Vsp insurance- take it or leave it?

[K Dog]

We are a company in Wisconsin that does not take VSP insurance at this point and have been approached about joining again. I say again, because we where part of there plan about 7 years ago and then where dropped because we did not fit "their definiation of a provider owned location/s" We tried to get them to icrease their reimbursement for our network. We are provider owned, but you don't tell VSP what to do- they tell you. Best thing that ever happen to us. We had the largest increase in net profit. Saw less patients nad made more money.

So, I wanted to know has things changed? I want to keep an open mind?

Are they great to work with?

Frames? Do you need to carry high margin frames to make a profit?

Lenses?

Insurance processing?

Overall?

[chip anderson]

Near as I can tell it's a toss-up on whether you want to do a lot of junk work for little or no profit with a lot of paper hassel or whether you will be upset when you have patients come in, shop, find what they want and then ask: "Do you take VSP?" and leave.

Chip

[K Dog]

Near as I can tell it's a toss-up on whether you want to do a lot of junk work for little or no profit with a lot of paper hassel or whether you will be upset when you have patients come in, shop, find what they want and then ask: "Do you take VSP?" and leave.

Chip

Thank you- We do provide a discount for VSP customers and also provide them with the stamped evelope and forms to fill out for "out of network" coverage.

[cocoisland58]

So, I wanted to know has things changed? I want to keep an open mind?

Some things have changed namely VSP has dropped the "independently owned by a doctor" criteria for being accepted although mere opticians are still banned.
You can make a profit on frames if you buy selectively for lower cost than list price.
Were they ever great to work with?
Insurance processing? Now that they are very good at.

[Fezz]

Try using the search function!

We may have discussed VSP a time or two before!

You will get many opinions, and I'll leave mine out of it! Hopefully Racethe1320 will chime in and give a different opinion from what many have!

Good luck on your decision!

[finefocus]

We take VSP, and do a lot of it, because without it our surgery business would fall way off.
If we want to see (and ultimately provide surgery and medical treatment for) a teacher, or a nurse, or a Caltrans engineer, or.....we need to be a VSP provider.

[racethe1320]

Hopefully Racethe1320 will chime in and give a different opinion from what many have!
Good luck on your decision!

I smell that I'm being set up but I'll chime in with an opinion anyway. The decision to accept and work with managed care is all up to you and opinions as such will very across the board. Given the demographics on Optiboard, it appears many don't like working with the various plans. That's okay, as you and many others have, a living can be made and in some cases quite a good one.

I've taken VSP from nearly the onset of their plans and have a very large thriving practice that I do attribute much of the success from having made the choice to work with managed care. I work all the plans to their fullest extent and from a profitability standpoint do very well. Key is to utilize their programs and balance out any ego or emotion with providing the patient good products at a fair cost yet still maintain he profits you are looking to have.

I say emotion as many of the posts here are filled with it. In the end, I'm here to run a business that cares for patients. I have very little room for worrying about the emotions, cares and dramas that tend to make discussions interesting. I sense by the tone of your post and interest in profits you will see where I'm coming from.

In the end, it's your call. I have a significant staff among several locations and I have since moved onto insuring that my people enjoy a happy profitable work environment too. So long as they do, their service level stays high, patients are happy and together we all deal with the ups and downs of managed care. No big deal. Of all the programs out there, VSP it's my opinion they are the best to work with. Others may say otherwise and go down a completely different path, but that's okay as thankfully they run their own businesses not mine.

[Fezz]

I smell that I'm being set up but I'll chime in with an opinion anyway.

No, not at all. I have grown to appreciate and respect your viewpoint on the topic. I also feel that if more of us would kick the grudge, that we may be able to learn from you and make our practice stronger and more profitable.

Thank you!

[DragonLensmanWV]

I think VSP would have more approval here if they would OFFICIALLY drop their requirement that the place be OD owned. They make so many exceptions (and it only takes one) that it damages their credibility in this respect. Besides, if they'd open up to more opticians, they would be an even bigger beast. Isn't that what they want in the end?

[Uncle Fester]

I'm trying very hard to drop the term insurance for any Managed Care plan.

We take Eye Med and VSP and make an ok profit. I think their main advantage is the patient base they provide my doc's. We also are in a demographic that has a significant percentage of patients working for companies or in insurance plans that have it. We dropped Davis and Specterrible years ago and never regretted it for a moment.

What's the down side of taking it again and the dropping it if it doesn't work out?

[kcount]

Alright, after the first year with Eyemed and VSP out of network, VSP payed 3X's as an 'Independent Provider' what Eyemed paid as an in-network provider. By the way, VSP out of network is rather profitable if you have purchased correctly. Should you take VSP? Yes, VSP brings volume with volume comes word of mouth and growth. Besides, in the end you'll simply ween off the vision plans. I took Eyemed, VSP and Spectera, this year Spectera is out and I'm opting out of many of the Eyemed programs. (turns out its better to bill Aetna directly) My approach is not new many of done this especially in the dental world.

[racethe1320]

I think VSP would have more approval here if they would OFFICIALLY drop their requirement that the place be OD owned. They make so many exceptions (and it only takes one) that it damages their credibility in this respect.

exceptions are just that, not the rule. every business has them. life isn't just black and white so you can't fault them for making exceptions where it makes business sense. IMO, they already have way too many providers and heck, enough rabble rousing occurs in the market with people complaining about them, so why make exceptions for folks that don't truly support VSP? That doesn't make sense. IMO they should cut half the providers they have. So many speak ill of them yet gladly see their patients and cash their checks....that to me is the real lack of credibility that needs squashed.

Besides, if they'd open up to more opticians, they would be an even bigger beast. Isn't that what they want in the end?

I wouldn't say they are out to be a bigger beast. Again, if you think VSP is the 800# gorilla, you're quite mistaken. I can name 8-10 other companies in the is industry that are much larger and more controlling in the market place. If you look at what they are really doing out there, it is supportive of their key practices not hurting them as much of the spin masters try and lead you to believe. I'm supporive of their new private label products because they are solid designs that benefit the patient, they pay me more and they are unique in the market ie..not the same old Essilor, Zeiss and Hoya designs the mass sheepel out there offer and build their business on. Bottom line is I see very little in the way of others stepping up to help support me, the independent, like VSP Does.

[AustinEyewear]

Alright, after the first year with Eyemed and VSP out of network, VSP payed 3X's as an 'Independent Provider' what Eyemed paid as an in-network provider. By the way, VSP out of network is rather profitable if you have purchased correctly.

I'm curious how this works, being an out of network VSP provider? Do you file, or does the patient? Can Lenscrafters do this?

What if a VSP patient wants to get glasses at some place that does not offer VSP? Can they get the glasses and have VSP reimburse them? What will VSP reimburse them I'm wondering?

[kcount]

I take the insurance as an out-of-network provider and file a CMS-1500 with VSP. VSP typically has a check in my hands within 2 weeks. The 'Independant Provider' program is a way of relaxing the patient. Typically I'll match the in network benefits on my eyewear. The exception being covered options such as PAL and ARC. The patient is happy because they get the glasses and the benefit they want, I'm happy because I get the business and the dollars. After a year I have found the loss to me is 30% of the retail dollars. Thats an easy pick-up by simply buying better. Lenscrafters may be able to do this but it would probably fail. The patient can submit a form for reimbursement rather easily. There is a form provided on VSP's website for just this thing. Google VSP reimbursement and something should pop up. Realize this works on 95% of the plans out there, I have one person who is barred from using my office.

[anthonyf1509]

We do exactly what kcount does, with exception to matching. Pays quick and easy (online) and patients understand difference.
Those that feel they're losing out on benefits usually are who want free junk.

[bigeyejim]

you will get many opinions, and i'll leave mine out of it! Hopefully racethe1320 will chime in and give a different opinion from what many have!

Good luck on your decision!

lol

[bigeyejim]

I would say if you are doing fine without them, don't join back up. We are a VSP provider, but not Eyemed, and Eyemed does pretty well as far as reimbursing the patients for their "stuff."

If you can get the patients similar reimbursements from VSP, then do so and stay out of network.

If you can get patients/customers without insurance sending them to you, then you'll be fine. We rely on patient referrals, and don't need the insurance plans sending them.

[drk]

Taking VSP is not an optical decision, it's a optometry practice decision. Capice?

[Dr. Bill Stacy]

I'm back here after a few years off. I'm a VSP doc for 35 yrs + (since almost the very beginning of VSP). Not being on the vsp list of course saves you from having to discount your services and materials on a regular basis, but that's also true of EyeMed, the other big plan here in CA. The thing is, VSP is about 1/3 of my practice, EyeMed another 1/3 and the remaining 3rd is a mix of private pay, misc. plans, medicare, etc. I know I could drop off the panel and tell my patients I can still see them, but unless I offer the same discounts as they now get, I'd probably lose at least half of them.

Having said that, I have a new problem here that I'll bring up. Maybe someone can tell me if there's a better place to post this> I now have patients bringing me frames that were given to them, or that they purchased on line. I see this as an increasing phenomenon that I must deal with. My take is that since HCPCs codes don't split frames from frame services, i.e. V2020 is the code for frames, including supply of the frame and all associated services, I should be able to just bill the V2020 code and deduct the wholesale price of the frame from my UCR price for providing that frame.

Initially VSP people say I can't do that, and that I could "get into trouble" doing it, but I've yet to claw up the ladder of authority there. Any ideas? (I've had 3 of these cases in the past 30 days).

[Barry Santini]

Frames, no matter what price point, are a commodity in the eyes of the consumer. When we sell a frame only to a client, often at just a keyston, and they are putting in lenses elsewhere, we ask if they wish to purchase the service bundle now or later for the frame. We explain that since frames are available on the internet, we'll price ours (not all, however) to be competative with frames only.

Most wont take the service package at intial buy in. Only if they have a problem/ need help later. Many providers will extend some frame service to lenses-only purchases ( frames not purchased here) in the lens costs.

Can't see any other way to do it.

B

[Dr. Bill Stacy]

Not sure what a keyston is but I take it you disagree with the idea of just subtracting the material out of my fee when I'm doing everything but buying the frame. I see frames as a much more service intensive item than say soft contacts, which obviously allow separate materials from services. By my count, when we furnish spectacles there are at least 11 steps we do, some of which are recurring (adjusting, replacing pads, screws, etc). I do see soft contacts (not rigid) as commodity items. I am moving to again lower my "sale" price for the contact materials down to actual cost and adjusting my contact service fees upward. At that point I really don't care if the patient "buys" the contact lenses from me or from Costco or the internet. Frames are more like rigid contacts, more custom and fitted, and actually do take some talent to fit properly. Anyway, I'm taking this as far as I can with VSP and will report back my results. BTW I could envision handing a patient a pair of finished lenses to go with his/her frame, and wish him the best of luck. Maybe not. I hate the pain whenever I shoot myself in the foot.

[Barry Santini]

Retail margins are typically a Keystone (2x) like the plano RayBans.

B

[AustinEyewear]

Maybe someone can tell me if there's a better place to post this> I now have patients bringing me frames that were given to them, or that they purchased on line. I see this as an increasing phenomenon that I must deal with. My take is that since HCPCs codes don't split frames from frame services, i.e. V2020 is the code for frames, including supply of the frame and all associated services, I should be able to just bill the V2020 code and deduct the wholesale price of the frame from my UCR price for providing that frame.

Initially VSP people say I can't do that, and that I could "get into trouble" doing it, but I've yet to claw up the ladder of authority there. Any ideas? (I've had 3 of these cases in the past 30 days).

Dr. Stacy - Thanks for pointing this out. After spending 2 hours looking into this this morning (like we don't have better things to do, this is one thing I can't stand about VSP, its a decoding process to figure out what occurred and if you were paid properly), I think you may be on to something here. Need more time to look, still not done, please keep this thread alive or feel free to PM me on this issue. I intend to follow thru with this as well.

BTW : Interestingly, I am finding quite a bit pts are using lens benefits for one purchase, and frame benefits for another. Need to verify if we are at getting dispense fee for at least one of these.

[Dr. Bill Stacy]

Retail margins are typically a Keystone (2x) like the plano RayBans.

B

Yes, I get that, although I rarely, I mean RARELY have anyone buying a regular ophthalmic frame for filling the Rx somewhere else. My pricing structure on frames consists of a modest markup for the materials and a service "bundle" that I have never separated out, esp. in writing. I can see having to change that now, esp. if I'm gonna be successful billing anything for patient supplied frames. I'm considering taking the "markup" component down to zero except for those rare cases where a patient is having the Rx done elsewhere, or in the slightly less rare case of a non-Rx sunglass. A guy named Joe Farrington, O.D. preached the importance of separating services from materials 40 years ago and all his predicitions seem to be coming true. I still get some pushback on charging contact lens refitting service fees, but considerably less than when I started that 25 years ago, when few of us did.

[Dr. Bill Stacy]

I think VSP no longer breaks out dispensing services from either frames OR from lenses. The EOMB doesn't even mention "dispensing" on lens items any more, and frames are now called "frame/disp." Worse yet, they do not allow us to charge anything for re-dispensing a patient's old frame (they used to, but quit that a year or 2 ago).