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Thread: Spectera Insurance

  1. #1
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    Spectera Insurance

    It has come to my attention that Spectera has gotten approval to provide vision coverage for 8 million federal government employees and retirees. Secure Horizon will switch to Spectera Jan 1, 07.
    There is an older thread regarding Spectera, but, I thought I'd start a new one. Can anyone offer some feedback on Spectera?

  2. #2
    Master OptiBoarder OptiBoard Bronze Supporter LENNY's Avatar
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    We end up always owe money to Spectera!

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    I am an optician, I would dispense only. The way I read things, they pay me a dispensing fee. I collect for the extras (surcharges) they get half , I get half.
    How do you end up owing them money? I suppose if you collect 100% of upgrades and they get half and the amount collected exceeds the dispensing fee...yes you would owe them money. You did in fact make money though. Correct?
    Last edited by CME4SPECS; 12-01-2006 at 06:27 PM.

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    It has been several years since I participated with Spectera. Do they have their own labs that have to do the work like VSP?

  5. #5
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    Quote Originally Posted by DocInChina View Post
    It has been several years since I participated with Spectera. Do they have their own labs that have to do the work like VSP?
    Yes, they have particular labs that you must use.

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    OptiBoardaholic a1vo's Avatar
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    Spectera is one with bad reputation

    If you r part of chain w/ in-house lab, as per their requirements, you can sell ur own frames, use ur own lab and it is as good (or bad) as any other insurance plan. (2 of such places I worked in the past: Costco & For Eyes).

    If u r independent, not that good (at least on glasses). U have to use their lab, which been labeled as slow and poor quality. U supposed to sell the ugly frames they provided to u, but heard u can send ur own frame (but been reimbursed at wholesale upto $50). U collect add-on charges, they subtract them from the reimbursement. That's how u get into negative and have to write checks to them.

    There are no need to purchase any frames from them. Ugly frames are sent to u to show the members at no charge. They will even pick up the shipping charge when u decide to become a non-provider and send back ugle frames (true in 2003).

    Their reimbursement on eye exam of CL fitting is ok. CL fitting is part of CL materail fee. Reimbursement on CL is so-so.

    Things I do not know is "are their charges on the add-ons competitable to what I pay (a discounted rate) to my lab?".

    I think their "true reimbursement" = "listed reimbursement amount" - "co-pay u collect from the patient" (my memory is fading on this one)
    Paul @ Silicon Valley California

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    sorry double post
    Last edited by Happylady; 12-01-2006 at 07:27 PM.

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    We used to take Spectra for everything but now just for exams and contacts. We give a 20% discount for glasses. The Spectra lab took too long and quality was only fair.

    The Spectra frames were ugly and most patients wanted to buy frames from our shop. We couldn't sell them our frames but had to tell the lab which frame from our store they wanted and the lab had to supply it. If they couldn't supply the frame it might take them a couple weeks to let us know.

    We have a reasonable number of our Spectra patients use the 20% discount so it has worked out.

    Federal employees can choice from several vision plans including VSP. Of course Spectra is the cheapest so many might go with it.

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    Quote Originally Posted by a1vo View Post
    If you r part of chain w/ in-house lab, as per their requirements, you can sell ur own frames, use ur own lab and it is as good (or bad) as any other insurance plan. (2 of such places I worked in the past: Costco & For Eyes).

    If u r independent, not that good (at least on glasses). U have to use their lab, which been labeled as slow and poor quality. U supposed to sell the ugly frames they provided to u, but heard u can send ur own frame (but been reimbursed at wholesale upto $50). U collect add-on charges, they subtract them from the reimbursement. That's how u get into negative and have to write checks to them.

    There are no need to purchase any frames from them. Ugly frames are sent to u to show the members at no charge. They will even pick up the shipping charge when u decide to become a non-provider and send back ugle frames (true in 2003).

    Their reimbursement on eye exam of CL fitting is ok. CL fitting is part of CL materail fee. Reimbursement on CL is so-so.

    Things I do not know is "are their charges on the add-ons competitable to what I pay (a discounted rate) to my lab?".

    I think their "true reimbursement" = "listed reimbursement amount" - "co-pay u collect from the patient" (my memory is fading on this one)
    I hear everything you are saying. I appreciate all input, so, I can see what I might be missing.
    They have some Essilor labs that they use now. One I am familiar with, that does pretty good work. You must use one of their approved labs.
    The amount that I would have to charge on the surcharges is in most cases lower and receiving 50% would not net as much as a self pay. But, it looks like something I could live with.
    I currently have to tell this same group of people, that I am a non provider as they are all VSP. So, I'm really considering...unless some real horror stories show up here. Please give them too me if you have them. Thanks

  10. #10
    OptiBoardaholic a1vo's Avatar
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    my bad

    This is for the case we use our own lab:

    I think their "true reimbursement" = "listed reimbursement amount" - "co-pay u collect from the patient" (my memory is fading on this one)

    -------------------------------------------------------------

    For independent - they send u "dispensing fee". Was told in Vision Expo in Sept. Now dispensing fee for G/L is $50 (increased from $30).
    Paul @ Silicon Valley California

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    [QUOTE=a1vo;166896]This is for the case we use our own lab:

    I think their "true reimbursement" = "listed reimbursement amount" - "co-pay u collect from the patient" (my memory is fading on this one)


    That makes sense, it still totals the same amount. The amount is now $55.

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    We are current Spectera providers and so far everyone here is spot on. Our biggest problem is the frame issue. We don't show the frames that Spectera provides because they are very low end compared to our normal stock. Most of the plans give a wholesale frame allowance that can be used towards any frame but like HAPPYLADY mentioned you can't send your frame of the board. You provide the frame info to the lab and they order one. I'm assuming they are making money off a buying group. Since we don't ever use their frames it always takes 2-3 weeks for turn around time and thats if the frame is not on B.O.

    They also have only had one lab so far, Crown Optical, but I understand they have recently affiliated with some Essilor labs. I'm hoping I can change labs and perhaps that will change the frame issue as well.

    Overall, I'd say an okay insurance but they sure have room for improvement.

  13. #13
    Rising Star OptiBoard Silver Supporter walleye's Avatar
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    Federal employees can choose from VSP, DAVIS VISION, or SPECTERA. We take Spectera and must use Crown Optical- which is owned by Spectera. Spectera is owned by United Health Care.
    They pay up to $50.00 wholesale for a frame and patient overage is what you wholesale cost comes to and no more. You make nothing on a frame over that. If your frame costs $79.95 they reinburse you $50.00 and patient pays $29.95 Why be in business. That is why we put Spectera frames on a special frame board and make them choose one of those. When they supply frame it is faster. They just sent us another 25 newer ones and they are getting better. We occasionally send frames off the board and get our whopping wholesale reimbursement.
    Spectera is one of the more mysterious 3rd party plans. When we get authorization we also have to ask the patient where the insured member works or which welfare plan it is then we can zero in on the benefits. Some of their copays are so high especially for their own employees they do better buying privately from our bargain board.
    Unfortunately they are making inroads in the Southeast Pennsylvania area.
    Can't imagine how bad this federal plan will work. Hope Fed employees all go with VSP.

  14. #14
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    I work with ECCA and we take spectera. It's a hit or miss with them as far as how good it is depending on what plan they have. Some people come in and can literally pick anything they want, others get the absolute bare minimum. The local university here uses spectera and has a really good plan and will even cover poly progressives.

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    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Quote Originally Posted by walleye View Post
    Federal employees can choose from VSP, DAVIS VISION, or SPECTERA. We take Spectera and must use Crown Optical- which is owned by Spectera. Spectera is owned by United Health Care.
    They pay up to $50.00 wholesale for a frame and patient overage is what you wholesale cost comes to and no more. You make nothing on a frame over that. If your frame costs $79.95 they reinburse you $50.00 and patient pays $29.95 Why be in business. That is why we put Spectera frames on a special frame board and make them choose one of those. When they supply frame it is faster. They just sent us another 25 newer ones and they are getting better. We occasionally send frames off the board and get our whopping wholesale reimbursement..
    So do they specify a retail amount to the patient, or is it a wholesale amount only?

    Cause VSP automatically assumes a certain markup. So no matter your own personal office markup, they tell you that as long as the frame's wholesale price is this amount or under you can not charge an upgrade fee.

    OF course if they do go over that wholesale amount, then they pay 80% of the overage which is where you can make some money off the frame.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

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    Bad address email on file fvc2020's Avatar
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    NEVER NEVER NEVER TAKE IT.

    I had jobs that took 6 weeks for anything over -5.00. Crown Optical is the worst lab I've ever dealt with and they don't care how bad the service is.

    IF you feel you need to, only do exams and cl fittings.

    Christina

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    Spectera is horrible and Crown Optical is a complete joke!!!!

    You can do your own in-house work only if you have 5 or more practices.

    Unlike some of the posters above, we actually send our frames form our board to the lab-you ARE allowed to, they never say anything to us. The only ones we wouldn't send would be the "spectera" frames which we rarely sell. They cannot get most of our frame collections anyhow.

    Patients get a 50.00 wholsale allowance so of course anything under that is no charge and they owe the difference if over the amount.

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    I won't let them look at anything other than the Spectera frames....I don't do Wholesale. I had to get on Spectera to get on United for Med billing (seems kinda underhanded). The Crown lab is brutal...the glasses only get a 30 day warranty from the lab regardless if they have a AR like Crizal that is a year or more

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    Bad address email on file uniqueu's Avatar
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    Spectera

    Why is it legal for Spectera to reimburse Wal-mart and other chains retail for products but the private practice gets a $25.00 dispensing fee and 20% of all surcharges. Also at Wal-mart patients can pick from frame with a value of $120.00 which includes all of their frames. If I were the patient I would go to the Wal-Mart. Why can't I use my lab and get reimbursed retail.

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    OptiBoardaholic a1vo's Avatar
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    legal?

    Good question. Maybe there is a class action law suit in cooking!
    Paul @ Silicon Valley California

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    Spectera is going through some major changes right now. They just brought a former Essilor executive on board and he's really changing things up. Biggest change thus far is Spectera providers can now use any Essilor owned lab (not Essilor partner labs). That's a huge lab network and I'd estimate they all do better work than Crown Optical.

    From what I understand, other changes will be equitable payments - right now chain stores get much better reinbursments while independants often find they have negative balances if their subscribers had lots of upgrades. I know he's changing that, I just don't know when or how. But in the end they will be run more like VSP with set prices on tiered products and flat dispensing fees.

    We still decided to dump them simply because only one major employer in the area (25 miles away) offers it and we don't see many of their subscribers within the year.

  22. #22
    OptiBoardaholic a1vo's Avatar
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    Essilor labs are onboard now

    Just talked to Optical One (Essilor's lab in N. California). Confirm that starting today, there is a pilot program they will take jobs from a selected group of Spectera providers in Califronia. Starting 1st of the year, they will serve all Spectera providers. Believe this is also valid for the "southwest" region on other Essilor labs.

    --------------------------------------
    Not that I'm a fan of Spectera or Essilor. just the fact.
    Paul @ Silicon Valley California

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    Several comments have been made about being negative and owing money at the end of the month. Isn't that a good thing? For every dollar you collect from the cusomer, half goes to Spectera, less the copay and dispensing fee. It would be nice to not have a lab bill at the end of every month. We all moan and groan when it arrives in the mail. If you are doing things right, the higher that bill the more money you should be making.

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    We are a Spectera provider and have never used their lab nor their frames though they would like you to believe that this is a requirement. It is not. There are so many plans within the plan that it gets confusing but it is do-able. Very slow pay so expect to wait. All options are highly discounted so be careful what you sell. IE: Some plans cover AR. Sell the cheap AR only for this plan as the pay is not enough for premium. The pay on lenses is low but the frame pay is not bad assuming your frames are priced right. Your best scenario is a patient that wants glasses and contacts which so many of ours are. Contacts and exam go through Spectera and glasses are private pay.

  25. #25
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    Quote Originally Posted by shellrob View Post
    Spectera is horrible and Crown Optical is a complete joke!!!!

    You can do your own in-house work only if you have 5 or more practices.

    Unlike some of the posters above, we actually send our frames form our board to the lab-you ARE allowed to, they never say anything to us. The only ones we wouldn't send would be the "spectera" frames which we rarely sell. They cannot get most of our frame collections anyhow.
    We were told we couldn't supply the frames. Maybe we should have argued with them.

    It sounds like Spectra patients do best if they go somewhere that can do lab work in-house.

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