Spectera Insurance

[fvc2020]

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

[shellrob]

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.

[pauly47]

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

[uniqueu]

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.

[a1vo]

legal?

Good question. Maybe there is a class action law suit in cooking!

[Audiyoda]

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.

[a1vo]

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.

[CME4SPECS]

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.

[cocoisland58]

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.

[Happylady]

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.

[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?