Spectera Insurance

[CME4SPECS]

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?

[LENNY]

We end up always owe money to Spectera!

[CME4SPECS]

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?

[DocInChina]

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

[CME4SPECS]

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.

[a1vo]

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)

[Happylady]

sorry double post

[Happylady]

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.

[CME4SPECS]

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

[a1vo]

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)

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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).

[CME4SPECS]

[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.

[akeroptical]

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.

[walleye]

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.

[gunner05]

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.

[Jubilee]

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.