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Thread: VSP and Costco

  1. #1
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    VSP and Costco

    One of my frame reps is visiting and just let me know that Costco and VSP have signed a deal to work together.
    Has any one heard more on this?

    Add to that with Safilo and Marchon selling direct to Costco ... Pennies on the Dollar ...

    ... Great ...

    Sphinx
    Last edited by Sphinxsmith; 07-23-2010 at 11:50 AM.

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    No, I hope it isn't true.

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    I actually like this. You should be allowed to use your insurance anywhere without having to worry about being in-network. But this deal will really suck for the private practice. Well hopefully Costco will cross-train all their cashiers and cart pushers as opticians for all the business they will get.

    Sidebar:
    What is the rule between membership and insurance? If I remember correctly you(the store) cannot deny a guest or member their right to use insurance(that your store is in-network for) to where their insurance would be relevant. If I am correct, that is why Sam's Club or Costco cannot deny you the use of their pharmacy or optometrist.

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    Doh! OptiBoard Gold Supporter braheem24's Avatar
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    Costco is not doctor owned, allowing them to be in-network providers would be a good precedence for opticians.

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    You no longer have to be doctor owned to be a VSP provider. This long time rule was quietly dropped last year. No reason opticians could not be providers as well one would think.

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    Quote Originally Posted by cocoisland58 View Post
    You no longer have to be doctor owned to be a VSP provider. This long time rule was quietly dropped last year. No reason opticians could not be providers as well one would think.
    Sorry, not true. They denied my office (3 months ago) when the OD tried to sign up. They sited the OD owner clause.
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    ABOC-NCLEC tigerlilly's Avatar
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    Quote Originally Posted by Leonazium View Post
    Well hopefully Costco will cross-train all their cashiers and cart pushers as opticians for all the business they will get.
    Considering that Costco is the only national optical retailer that requires ABO and NCLE certification of its opticians, even in unlicensed states, I don't see this happening. I don't think membership and insurance ahve anything to do with one another, either. You do need a membership to buy contacts or glasses, and none of the Costcos near me take any insurance.

    I keep hearing all these VSP + Costco= BFF rumors, and I just don't believe it. I thought it turned out there was one particular VSP plan in one particular location serving one particular employer, rather than some sort of a widespread rollout of Costco as a new VSP provider? Particularly since the doctors are independent and control which insurance they take (if they choose to take any at all), I don't see how an agreement would work all that well.

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    Quote Originally Posted by Johns View Post
    Sorry, not true. They denied my office (3 months ago) when the OD tried to sign up. They sited the OD owner clause.
    No doubt only because you are too small to buy enough Marchon product (or boycott said product) to make them bend their rules.

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    Quote Originally Posted by cocoisland58 View Post
    No doubt only because you are too small to buy enough Marchon product...
    Yeah...that's probably it.
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    This is a confirmed rumor. VSP is downplaying it as merely a test with several (as many as 8) clients. They lost a large corporate client to Davis, and the reason given was that their members desired access to more retail locations with 'Sunday' hours. Having worked commercial, I call BS on the Sunday thing, but that's what has come out so far. They hope to show that members are not seeking retail or Sunday services.

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    So the latest Ive heard on this is that VSP is loosing contracts to Eyemed/Lux because their clients want more retail options.
    VSP is test-bedding it with Trader Joes and Costco right now. If the client decides to go to Costco then they will have their benefit available though diminished.
    Also Ive been told that Marchon is not selling current product to Costco direct.

    That's the latest scuttle-butt so take for what it's worth.

    Sphinx

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    Here's the scoop... VSP got the Trader Joe's account by agreeing to allow Costco to file claims on behalf of the patient. At Costco, the patient will receive a higher out-of-network benefit. Costco is NOT in-network.

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    OptiBoardaholic pezfaerie's Avatar
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    All I can say is that there's a program through Marchon that allows them to act as in-network providers and they can tell the pt "yes we accept VSP" but their reimbursement is much less than that of an in network VSP provider. And the Costco 30miles away from here takes VSP so I don't think its much of a rumor anymore.
    Pez:D

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    Had not heard as fact they were allowing Costco to be in network... thanks for the info.

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    ABOC-NCLEC tigerlilly's Avatar
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    Quote Originally Posted by inslady View Post
    Here's the scoop... VSP got the Trader Joe's account by agreeing to allow Costco to file claims on behalf of the patient. At Costco, the patient will receive a higher out-of-network benefit. Costco is NOT in-network.
    There used to be an arrangement with VSP that allowed Costco to provide patients with a form that would enable them to get a higher reimbursement rate. This is not a new thing - who knows how long it went on? - but VSP got shirty and demanded an end to that a while back. If that's what's going on with Trader Joe's, then this rumor is not all it's cracked up to be.

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    OptiBoardaholic a1vo's Avatar
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    Oh! That's why now I can send in CMS1500 to VSP and get paid directly and I do not need to ask my "out-of-network" VSP patients to pickup their eyeglasses AFTER they receive the VSP check.

    Haleluya
    Paul @ Silicon Valley California

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    Quote Originally Posted by a1vo View Post
    Oh! That's why now I can send in CMS1500 to VSP and get paid directly and I do not need to ask my "out-of-network" VSP patients to pickup their eyeglasses AFTER they receive the VSP check.

    Haleluya

    But how would you know how much VSP reimburses to calculate how much the patient needs to pay beyond what is covered? Each plan reimburses a little differently, don't they? Besides, I thought all out-of-network payments go directly to the patients, not providers.

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    Quote Originally Posted by Eyeball View Post
    But how would you know how much VSP reimburses to calculate how much the patient needs to pay beyond what is covered? Each plan reimburses a little differently, don't they? Besides, I thought all out-of-network payments go directly to the patients, not providers.
    "patients to pickup their eyeglasses AFTER they receive the VSP check."
    It looks like this is VSP's way of weaning the patients away from the traditional type (OD) providers. And why not? If VSP can reimburse a lower rate to the pt. then they would to an OD, that's more money in their pocket. If they can give even less to Costco, and less still to Frames Direct, why in the world would they promote their panel ODs?

    I see this as phase 3 (of 5). The traditional VSP providers were the vehicle to capture market share. For the most part, that has been accomplished. Now, the search (and they don't have to search far) for avenues that will net them more profit is on. Non traditional providers (lowest overhead) are lined up ready to take over.

    I'd hold the "Haleluya"...unless of course you are Costco, or Frames Direct.
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    Quote Originally Posted by Johns View Post
    It looks like this is VSP's way of weaning the patients away from the traditional type (OD) providers. And why not? If VSP can reimburse a lower rate to the pt. then they would to an OD, that's more money in their pocket. If they can give even less to Costco, and less still to Frames Direct, why in the world would they promote their panel ODs?

    I see this as phase 3 (of 5). The traditional VSP providers were the vehicle to capture market share. For the most part, that has been accomplished. Now, the search (and they don't have to search far) for avenues that will net them more profit is on. Non traditional providers (lowest overhead) are lined up ready to take over.

    I'd hold the "Haleluya"...unless of course you are Costco, or Frames Direct.
    It's true that VSP would benefit by paying less to out-of-network providers, but the patient wouldn't go to an out-of-network provider because they have to pay more out of pocket. So in your case, the patient would wait for the check to come, then bring the check to your shop, and then you calculate how much he has to pay based on how much was paid on the VSP check, right? The difference between your usual and customary fees and what was paid on the out-of-network check is the amount in question here. Isn't it usually higher than what the patient would normally pay if they were in-network? That is why it is hard to convince a VSP patient go out-of-network, unless your fees are really low.

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    Quote Originally Posted by Eyeball View Post
    It's true that VSP would benefit by paying less to out-of-network providers, but the patient wouldn't go to an out-of-network provider because they have to pay more out of pocket. So in your case, the patient would wait for the check to come, then bring the check to your shop, and then you calculate how much he has to pay based on how much was paid on the VSP check, right? The difference between your usual and customary fees and what was paid on the out-of-network check is the amount in question here. Isn't it usually higher than what the patient would normally pay if they were in-network? That is why it is hard to convince a VSP patient go out-of-network, unless your fees are really low.

    That is true, but unlike in the past, VSP is not making the barriers to out-of-network as high as they once were.
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    Optiboard Professional Bill West's Avatar
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    Quote Originally Posted by Johns View Post
    Sorry, not true. They denied my office (3 months ago) when the OD tried to sign up. They sited the OD owner clause.
    Ouch! Hey friend, are you fixing to give up the ship and sign on with these optical pirates? Guess things are getting tough all around. I wish you the best however you choose.
    Your friend, the original O.D.,[ Optical Devil ]

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    Quote Originally Posted by Bill West View Post
    Ouch! Hey friend, are you fixing to give up the ship and sign on with these optical pirates? Guess things are getting tough all around. I wish you the best however you choose.
    Your friend, the original O.D.,[ Optical Devil ]
    No, not at all. However, I just opened up 2 new offices, and I have the same OD working both of them. Although he is booking nicely, he thought he had more room on his schedule, so he thought he'd add "another 3rd party plan". Little did he know that this is not just "another 3rd party plan".

    It was actually humorous to watch him sputter when they told him that he couldn't be on the panel due to his association with me...an optician! I told him the problem could be easily remedied by simply giving me $200k (I gave him the discounted rate:bbg:) and taking over ownership of the practice. He wasn't amused.
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    Optiboard Professional Bill West's Avatar
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    Quote Originally Posted by Johns View Post
    No, not at all. However, I just opened up 2 new offices, and I have the same OD working both of them. Although he is booking nicely, he thought he had more room on his schedule, so he thought he'd add "another 3rd party plan". Little did he know that this is not just "another 3rd party plan".

    It was actually humorous to watch him sputter when they told him that he couldn't be on the panel due to his association with me...an optician! I told him the problem could be easily remedied by simply giving me $200k (I gave him the discounted rate:bbg:) and taking over ownership of the practice. He wasn't amused.
    WHEW!!!! Shame on me for even thinking you would do this. Hey, he can buy me out for less but I've always been CHEAP or is that CHEEP?

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    Quote Originally Posted by Johns View Post
    It looks like this is VSP's way of weaning the patients away from the traditional type (OD) providers. And why not? If VSP can reimburse a lower rate to the pt. then they would to an OD, that's more money in their pocket. If they can give even less to Costco, and less still to Frames Direct, why in the world would they promote their panel ODs?
    Not true at all. The intent of the program isn't to hurt private practice. Doing nothing and allowing EyeMed to take the deals at Trader Joe's and other pilot customers they are trying to win back would significantly hurt you, me, and other independents as we would way more often than not, NOT see that patient again.

    What's happening here is nothing new. It's out of network benefits just called something different. Big deal if Costco can now log online to file claims. The patient is still willing to pay more to NOT see the private practice doc. Percentage wise, that is low single digits. However, in order to compete at the provider level and even have a shot at these clients, it had to be done. Don't say it's VSP trying to score anything other than a previous client back in order to HELP private practice.

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    Master OptiBoarder OptiBoard Bronze Supporter LENNY's Avatar
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    Quote Originally Posted by racethe1320 View Post
    Big deal if Costco can now log online to file claims. The patient is still willing to pay more to NOT see the private practice doc. Percentage wise, that is low single digits. However, in order to compete at the provider level and even have a shot at these clients, it had to be done. Don't say it's VSP trying to score anything other than a previous client back in order to HELP private practice.
    Yes it is a BIG deal!
    I lose 1-3 patients a day that dont want to go through the reimbursement process themselves! Why Costco has to be any different than regular office. Who cares who owns it! We are licensed to provide the service!!!!!!!!!!

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