United Healthcare Vision Care ... Questions ??

[sharpstick777]

What is United Healthcare doing for Vision Insurance these days. Are they going in-house? I believe they contracted with Eyemed years ago for adminstration, or was that someone else I was thinking of?

If you are a provider, what do you think of the plan, benefits and compensation?

Thanks
Sharpstick777

[2020Karen]

Most United HealthCare vision plans use Crown lab. In my opinion, run away! The compensation is not good but fairly typical of vision plans. The problem we have is with the lab itself, turn around time is HORRIBLE! We tell patients a month to get glasses and if you have problems, it's a big pain to fix.

[sharpstick777]

Most United HealthCare vision plans use Crown lab. In my opinion, run away! The compensation is not good but fairly typical of vision plans. The problem we have is with the lab itself, turn around time is HORRIBLE! We tell patients a month to get glasses and if you have problems, it's a big pain to fix.

Thanks Karen... is it billed direct to United or do they have a 3rd party handling claims? Also, how to they handle lens choices? Is it restrictive where every lens has to approved and have a fixed price (like VSP Signature), or do they just get a dollar amount and everything over that is the patient responsibility?

[EyeCare Rich]

Sharpstick, there have been other threads about this insurance. United Healthcare usually uses OptumHealthvision, previously known as Spectera. 2020Karen pretty much summed it up very accuratly. Run if you can, be prepared if you can't.

[anthonyf1509]

Can someone inform me a little on my ignorance? I guess I don't know enough about our own operation, or theirs, but we accept OptumHealth (Spectera) and don't have to use their lab(s). Why is it that most others on here refer to always staring these labs suck, can they not do it differently?

Reimbursement isn't bad at all, but just slow (30-45 days) and also still paper claims.
But otherwise simple and easy to use and make $$

[sharpstick777]

Sharpstick, there have been other threads about this insurance. United Healthcare usually uses OptumHealthvision, previously known as Spectera. 2020Karen pretty much summed it up very accuratly. Run if you can, be prepared if you can't.

I was wondering if they still used Spectera... but they claim on their website that there is no restriction on the frame. Very unlike Spectera. I had heard they were switching to Eyemed for processing claims and network, like Blue Vision did a few years ago.

[Johns]

Can someone inform me a little on my ignorance? I guess I don't know enough about our own operation, or theirs, but we accept OptumHealth (Spectera) and don't have to use their lab(s). Why is it that most others on here refer to always staring these labs suck, can they not do it differently?

Reimbursement isn't bad at all, but just slow (30-45 days) and also still paper claims.
But otherwise simple and easy to use and make $$

I recently purchased an office that handles a lot of Optdumb, and was under the impression that we must use their lab. It would be cool/awesome/fantastic if we didn't have to.

[LENNY]

Most of the chain don't use Crown...
Tell them you are a chain

[tdj]

It's Spectera (OptumHealth.) You do have to use their in-house lab in Maryland which produces awful, shoddy work in the short, short time frame of 3 to 4 weeks. You make no money. Run away.... run far, far away.

I saw someone else mention "still paper claims"... everything can be done online except for contact lenses that aren't on their "formulary." I think they have about 15 lenses on that list.

[tdj]

I was wondering if they still used Spectera... but they claim on their website that there is no restriction on the frame. Very unlike Spectera. I had heard they were switching to Eyemed for processing claims and network, like Blue Vision did a few years ago.

maybe it has to do with the brands of frames we carry (we have Kenmark, Tura, Viva, Europa, among others), but we are able to use any of our frames for Optum/Spectera.... they do order them in themselves, we don't send in our frames.

[walleye]

Optumhealth is owned by United Health. we are mandated to use Crown Optical. They also supply many of the name brand frames at their wholesale cost. The turnaround time is around 2 weeks. There is a Johnson and Johnson facility near hear who used them-now they use Eyemed. Another is Pfizer who took over Wyeth and they had VSP until Jan 1. Now they have Optum. Most patients will jump ship if you don't take their plan. Especially people who work for big pharma.
Highly educated and highly cheap.

[ccampb63]

Hi evrybody. I am from the UK and have been wondering exactly how does the Insurance system work? We have similar plans but nothing as extensive as the USA. If someone has time I would really appreciate a detailed (ish) answer on how does it work for the patient and then for the practice. Who bills who? What are the patients entitled too. Why don't all practices carry all the vision plans. Are they worthwhile Do patients buy glasses privately with no insurance plans.

My email is lmcamp@hotmail.com if anybody should want to give this british optician an insight to the USA way of optics.

Thanks kindly

[sharpstick777]

Hi evrybody. I am from the UK and have been wondering exactly how does the Insurance system work?

ccapmb63,
Welcome to Optiboard from across the pond! The insurance system here simply doesn't work. The patients still pay a lot out of pocket, and the dispensers get paid very little. The insurance carrier makes out like a bandit though. So what happens is that most small offices don't have much marketing ability, so they sign up with insurance plans because they send a steady stream of patients. In exchange, they essentially agree to discount their services for a contracted amount, often half. In some cases the patient ends up paying some, or even a lot, out of pocket. That out of pocket money in most cases covers all the insurance companies costs, but they get to keep the premiums paid by the employer as up front profit.

In many cases the insurance companies double-dip because the patient and practice are "encouraged" to sell those insurance company's own frames and lenses. So they can make a good profit working at different points in the stream.

Very lucrative for insurers, very dissapointing for dispensers, marginally benificial to the patients. As a result, the overall costs go up because practices have to raise thier cash prices to cover for what they are not making in insurance. So cash patients really end up subsidising out insurance industry.

[David_Garza]

Highly educated and highly cheap.

Or perhaps highly frugal, there are some educated folks who create wealth through being frugal, not cheap. See THE MILLIONAIRE MIND for examples of such folks.

[Now I See]

Spectera/Optumhealth/United Health Vision...all the same. All work from my office must be done at their lab (Crown), patient can choose any frame, but must pay overages on frames and lenses (the basic lenses are typically "free," however, there is a whole list of add-ons the patient may choose from) The money the patient pays for overages gets sent to Spectera/Optumhealth/United Health Vision (less the copay and a small percentage of overage collected.)

[ccampb63]

Thats amazing. It sounds like the real losers are the patients who recieve the best advice from the optician but are given the worst options as financially suits the insurance companies.

My understanding is that to attract new clients the practice signs to a plan, they are sent the clients who then get subsidised spectacles from a range predetermined by the insurance company and then add ons are available should the client wish to pay more. The Gross Profit % per sale is therefore reduced which the volume of sales attempts to counteract.

My next question if I can be so bold - what is the percentage of cash patients vs insurance claimants? I guess if a practice accepts a large number insurers does this practice survive?
Is is ethical to jsut blanket accept as many insurers as possible to attract maximum number of clients or is this more hassle than its worth?

Thanks again

[sharpstick777]

My next question if I can be so bold - what is the percentage of cash patients vs insurance claimants?

About 40-45% of patients have some material benefits... but it depends greatly by region. However, since many of the cash patients go to discount chains, or don't buy glasses very frequently, etc, Private Practice OD's often see an insurance rate of 60%-90% of their total patients. PP OD's have not done a great job of capturing cash patients in most offices.

MD's will see a higher rate of cash patients than OD's because Medicare doesn't cover eyewear very frequently (only post cataract).

[drlee]

We have had problems with United Spectra/Optum for years. It doesnt pay enough to cover time and staff costs to provide glasses. It used to be the patient picked out of a box. Now they tell patients they can get anything. What they dont tell the patient is unless it is a very cheap frame, the patient will have overcharges. Sometimes its hard to determine exactly what to charge the patient. And since optum payments (and EOB) is slow to come. The patient is long gone by the time the doc finds out he should have charged more. The Patient will never pay now that they got their glasses. Quality for more than SV is awful. Optum also wants to see contact lenses direct to patient. The doctor takes all the responsibilty, does the work, and Optum keeps the profit.

[David_Garza]

We have had problems with United Spectra/Optum for years. It doesnt pay enough to cover time and staff costs to provide glasses. It used to be the patient picked out of a box. Now they tell patients they can get anything. What they dont tell the patient is unless it is a very cheap frame, the patient will have overcharges. Sometimes its hard to determine exactly what to charge the patient. And since optum payments (and EOB) is slow to come. The patient is long gone by the time the doc finds out he should have charged more. The Patient will never pay now that they got their glasses. Quality for more than SV is awful. Optum also wants to see contact lenses direct to patient. The doctor takes all the responsibilty, does the work, and Optum keeps the profit.

And you still see these patients because........???????????

[EyeCare Rich]

We have had problems with United Spectra/Optum for years. It doesnt pay enough to cover time and staff costs to provide glasses. It used to be the patient picked out of a box. Now they tell patients they can get anything. What they dont tell the patient is unless it is a very cheap frame, the patient will have overcharges. Sometimes its hard to determine exactly what to charge the patient. And since optum payments (and EOB) is slow to come. The patient is long gone by the time the doc finds out he should have charged more. The Patient will never pay now that they got their glasses. Quality for more than SV is awful. Optum also wants to see contact lenses direct to patient. The doctor takes all the responsibilty, does the work, and Optum keeps the profit.

With Optum, you are recieving only a dispensing fee for the order. As for the overage, most of the plans I have seen lately are $130 towards your standard retail price, and 30% discount off of whatever is above your $130 price tag. You collect that amount that is left over from the patient. Example, you have a frame priced at $200, Optum covers $130, that leaves $70, discount 30% = $49 that the patient ends up paying for a $200 frame. Optum supplies the frame and the lens, so you don't have that added expense, like you would if it were a private order. It's all in how you communicate that to the patient, but it sounds like a pretty good deal to me, $49 for a $200 frame. There are some plans though, that have the frame benefit set off of Wholesale, I don't care for this one, but don't see it very often anymore.

If you are loosing money with OHV, you need to reevaluate your process. It's not a lot, but minimum should be around $100 profit/dispensing fee, before your time is factored in.

[drlee]

With Optum, you are recieving only a dispensing fee for the order. As for the overage, most of the plans I have seen lately are $130 towards your standard retail price, and 30% discount off of whatever is above your $130 price tag. You collect that amount that is left over from the patient. Example, you have a frame priced at $200, Optum covers $130, that leaves $70, discount 30% = $49 that the patient ends up paying for a $200 frame. Optum supplies the frame and the lens, so you don't have that added expense, like you would if it were a private order. It's all in how you communicate that to the patient, but it sounds like a pretty good deal to me, $49 for a $200 frame. There are some plans though, that have the frame benefit set off of Wholesale, I don't care for this one, but don't see it very often anymore.

If you are loosing money with OHV, you need to reevaluate your process. It's not a lot, but minimum should be around $100 profit/dispensing fee, before your time is factored in.

Thanks for the update. We stopped seeing eyeglass patients because most of the plans in our area were based on wholesale. We simply couldnt afford to do glasses for these people. If now most are based on retail, maybe we can try again ( buts still have issues with quality !!)

[SharonB]

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