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Thread: It begins

  1. #1
    What's up? drk's Avatar
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    It begins

    Trendy, kid friendly Otis & Piper™ Eyewear Collection coming soon
    VSP® is introducing the VSP Elements Plan, a covered-in-full plan that meets the Affordable Care Act guidelines for pediatric vision as an Essential Health Benefit through Qualified Health Plans both in and outside of the Health Insurance Exchanges.

    The Elements Plan offers children up to age 19 a selection of trendy, kid-friendly frames from the Otis & Piper Eyewear Collection in a variety of styles, sizes and fun colors, with no out-of-pocket costs.
    Your frames are on their way
    Your practice is in an area where enrollment in the Exchanges and the VSP Elements Plan is expected. To ensure your practice has Otis & Piper frames for patients to try on before ordering, we'll begin mailing frame kits in November, 2013. Practices carrying the Otis & Piper Eyewear Collection will be identified on the vsp.com Doctor Directory making it easy for patients to locate providers in their area. Likewise, if your practice doesn't carry the frames, it won't include the Otis & Piper indicator in the Doctor Directory.

  2. #2
    Manuf. Lens Surface Treatments OptiBoard Gold Supporter
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    ......nice, you are being forced to carry other peoples choice or else .....................................
    Chris Ryser
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    http://optochemicals.com............................. http://arcoatings.com

  3. #3
    Master OptiBoarder OptiBoard Silver Supporter Craig's Avatar
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    Quote Originally Posted by drk View Post
    Trendy, kid friendly Otis & Piper™ Eyewear Collection coming soon
    VSP® is introducing the VSP Elements Plan, a covered-in-full plan that meets the Affordable Care Act guidelines for pediatric vision as an Essential Health Benefit through Qualified Health Plans both in and outside of the Health Insurance Exchanges.

    The Elements Plan offers children up to age 19 a selection of trendy, kid-friendly frames from the Otis & Piper Eyewear Collection in a variety of styles, sizes and fun colors, with no out-of-pocket costs.
    Your frames are on their way
    Your practice is in an area where enrollment in the Exchanges and the VSP Elements Plan is expected. To ensure your practice has Otis & Piper frames for patients to try on before ordering, we'll begin mailing frame kits in November, 2013. Practices carrying the Otis & Piper Eyewear Collection will be identified on the vsp.com Doctor Directory making it easy for patients to locate providers in their area. Likewise, if your practice doesn't carry the frames, it won't include the Otis & Piper indicator in the Doctor Directory.
    Can you make a profit with a VSP plan that has no out of pocket or is this more like charity for under 19. It appears only VSP will make money on this program.

    Craig

  4. #4
    OptiBoardaholic vcom's Avatar
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    Here is what I found on the VSP website for the Elements plan reimbursements.



    • For eye exams, you'll be reimbursed your assigned exam fee depending on the qualified health plan's selected network, (Advantage, Choice, or Signature).
    • You'll receive a flat $** dispensing fee for glasses.
    • Members and their parents may also choose to purchase additional lens options.
    • You'll be paid 85% of U&C for contact lens fitting & evaluation, and 100% U&C for contact lens materials, subject to specified service limitations.
    • Refer to the VSP Elements Fee Schedule for full details
    Patient, ".. Doctor says I have a subscription for stigmata.. Can you fill that?"
    Me, "..Um.. "

  5. #5
    OptiBoard Professional
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    There is a video on you tube about this. The dispensing fee is 25 dollars which is less than Medicaid. Also all orders have to go to vspone Columbus. The lab supplies all materials.

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    Eyes eastward... Uilleann's Avatar
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    Quote Originally Posted by drk View Post
    Trendy, kid friendly Otis & Piper™ Eyewear Collection coming soon
    VSP® is introducing the VSP Elements Plan, a covered-in-full plan that meets the Affordable Care Act guidelines for pediatric vision as an Essential Health Benefit through Qualified Health Plans both in and outside of the Health Insurance Exchanges.
    Hmmm...

    In our research, the ONLY mandate of the ACA was that MEDICAL plans were required to provide vision SCREENINGS to kids - but NOT provide comprehensive eye exams OR hardware in any way, to anyone at any age. In fact, the Vision Council has confirmed that there is no mandate for Americans to have vision coverage. The Well-Baby program covers the previously mentioned screenings through age 22, and if a primary care doc or pediatrician finds something they feel warrants a more comprehensive examination by a specialist (OD or MD) they can make the referral to them. However, the secondary visit may or may not be covered depending on the patients insurance coverage (any third party vision for example) or diagnosis medical vs. routine vision.

    Has something changed we're not aware of?

  7. #7
    What's up? drk's Avatar
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    Has something changed we're not aware of?
    Yes.

    In our research, the ONLY mandate of the ACA was that MEDICAL plans were required to provide vision SCREENINGS to kids - but NOT provide comprehensive eye exams OR hardware in any way, to anyone at any age.
    It's a "comprehensive exam" benefit. Materials are based on state-by-state decisions.

    In fact, the Vision Council has confirmed that there is no mandate for Americans to have vision coverage.
    True.

    The Well-Baby program covers the previously mentioned screenings through age 22, and if a primary care doc or pediatrician finds something they feel warrants a more comprehensive examination by a specialist (OD or MD) they can make the referral to them.
    Unlikely true, but pediatricians are probably welcome to get into the comprehensive eye exam game, if they wish.

  8. #8
    What's up? drk's Avatar
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    Quote Originally Posted by Sledzinator View Post
    There is a video on you tube about this. The dispensing fee is 25 dollars which is less than Medicaid. Also all orders have to go to vspone Columbus. The lab supplies all materials.
    Oddly, that's what people are charging for p.d.s. The irony is going to make me cry.

    Nobody loves a good optical service, I guess.

    Great googly-moogley, that low a fee won't cover pupillometer bulbs, marking pens, and lens wipe-offs, let alone electric bulbs, cool air, music, soft chairs, and a gun-free environment.

    An optician demands a little higher pay than $25 for all the work that goes into frame selection, lens design, measuring, ordering, quality control, dispensing, and aftercare. How much can we cut out?
    Last edited by drk; 10-09-2013 at 12:05 PM.

  9. #9
    Ophthalmic Optician OptiBoard Gold Supporter
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    Quote Originally Posted by drk View Post

    Great googly-moogley, that low a fee won't cover pupillometer bulbs, marking pens, and lens wipe-offs, let alone electric bulbs, cool air, music, soft chairs, and a gun-free environment.
    Wait one darn second!! Nobody said anything about a gun-free environment! (or gub-free as Woody would say).

    This might be a deal breaker!

  10. #10
    What's up? drk's Avatar
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    Who wants a piece of this action? C'mon, guys! Step up! Don't push each other down lining up to provide the pediatric benefit!

  11. #11
    Ophthalmic Optician OptiBoard Gold Supporter
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    Ironically, back in the day, when our docs wouldn't take VSP, the rep's mantra was always, "But think of the traffic it will bring!".

    Well, you'll be getting the traffic now, but not much of anything else.

  12. #12
    Ophthalmic Optician OptiBoard Gold Supporter
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    Quote Originally Posted by drk View Post
    Practices carrying the Otis & Piper Eyewear Collection will be identified on the vsp.com Doctor Directory making it easy for patients to locate providers in their area. Likewise, if your practice doesn't carry the frames, it won't include the Otis & Piper indicator in the Doctor Directory.
    Actually, this might be pretty funny to watch. Say for instance, there are 4 providers in a neighborhood, and three of them decide not to be on the coveted Otis & Piper (OP), list. That one guy that is will be slammed by non-paying patients like flypaper in the outhouse. That will free the others up to concentrate on those pts. they can profit from.

    This could be good..

  13. #13
    What's up? drk's Avatar
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    The inevitable sorting into two tiers can begin.

  14. #14
    What's up? drk's Avatar
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    The good news is that I'm sure the frames are going to be top quality. Plus, kids don't need much in the way of repeat adjustments and warranty work.

  15. #15
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    This is the design team for the Otis & Piper frame line:



  16. #16
    Eyes eastward... Uilleann's Avatar
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    I am having such insane mullet/kilt envy right now!!!

  17. #17
    Eyes eastward... Uilleann's Avatar
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    So some further research HERE shows some interesting complications related to the vision aspect of the PPACA, such as:

    "The U.S. government has chosen not to define "pediatric vision care" but has left it to the discretion of individual states to define the coverage through the selection of a benchmark vision plan, or by defaulting to a federal plan. What’s covered by these plans varies significantly from state to state.

    For example, Colorado’s benchmark medical plan includes a pediatric eye exam, but no eyewear materials. Connecticut has decided on much more robust coverage, including an annual exam for children and adults, plus annual eyeglasses or contacts for children as well. Employers will have to follow the specific requirements for their states closely. (Please Note: These are ‘initial indications’ and not necessarily final guidance.)"


    and

    "Under PPACA, pediatric essential health benefits must be embedded in a medical plan, and out-of-pocket vision expenses have to accumulate as part of an employee’s medical plan deductible.


    Many medical carriers are planning buy-up options so materials coverage for children and all vision coverage for adults can be included in the medical plan beyond just what is defined as "essential". This will help ensure a family can have consistent coverage, including the network of eye doctors and benefits, between the children’s pediatric vision coverage and adult coverage. Without these options, the adults in the family may have to go to one eye doctor while their children have benefits at a different eye doctor."


    So much awesome in the chaos of letting the states fight the details out for themselves. BRING IT! Now, where'd I put my kilt...

  18. #18
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    The only benefit I see to this is that a diagnosis of amblopyopa will allow us to bill to their medical and run a VEP scan as needed to follow the condition. This should also give anyone the opportunity for a lead into VT programs for those in need. Medical billing is the only reason to be aligned with vision plans. I just wonder if we will be able to get any out-of-network action on this.

  19. #19
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    The first plane I ever flew was an Otis-Piper. I always wondered what happened to them.

  20. #20
    What's up? drk's Avatar
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    Obviously, VSP bought them out.

    I can't wait for Rowdy Roddy and the Man from Mayberry to be spokesmodels!

  21. #21
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    The best thing about this plan is that they let you bow out. The bad thing this that VSP will begin an aggressive ad campaign for the highly touted Otis-Piper line and soon everyone will be asking for it by name. Curses, foiled again.

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    I just sent vsp my opt out email. I feel much better now.

  23. #23
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    Dr K, did VSP send you a letter or an e-mail letting you know that you were lucky enough to be part of this program?? in our area we take care of most of the VSP clients, i think one other dr here takes it, so i'm suprised we haven't heard anything about this yet.
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

  24. #24
    What's up? drk's Avatar
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    No, that was cut n' paste from some other OD post on another forum.

  25. #25
    Master OptiBoarder OptiBoard Silver Supporter
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    Quote Originally Posted by Stan Tabor View Post
    This is the design team for the Otis & Piper frame line:


    Otis does his best work in the morning. Piper is simply too rowdy to be very productive.

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