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**a1vo** · 09-07-2010, 04:55 PM

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

**Eyeball** · 09-25-2010, 12:52 AM

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.

**Johns** · 09-25-2010, 04:13 AM

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.

**Eyeball** · 09-25-2010, 05:02 PM

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.

**Johns** · 09-25-2010, 06:37 PM

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.

**Bill West** · 09-26-2010, 06:05 PM

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 ]

**Johns** · 09-26-2010, 06:34 PM

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.

**Bill West** · 09-26-2010, 06:40 PM

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?

**racethe1320** · 09-27-2010, 05:49 AM

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.

**LENNY** · 09-27-2010, 06:17 AM