Spectera Insurance

[akeroptical]

There have been a couple of posts on here saying that you send your frames in to the lab. I use their website when ordering jobs and they don't have a doctors supplied frame as an option. Its either Spectera selection supplied by lab or Non-Spectera selection supplied by lab. How are those of you that are sending in frames ordering your jobs? Paper forms of some sort? Have you double checked to make sure you are being paid for your frame? If there is a way to sucessfully send our frames to the lab and be reimbursed wholesale I would love to hear it.

Thanks

[shellrob]

If we are supplying the frame-we have order forms we use. We don't use online unless we want them to supply the frame. Like I said, most of our frames they cannot get anyhow, so we have to send it.

We get a seperate invoice paying us for frames that we have supplied to the lab.

[walleye]

There have been a couple of posts on here saying that you send your frames in to the lab. I use their website when ordering jobs and they don't have a doctors supplied frame as an option. Its either Spectera selection supplied by lab or Non-Spectera selection supplied by lab. How are those of you that are sending in frames ordering your jobs? Paper forms of some sort? Have you double checked to make sure you are being paid for your frame? If there is a way to sucessfully send our frames to the lab and be reimbursed wholesale I would love to hear it.

Thanks

We submit all Spectera orders either by mail with our frame on their lab order form by by fax to Crown optical on their lab order form for them to supply frame. You will get reimbursed separately for the frame wholesale cost with a check from Spectera in Minnesota or somewhere like that. Then you will be reimbursed for exam and lenses minus any copays with a check from Baltimore.
Spectera is the most confusing third party plan out there. When we get an authorization on the website many times it will not give us a plan number but just say "employee". So we ask the patient where the member works and that is our bingo card for what is covered.
The three big groups we deal with here are Johnson&Johnson, Americhoice (one of the welfare HMO's in Pa) and the retail clerks in the Phila area. The retail clerk plan issues a paper form for the patient to come in with. Then we get a lab authorization from a toll free number of a subsidiary of Spectera called GVA (Group Vision Assoicates). Then we send the job to Crown optical and figure out and send the paperwork to the union here
in Philly area for payment from the union. I am the only Dr. in town that takes it as all the others gave it up. The bottom line is that your net may be as good as VSP and you can get contact lens fittings and second pairs.
Recently it took the 1 month for a job. I thought it was lost in the mail but I suspect it was at their lab and lost there. A few weeks ago they called me asking for information on a job and before we got back to them the finished job was delivered!! Go figure!!

[walleye]

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.

Everything we do with Spectera and VSP with frames is wholesale. Spectera allows $50.00 wholesale with no markup for us at all. That is why we direct all Spectera patients to Crown optical frames. ( We close the frame bars so other patients don't see their frames and the same with Davis frames-but the Davis tower is harder to hide).
It is truly frustrating when a VSP patient chooses a Davis frame. I tell some sales reps-especially from VIVA why should I buy sample frames when your parent company is giving me them for free. The third party plans have eliminated any decent profit for the 3 O's but unfortunately the numbers in these plans are overwhelming and will get worse Jan 1 when the Feds are in it.
When I try to explain to patients that any copay they pay me is taken away from me by the plan-in fact they are paying the plan through me-
they look perplexed. Especially the foreign patients who try to bargain me down on the copays!! Can you imagine you car repair place taking an insurance card and then accepting only what a higher up gives them.
Even hair salons are better off then us. We are already seeing socialized medicine in these plans and have seen it for years. Sorry for this rant- I think I will stop the coffee this morning and it's my day off. I'm going to go out and rake leaves-they don't talk back and they don't have insurance cards.

[cocoisland58]

According to my Spectera info most of the plans cover up to 130.00 towards a frame. The patient pays anything over that and we get 82.00 from Spectera. An 82.00 wholesale frame gets a bigger markup than 130.00 so I don't get what you mean by no markup at all. We also use lenses from our wholesale lab and any frame the patient wants to buy. We bill through Eyefinity. I didn't even know Spectera had a website for ordering. Are you sure you are required to do it that way? Why don't we I wonder?

[CME4SPECS]

According to my Spectera info most of the plans cover up to 130.00 towards a frame. The patient pays anything over that and we get 82.00 from Spectera. An 82.00 wholesale frame gets a bigger markup than 130.00 so I don't get what you mean by no markup at all. We also use lenses from our wholesale lab and any frame the patient wants to buy. We bill through Eyefinity. I didn't even know Spectera had a website for ordering. Are you sure you are required to do it that way? Why don't we I wonder?

They are pretty clear, that you have to use one of their approved labs. Do you get paid?

[a1vo]

According to my Spectera info most of the plans cover up to 130.00 towards a frame. The patient pays anything over that and we get 82.00 from Spectera. An 82.00 wholesale frame gets a bigger markup than 130.00 so I don't get what you mean by no markup at all. We also use lenses from our wholesale lab and any frame the patient wants to buy. We bill through Eyefinity. I didn't even know Spectera had a website for ordering. Are you sure you are required to do it that way? Why don't we I wonder?

You must be one of the lucky ones who are allow to use in-house lab for Spectera jobs. Independent optical must use Spectera lab.

[walleye]

According to my Spectera info most of the plans cover up to 130.00 towards a frame. The patient pays anything over that and we get 82.00 from Spectera. An 82.00 wholesale frame gets a bigger markup than 130.00 so I don't get what you mean by no markup at all. We also use lenses from our wholesale lab and any frame the patient wants to buy. We bill through Eyefinity. I didn't even know Spectera had a website for ordering. Are you sure you are required to do it that way? Why don't we I wonder?

Where are you a dispensing optician? Walmart? We get nowhere near what you are getting and MUST use Crown Optical for all work. All their plans pay $50.00 wholesale for a frame and no markup allowed period. If they reinburse you that much it shows how we independents are discriminated against. Like I said in a previous post they are the most mysterious 3rd party plan out there.

[Framebender]

Dr's Vision Works is their insurance store. They don't have to pick out of the coffin. I believe they can get anything off the boards at a certain price point and they don't use crown.

Most of what we see are the 20% discount programs. They are kind of a strange company to deal with.

[cocoisland58]

They are pretty clear, that you have to use one of their approved labs. Do you get paid?

Of course we get paid but slowly, like three months later and sometimes rebilling. Not our favorite carrier I can tell you. Give me VSP anyday.

[cocoisland58]

Where are you a dispensing optician? Walmart? We get nowhere near what you are getting and MUST use Crown Optical for all work. All their plans pay $50.00 wholesale for a frame and no markup allowed period. If they reinburse you that much it shows how we independents are discriminated against. Like I said in a previous post they are the most mysterious 3rd party plan out there.

We are an independent though are a panel provider (not a franchise) for a chain. That may make the difference.

[shellrob]

You must have 5 or more stores in order to in house work. That's why most retail opticals do in house and us independents cannot.

[pauly47]

Had a patient that rec'd their SPectera/Crown specs 3 weeks after the order....brutal

[shellrob]

Oh, to me that's good, it usually takes mine about 3-5 weeks and god forbid you try to order a drill mount.

[cocoisland58]

Oh, to me that's good, it usually takes mine about 3-5 weeks and god forbid you try to order a drill mount.

If Spectera is as bad as I've been reading for some of you. Why on earth do you participate in it? I have dropped a few in the last year or so including Davis and VBA. Sometimes it's just not worth it.

[Jubilee]

Looking at my VSP statements, yes I get reimbursed the wholesale amount, but then I also receive a dispensing fee as well for the frame. Now my understanding is that you can use frame facts price for insurance reimbursement and not your actual discounted price to garner even more profit from the sale...

In fact when I look at the VSP plan compared to Eyemed, I get better reimbursement rates from VSP.

Why hide force people to stick to the Davis or Spectera tower? I have done remarkably well offering people other frames. I have people willing to pay for the convienence of a magnetic clip, a more fashionable frame, flex titanium, or any number of features that they want that the insurance supplied frames don't provide. That combination yields me far more $$ than just utilizing one of their frames.

Cassandra

[akeroptical]

Jubilee,

The main point about Spectera is that they don't want to let you make that money on the frame. Or atleast for those of us forced to use Crown Optical. When I upsell some one one a frame Spectera takes back the full amount collected beyond the wholesale and their dispensing fee to us is $25. If a person gets a frame and lens that is completely covered all we make is the $25. We end up providing a comperhensive exam and a pair of glasses and make about $75. If you ask me that blows.

[Jubilee]

so if the patient bought a Cartier frame and paid $400 extra for the frame, they would still only leave you with $25 after paying the wholesale cost of the frame...

So why do you take this insurance?

[akeroptical]

Yeah I guess so. We make the disp. fee and we get to keep some money from lens upgrades, I forget the percentage. We make nothing on the frames.

As far as High end lines I'm not sure. On core product Spectera orders their own frame and "provides it", in which case there is no money exchanged at all on frames. Just lens upgrades and disp. fee. Perhaps if they can't provide the frame then you could get some reimbursement based on wholesale.

I have asked my OD to drop them several times but we see alot of patients with Spectera. He is happy with the exam payment and he doesn't fully appreciate how we are spinning our wheels in the optical for chump change.

[cocoisland58]

[quote=Jubilee;167920]Looking at my VSP statements, yes I get reimbursed the wholesale amount, but then I also receive a dispensing fee as well for the frame. Now my understanding is that you can use frame facts price for insurance reimbursement and not your actual discounted price to garner even more profit from the sale...

I have been working with VSP since 1982 and figured out rather quickly that the amount you actually recieve in total from VSP and the patient is almost exactly the total retail price of the frame (always use list wholesale when billing. Your discount does not factor in.) plus the exam fee. What other materials are you providing anyway?