Moda Insurance patients, be warned. While this clinic is listed as in-network with Moda, their…read morebilling practices can result in unexpected, out-of-network-level charges due to how they handle Moda's annual vision benefit limits.
Moda allows vision providers to balance bill once you exceed your yearly vision benefit (typically $250, $400, or $600 depending on your plan). Some providers voluntarily honor in-network pricing even after that cap is reached--this provider does not. Instead, they charge full higher fees once your benefit is maxed out.
Examples:
* A standard glasses exam was billed at $250.
* A contact lens exam was billed at $480--just for the exam.
* For a single pair of glasses, I was billed $327 for the frames, $390 for the lenses, plus an additional $255 in uncovered upgrades--a total of $972 for one pair of glasses. A quick google search shows these exact frames have pricing from $115 to $150, this office outrageously overprices their frames.
This means you can reach your plan maximum without even covering the cost of the exam, leaving everything else--exam overages, frames, lenses, contacts--billed at out-of-pocket, non-discounted rates.
On top of this:
* Their billing is incredibly error-prone. Of the five insurance claims submitted for my family, four were incorrect, primarily due to missing or incomplete charge details.
* They over collected at the time of service and have not issued timely refunds. I am currently waiting on two separate refunds, one for services rendered four months ago, and another from three months ago--still unresolved.
* They upsold glasses upgrades without clearly disclosing that these options are not covered by insurance, leading to more surprise charges.
* And when you try to resolve issues, the billing office is condescending, dismissive, and unresponsive.
In summary, this office appears to leverage technicalities in insurance policy to maximize patient costs and hence provider profits, while offering little transparency and poor customer service in return. If you rely on Moda Insurance--or just want transparent, respectful service--I recommend looking elsewhere.
