Q: Hi, do you take X Insurance?
A: Yes, we are an open access provider for X insurance. Can you let me know the primary member of your plan first name, last name, DOB and last 4 of SSN (or member ID)? I can check your eligibility with X insurer, tell you what your visit would cost today and save you the hassle and submit your claim for reimbursement!
Additional Information:
A: Your employer created your plan to include open access benefits so that you can go to the doctor of your choosing, regardless of insurance! You have benefits associated with buying from us today and we are going to handle all the paperwork to make sure you receive your reimbursement.
A: I have invested in a service to be able to look up your benefits on your behalf. This way, we can give you an in-network experience even though we are an open access provider.
A: I can give you X% discount. We value our customers here and we want you to be happy with your purchase today!
Discounting materials for out of network patients is OK because you are no longer splitting profits with insurance companies. By giving a discount, you can offer patients a very attractive deal and make them feel that even though they are paying out of pocket, they are getting a deal!
Q: What is an open access provider?
A: All an open access provider means is that the reimbursement is not applied at the point of sale, but a check is sent directly to you from the carrier. This allows us to use our own materials and labs and offer discounts!
Q: What are the differences between in and out of network (OON) benefits?
A: Great question, both have great benefits! Being an open access provider we are able to access and bill for your out of network (OON) benefits. This allows us to use our own materials, labs and offer discounts. I am able to show you exactly what you benefits you have available, what you will pay and submit your claim for you!
Q: Would I have more benefits if I went in network?
A: It really depends on your plan. What I can tell you is that we decided to be OON with X provider because we value customer experience. We wanted to offer better materials and use trustworthy labs and we were not able to do so if we were in network. Let me show you what you are eligible today and we can look around at the best options for you!
Q: If I went in network I would only have to pay X dollars, why do I have to pay in full today?
A: Yep! The way open access provider’s benefits work are the customer pays in full to the practice and then you will receive the check directly from the carrier in 14 business days. I am going to show you exactly what you would pay today and exactly what you will receive back and then I will submit the claim for you during your purchase and send you a confirmation so you can track the claim!
Q: How long will it take for me to receive the reimbursement check?
A: I will submit the claim right after purchase. Claims take about 2-4 weeks to process with the carrier. You will receive a check directly from the carrier to your address!
Q: Why can’t I use my in network benefits here?
A: Our practice decided to be an open access provider to be able to offer the best experience and glasses to our loyal patients. There are benefits associated with purchasing from our store today! Open access benefits are just applied a little differently, but we are going to handle all the hassle for you, tell you your eligibility and file the claim for you to ensure proper processing!
Q: What if I do not get a reimbursement?
A: We are going to make sure that that does not happen! We are going to check your eligibility and we have a system that will ensure is submitted to the carrier for proper processing. While we're not able to reach out to the insurance provider directly (only the patient can do that), we can ensure the claim was submitted properly and resubmit it if necessary to ensure you receive the reimbursement!
Q: How do I find out about my open access plan?
A: Head over to optical and the optician will be able to assist with pulling your coverage and eligibility.