's going to take more abuse before it breaks or has to come in for adjustment. It's substantially more durable," Hatley said.
That trend continues until around the
"After that, it's like buying a car," he said. "You can buy a very nice car for
At the top end of what Valley Vision carries -- designer frames costing
"You're paying for something that makes you feel good, not necessarily for more function in the product."
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Due to interpretations of new federal health-care laws, some local children are leaving optical shops with expensive designer frames and the best lenses money can buy.
Insurance money, that is.
According to insurance and vision sources, some plan options with the largest insurance companies in
And word is getting out, said
"People are definitely taking advantage of it," he said.
Dunn was referring to a tenet of health-care reform called "essential health benefits." There are 10 in the new health insurance landscape, all immune to the cost caps traditionally set by insurance companies.
Pediatric vision services is among the 10, and all qualified health plans must offer it to participate in health insurance exchanges.
The benefit has solid roots, Dunn said.
"It was intended to make sure children get proper eyewear and to prevent eye damage over time," he said. "Part of the law was to help catch things before they got too bad."
Many employer-based insurance plans in this state and others have long had allowance-based models with the same goal of regular checkups. A typical plan would pay for eye exams once a year and allotted a set figure for new glasses or contacts every two years for kids and adults alike. Anything above that line would be paid for by the consumer, Dunn explained.
"An average pair ... is
And that's how things remain for adults. But for children in
Children enrolled under state-covered insurance plans don't reap the same benefits.
"Basically for children (
With five doctors on staff
"We called each of these insurance companies," he said. "We verified this is what they are saying, that kids can choose whatever they want. We're so used to dollar limits or discount plans, so when this came along, we really weren't forewarned."
As people who wanted to use the benefit began coming in and getting "very nice" glasses for their children, Dunn said, he and others worried about potential insurance fraud issues for every vision business in this situation.
"We want to make sure things are correct for our patients so we did a lot of research," he said.
What they found seems to be the opposite of good economic sense, Dunn added.
As
"We're torn," Dunn conceded. Valley Vision could potentially see more designer frames such as
Asked for comment, Regence spokeswoman
Insurance companies are free to decide a dollar mark for eyewear once that condition is met, she explained.
"If the insurance company has decided 'no cost sharing' on any frame, that's their decision, not one we have mandated," Marquis added.
And, as with any change, there will be unintended consequences, he added.
Such as those pediatric vision benefits, which
When asked if
The benefit, like other parts of the ACA, is bound to be reconsidered by every health plan on the market at some point, Earling added.
"We will definitely take a look at what's working and what's not," he said.
Dunn said Valley Vision's staff believes the boundaries of the pediatric vision benefit will be better defined by officials as time goes on.
"The law is well intended, but most doctors would agree there should be a limit," he said. "We're definitely not advertising this benefit is there, we feel there should be a cap. We're concerned about the perception of this."
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