Do you take VSP out of network? How do you present OUT OF NETWORK to the customer, and how do you charge for frames, lens, and lens enhancements?
Do you take VSP out of network? How do you present OUT OF NETWORK to the customer, and how do you charge for frames, lens, and lens enhancements?
Its tough!
Works for us. When a patient calls in and ask if we take VSP we say yes. Take down the information to verify their out of network benefits, last four digits of ss#, DOB, name. If no out of network benefits then no can do. Place order as usual. We then take a 30% discount on our usual customary prices, deduct the benefit charges, add back any co-pay amounts, send in the HCFA to VSP.
what if member knows they have a $120 allowance? You take 30% off your retail price of frame?Originally Posted by mshimp
Yes, 30% is taken off the retail price of the frame. If someone questions the frame allowance, I would then tell them that the claim has to be file as an out of network claim. Never had anyone reject placing an order. We do have an Optometrist on the premise that is not on VSP. Copays are the same for exams in network or out of network. We use our own lab......No "charge backs" to us!
We do a small discount upfront and then fill out the VSP out of network form for them. Between our discount and the money they get back we are usually close enough not to lose the sale. However we also seek only premium independents so our customers can't just go anywhere.
Seems a bit misleading to me? You bait them in and then hope they will buy if your prices are close enough? I had a dental plan and the office I called said they were a provider, went to them for a year and then found out through my insurance company that they were not and I had overpaid for services by a couple hundred dollars!! Needless to say I wasn't happy, their excuse was that they gave us a nice discount to make up the difference but, I would have saved even more if I went to a participating provider! Not a very ethical move IMO.
Our prices are moderate to begin with. Our VSP patients DO end up with better pricing than an in network VSP provider. I don't believe giving a patient a better price is misleading at all. If you really think about vision insurance as a whole it IS MISLEADING!
We do take VSP...... Out of network!
optician2601 not sure if you received my reply from your PM?
I don't see how you could operate while beating their VSP copay amounts unless you are using a low quality product offering? It IS still misleading because you are not being honest with the pt to bring them into your store. I just feel you should tell them upfront why and how you will be able to offer a lower price for same products? If you want to provide services to an insurance companies customers , then you should jump through the proper hoops and get on their panel of providers like the offices that do accept it, like us. Just sayin
I would be interested in how you verify the client coverage. Great move on your end, we have been taking VSP out of network and beating in network provider prices as well. If I can verify coverage I think I would have a better process.
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Yes I did. i have more questions. Please check your inbox. Thx
VSP like many other insurances is scam to begin with!I don't see how you could operate while beating their VSP copay amounts unless you are using a low quality product offering? It IS still misleading because you are not being honest with the pt to bring them into your store. I just feel you should tell them upfront why and how you will be able to offer a lower price for same products? If you want to provide services to an insurance companies customers , then you should jump through the proper hoops and get on their panel of providers like the offices that do accept it, like us. Just sayin
Just look at "wholesale" frame book prices.
So we are taking VSP out of network and will be taking it!
It's not about you TAKING it out of network, it's about lying to people to get them in your store! If you tell them up front that you are not a participating provider and they still choose to come to you then so be it. I, as a consumer, would not appreciate it if I found out after the fact, so it's at your expense to be deceitful. Also, not sure how you are considering insurance to be a scam? You either participate in it or you don't? Best of luck to you though.
Last edited by golfnut; 02-01-2014 at 12:26 AM.
Its easy to explain!
My regular price for some frames are lower then out of pocket price with some VSP plans!
So you think I am misleading people!?
I wonder if Costco explains their out of network status?
golfnut........As an optician owned company VSP will not let us participate as an in network provider. So we play the GAME the best way we can.
Maybe even better then to participate and depend on VSP sending you bodies!
We do not lie to the patient to get them into the store. The customer is well aware what "out of network" means. We let them know that we take VSP, but we are not a provider. We are out of network.
Check out this website
http://www.craigsteinberglaw.com/ind...on-vsp-billing
I am sorry I misunderstood! I thought you were not telling the Pt you were an out of network provider. I meant no disrespect to all the independent optical owners out there! I have worked in that environment myself so I know how you feel. I just have had misleading issues with my dentist office and when I read what you posted I thought you were doing something you weren't! My bad:) I am not like some of the combatant insurance experts on here, um cough "race"! :)) have a good oneWe do not lie to the patient to get them into the store. The customer is well aware what "out of network" means. We let them know that we take VSP, but we are not a provider. We are out of network.
Check out this website
http://www.craigsteinberglaw.com/ind...on-vsp-billing
But you really should say "We are not a participating provider but we will assist you in being reimbursed". Saying "Yes we take VSP" is misleading if not an outright lie because you are not "taking" a payment from VSP.
Your response indicates you didn't read the provided link which was very informative.
I read it, it sounds like the pt could very well spend MORE than they would at an in network office?? Imo it still is a big Grey area if the pt would be paying one cent more than in an in network office! If so, they should know UPFRONT, not after they enter your office based on incomplete information. If you can't guarantee that to the pt and they find out after the fact, not only will you lose them, you will probably lose ten of their friends!Your response indicates you didn't read the provided link which was very informative.
No I'm sorry I did not because my antivirus suite lit up like the 4th of July.
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