Business

Eye doctor not registered? You might not get insurance to pay for your glasses

BY CLAUDIENNE EDWARDS Observer writer

Sunday, August 31, 2014    

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Dear Claudienne

I am writing to you on behalf of my wife. On June 4, 2014, I accompanied my wife to an ophthalmologist in Portmore to have her eyes checked.

The doctor recommended that her glasses be replaced and charged a fee of $21,500.

The payment was made with a credit card and thereafter the requisite Sagicor Optical claim form was completed and the receipt attached for submission to Sagicor for reimbursement.

On June 6 my wife and I went to Sagicor and submitted the claim.

On July 8, Sagicor sent us a non-payment statement saying that "a copy of the prescription is required for further processing."

On July 14 we received a copy of the prescription as requested and forthwith delivered it and the non-payment statement to a customer clerk at Sagicor. After perusing the document, the clerk told us that the ophthalmologist must write his full name and use his official stamp on the prescription before it could be accepted.

We went back to the ophthalmologist and informed him of the insurance company's requirement for the prescription to bear an official stamp. He told us that he did not have an official stamp, but used his office stamp for official purposes.

I am disgruntled, as I believe I am getting the run-around.

Furthermore, I am a pensioner and am in urgent need of the reimbursement.

Please help us to have Sagicor resolve this matter.

RM

Dear RM

We have been advised by Sagicor that the ophthalmologist whom your wife consulted is not registered with the Medical Council of Jamaica or the Jamaica Optometry Association. Sagicor said that they reimburse for both the lens and frames in instances where the provider is a registered optometrist/ophthalmologist. Because your wife's provider was unregistered they will therefore only provide reimbursement for the frames of her glasses.

The Sagicor e-mail to Tell Claudienne stated as follows:

"We have received the letter of complaint sent to you by RM in respect of the claim for his wife.

"We regret the inconvenience caused to him and are actively in the process of verifying the status of the "ophthalmologist". This was being done prior to your call as we tried to make a determination on how to settle the claim.

"As a health insurance company, Sagicor reimburses its members for medical expenses received from practitioners who qualify to participate under Sagicor's Provider network. This includes providers who are registered by their professional body to provide a particular service. The provider which provided the service in this instance is no longer a member of our panel of Providers. In our assessing the claim we requested a copy of the prescription to ascertain the benefit available to the member. This will depend on whether or not the provider is a registered optometrist/ophthalmologist. If the prescription is from a registered optometrist/ophthalmologist we reimburse for both the lens and the frames. However, in cases where the prescription is from an unregistered provider, then the plan will pay for the frames only.

"Having done our checks with the professional groups, this ophthalmologist is neither registered with the Medical Council of Jamaica or the Jamaica Optometry Association. Based on this, Sagicor will provide reimbursement to your wife for the frames only.

I trust this explains the delay in settling the claim as well as the reason we asked for the prescription and the provider stamp.

Please feel free to contact us if clarification is needed."

Good luck.

Dear Claudienne

I have a business in a plaza and had a sign erected on the front of my store. I was recently informed by the Kingston and St Andrew Corporation (KSAC) that I must pay a licensing fee to display the sign in front of my store. However, I don't know what to do to obtain the licence.

Could you kindly find out from the KSAC for me what is required to get the licence?

DB

Dear DB

The KSAC said that the application form for the signage licence has to be filled out in triplicate and taken to the KSAC registry. You can obtain the forms at the KSAC office on Church Street. The application should also include a photograph and drawing of the sign and its measurements. The application will then be submitted to the Building and Town Planning Committee meeting for approval.

Good luck.

Have a problem with a store, utility, a company? Telephone 936-9436 or write to: Tell Claudienne c/o Sunday Finance, Jamaica Observer, 40-42 1/2 Beechwood Avenue, Kingston 5; or e-mail: edwardsc@jamaicaobserver.com. Please include a contact phone number.

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