This class action alleges that Walmart Vision Centers and Sam's Club Optical stores overcharge consumers. How? When a consumer presents an insurance card, the complaint alleges that these vision centers collect the maximum allowed under the particular insurance plan but then do not fully deduct that collected amount from the amount the consumer is charged.
Ms Epps, the Plaintiff in this case, purchased vision insurance through Delta Dental. The insurance provides that after a co-pay, Delta Dental covers vision examinations, frames, and certain categories of lenses in full if the beneficiary uses an in-network provider. For progressive lenses purchased from an in-network provider, the Plan specifies that it will cover "up to 20% off retail, plus a $50 allowance."
On April 12, 2013, Ms. Epps visited a Walmart Vision Center in Jacksonville, Arkansas. Walmart Vision Center is an in-network provider for Delta Dental. On this day, Ms. Epps purchased a pair of progressive lenses with anti-reflective coating. Ms. Epps was charged as follows: two charges of $112.50 for "Zeiss Poly"; two charges of $5 for "Roll Polish"; and $10 for a "Lens Procfee." The total of these purchases was $245 before tax.
Ms. Epps presented an insurance card showing her enrollment with Delta Dental. Walmart applied her benefits to provide a $25 after-tax discount, thus bringing the final total of her purchase to $242.05. (I know $245 minus $25 does not equal $245.05. The first is a pre-tax amount and the second is a post tax amount.)
OK so what did Walmart submit to the insurance carrier?
Ms. Epps obtained an explanation of benefits showing that Walmart submitted a claim of $245.75. Broken down as follows: (1) 75 cents for "Frame"; (2) $50 for "Progressive Lens"; (3) $125 for "POLYCARB - Aspheric"; (4) $50 for "Standard AR"; (5) $10 for "RIMLESS GROOVE"; and (6) $10 for "Frame Dispensing."
The explanation of benefits shows Walmart was paid $80 in satisfaction of its claim: $50 for "Progressive Lenses" and $30 for "POLYCARB - Aspheric."
Net/net: Ms. Epps received $25 off her prescreen but Walmart got $80 from the insurance carrier.
In a nutshell, this case alleges that she should have gotten the full $80 discount not the $25 discount.