An optician who offers to alter your invoice to increase your reimbursement is not doing you a favor. They are involving you in insurance fraud. This is not an administrative arrangement between them and your supplementary health insurance: your name is on the invoice, your coverage rights are used up, and it is your contract that is put at risk. Ekla is an independent Parisian optician, located in the 10th and 11th arrondissements, and a partner of major healthcare networks. At Ekla, we refuse these arrangements, and here is why this concerns you much more than you might think.
If you have already heard one of these phrases in a shop, you are in the right place.
The three arrangements you will be offered
Frame-lens rebalancing. The price of the lenses is inflated to free up reimbursement for the frame, or vice versa, depending on what your contract covers. The total invoiced no longer corresponds to what you are actually buying. This is the industry's historical scam.
The phantom contact lens package. The most widespread today. You are directed to a lax ophthalmologist to obtain a prescription for contact lenses that you will never wear. Your supplementary health insurance's contact lens package is then billed to cover the remaining cost of your frame.
The disappearing sunglasses. A pair of non-prescription sunglasses is given to you for free, but it does not appear anywhere on the invoice. It has been absorbed into the optical category. Non-corrective sunglasses are never covered by the national health insurance (Assurance Maladie), and most supplementary plans only cover them under a clearly identified prevention package.
In all three cases, the presentation is the same: "I'll sort it out for you." In practice, it is the optician who secures their sale, and you who bear the risk.
What you really risk, in order of probability
Let's start with the most common risk, the one that materializes almost every time. Prison comes after that, and it remains theoretical for a client.
1. You burn your rights, and you don't get them back
This is the point that no one explains to you at the counter. Reimbursement for optical equipment is limited to one pair every two years for those over 16, and the period runs from the date your glasses are issued. Once the allowance is consumed, it is consumed.
Concretely: if your prescription changes within eight months, you pay for your new pair in full. Early renewal is only possible in specific cases, notably a change of at least 0.5 diopters on one lens or 0.25 on both, or certain pathologies like glaucoma and AMD. A desire to change frames is not one of them.
The contact lens allowance follows a different logic, and this is what makes a courtesy prescription particularly visible. The national health insurance only reimburses contact lenses for six specific medical indications: irregular astigmatism, myopia of at least 8 diopters, accommodative strabismus, aphakia, anisometropia of at least 3 diopters, and keratoconus. If you don't fall into any of these categories, the prescription you were made to get fools no one but your supplementary health insurance.
2. Your insurer can demand the money back, and terminate your contract
If fraud is established, your organization can invoke the forfeiture of coverage clause provided in your contract. You lose the benefit of the reimbursement for this equipment, the organization can demand its restitution, and it can terminate your contract. The Court of Cassation has confirmed that this forfeiture applies in its entirety, without the judge being able to modulate the effect, once the bad faith of the insured party is established.
And audits do happen. Healthcare networks have invested in this subject: SantΓ©clair indicates it avoided 6 million euros in fraud in 2023 within the scope entrusted to it by its clients, Itelis has developed a quote analysis tool, and a lens traceability system is currently being deployed by several networks. An invoice that hits the exact limit of a contract stands out.
3. You are on the invoice, so you are in the file
The use of a false invoice with a supplementary health organization constitutes fraud within the meaning of Article 313-1 of the Penal Code, punishable by five years imprisonment and a fine of 375,000 euros. Complicity exposes you to the same penalties. These are maximums, and prosecutions target organized professionals as a priority, not the client buying a pair of glasses.
But remember the principle: in the event of an audit, it is your name that appears on the document, and it is your word against the optician's. You haven't signed anything that proves the initiative came from them.
Why "the health insurance pays for it" doesn't hold up
Supplementary plans calculate their premiums based on actual observed consumption. When part of this consumption is artificially inflated, the average cost of the optical category increases for everyone, and premiums follow the following year.
The amounts are not anecdotal. According to the 2025 activity report of the ALFA, the agency for the fight against insurance fraud, about thirty supplementary organizations detected 112.4 million euros of health fraud over the year. Optics accounts for 53%, or approximately 60 million euros, far ahead of dental (15%) and hearing aids (8%). It is the primary category of detected fraud, and the trend is rising: 83.5 million in 2023, 93.3 million in 2024.
Be careful about what these figures mean. They are detected amounts, not the actual amount of fraud, and part of it is due to insured persons acting alone, without an optician on the other side. The profession as a whole is not at fault. The problem is real, it is documented, and it structurally drives up the price of your own health.
An opinion we stand by at Ekla: an optician who offers you an arrangement mainly shows you that they are ready to lie on an invoice. There is no reason to think they will be any more honest about the quality of the lenses they are mounting for you.
The four signals that should alert you
- You are asked for your supplementary insurance reimbursement limit before being shown a detailed quote.
- You are offered a "quick" contact lens prescription, even though you don't wear them and haven't mentioned them.
- The final quote falls exactly on your allowance, to the nearest euro.
- You are offered a pair of sunglasses that does not appear on any line of the invoice.
An honest quote can perfectly approach your limit. What should alert you is the order of operations: the limit asked for first, the quote built afterwards.
How to verify, with us or elsewhere
Ask for a detailed item-by-item quote before any purchase. It is your right, and an optician who works correctly will provide it without seeing it as a sign of distrust. Verify that each line corresponds to a product you are taking home with you.
If you have a doubt about a past or ongoing purchase:
- Contact the fraud department of your supplementary insurer if you suspect abnormal billing. Coming forward yourself is nothing like being audited.
- Report the professional on SignalConso, the DGCCRF platform, which handles this type of dispute.
- In case of an unresolved dispute, the consumer mediator the optician falls under can be contacted free of charge, provided you have sent a written complaint to the professional beforehand, and within the following year.
Our commitment at Ekla
At Ekla, each quote corresponds exactly to what is delivered: the frame you choose, the lenses prescribed for you, nothing more and nothing less. No courtesy contact lens prescriptions, no artificial shuffling between categories.
If your coverage doesn't cover the entirety of your choice, we tell you clearly, and we look together at the options that actually exist. "100% SantΓ©" (Zero Out-of-Pocket) is one of them: it is the only offer where the absence of out-of-pocket costs is guaranteed by law, and depending on your contract, Class B equipment can also be fully covered. We explain the difference in the shop rather than making it disappear into an invoice.
We practice direct billing (tiers payant) with major healthcare networks, which is rare for an independent shop. This is precisely what requires us to be impeccable regarding billing, and that is just as well.
If you want to understand how your coverage works before coming in, everything is detailed on our insurance page. And if your current frame is still holding up, we repair it rather than selling you a new one.
Choose Ekla if you are looking for:
- a detailed item-by-item quote, provided before any commitment,
- an optician who tells you what your contract actually covers, including when the answer doesn't suit them,
- direct billing with major healthcare networks, without manipulating the invoice.
Ekla is not for you if you are looking for an optician who agrees to make your purchase fit your allowance by any means necessary. It is not a service we provide, and it is not just a question of principle: you are the one who bears the risk.
Practical information
π Ekla Paris 10 β 84, rue d'Hauteville, 75010 Paris β 01 42 28 90 89
π Ekla Paris 11 β 147, rue du Faubourg Saint-Antoine, 75011 Paris β 01 56 61 00 00
π Tuesday to Saturday, 10 a.m. to 7 p.m.
Frequently asked questions
Is it legal to put sunglasses through my supplementary health insurance?
No, if they are not corrective and are billed as optical equipment. Non-corrective sunglasses are never covered by national health insurance. Some supplementary plans provide a dedicated prevention package, but it is identified as such in the contract. Prescription sunglasses, with a prescription, however, fall under normal coverage.
My optician is offering to get me a contact lens prescription even though I don't wear them. What should I do?
Refuse, and ask for a detailed item-by-item quote. National health insurance only reimburses contact lenses for six specific medical indications. If you do not fall into any of them, the prescription has no medical justification, and billing the allowance is a false declaration to your supplementary insurer.
If the optician organized everything, do I risk anything?
Yes. Your name is on the invoice sent to your supplementary insurer. You could lose the benefit of the reimbursement, be asked to pay it back, and have your contract terminated. In terms of criminal law, complicity in fraud carries the same penalties as fraud. The fact that the initiative came from the optician is not enough to exonerate you, especially if there is no proof of it.
How long do I have to wait before getting reimbursed glasses again?
Two years for those over 16, starting from the date of issue. The waiting period drops to one year in case of a sufficient change in prescription, and disappears for certain pathologies. This is exactly what fictitious billing consumes.
How do I know if my invoice is correct?
Each line must correspond to a product you take with you. Frame, lenses, options: if an item appears on the invoice without you taking it home, the invoice is false. A detailed quote provided before the purchase allows you to verify it calmly.
I think I accepted this kind of arrangement in the past. What should I do?
Gather your invoices and contact your supplementary insurer's fraud department. A spontaneous approach is not treated like an audit you are subjected to. You can also report the professional on SignalConso.