Questions about Spectera

[DrDL]

These are questions for other current Spectera providers:

I am an independent O.D. working inside an independent optical shop (not a corporate store like Lenscrafters). The optician and I work independently for legal reasons (state law). I make my money from exams and CL fittings, he from glasses and contact lens sales. I take a few insurance plans, he takes none. The only vision plan I currently take is Eyemed and their reimbursement rates are horrible in my opinion. The medical plan I am on pay much better.

*What are their typical reimbursement rates for exams and/or contact lens fittings? I have been thinking about applying as a provider with them.
*Do they allow for only the exam and CL fitting benefits to be accepted in the contract? I think with VSP the OD must accept both the exam and materials benefits (correct me if I'm wrong). Any help would be greatly appreciated.

[Judy Canty]

You might want to pose this question on the "ODs on Facebook" page.

[DrDL]

Can you please post the link? I can't seem to find it.....I'm still very new to this board. Thanks.

[Java99]

It's on Facebook. Go there and search ODs on Facebook.

[DrDL]

Ok I don't use Facebook and was hoping to find some answers here since there have past threads about Spectera, Eyemed, VSP, etc.

[mshimp]

Stay away from Spectera.

[mshimp]

If I could I would stay away from all insurance!

[DrDL]

I wish I could survive on just self-pay patients but I can't at the moment because my practice is relatively new so I need to get on a few panels at least in the beginning. The medical plans aren't bad, they pay much better than EyeMed that's for sure. I usually get my full fee and then some with the med plans. I've Googled a bit but can't seem to find any info regarding the reimbursement rates for Spectera and VSP and I'm only interested in the exam/CL fitting reimbursement rates. The optical side of things doesn't take any insurance which is a good thing. Our frame and lens prices are very reasonable and people are more than willing to pay out of pocket for materials.

[Fezz]

I wish I could survive on just self-pay patients but I can't at the moment because my practice is relatively new so I need to get on a few panels at least in the beginning.

You may not be able to survive at all with this kind of thinking!

[David_Garza]

Stay away from Spectera.

1+ if you think Eyemed is bad you don't even want to waste your time with the other.....

[DrDL]

You may not be able to survive at all with this kind of thinking!

Well my practice is only a month and a half old and I started with a zero patient base. I didn't purchase a practice and it's like I'm the 'new doc taking over' plus the optical has never had a doctor in-house on a regular basis before. The last doctor the optician had worked half a day per week and that was about 6 months ago. I am busier than she was but would still like to get more patients. I understand I need to do marketing and such but any new business is slow in the beginning. I'm hoping you can understand that. Not too sure why you even bothered to reply at all since your response didn't address anything regarding my original post.

[DrDL]

1+ if you think Eyemed is bad you don't even want to waste your time with the other.....

Thanks as I was looking for responses by other ODs. I guess this gives me a good idea that all vision plans have horrible reimbursement rates.

[teach4]

Contract terms & reimbursements may vary. I was required to provide both contact lenses and eyeglasses and exams for Spectera - years ago, I was allowed to provide only exam and contact lenses. You must use Spectera lab for eyeglasses. Most frames are "provided" by Spectera lab, to keep dispensing fees to you low. If patients provide their own frame to send into Spectera lab for lenses - you must print out a "waiver" that patients sign & understand that Spectera does not accept liability for broken or lost frames. If Spectera does not have the frame in their stock, it is "provider supplied," & you must warranty 1 year for defective. Be careful about discontinued frames, because if it is "defective," then you are required to provide both a new frame & lenses at your cost. There is a "Spectera contact lens collection" - again Spectera provides the contact lenses - patients pay a copay - you get a CL fitting fee of about $60. If contact lenses are outside the collection - then there is a $110 allowance & you are able to charge your U&C contact lens fitting fees + contact lenses then subtract off $110 for patient to pay.

[DrDL]

Contract terms & reimbursements may vary. I was required to provide both contact lenses and eyeglasses and exams for Spectera - years ago, I was allowed to provide only exam and contact lenses. You must use Spectera lab for eyeglasses. Most frames are "provided" by Spectera lab, to keep dispensing fees to you low. If patients provide their own frame to send into Spectera lab for lenses - you must print out a "waiver" that patients sign & understand that Spectera does not accept liability for broken or lost frames. If Spectera does not have the frame in their stock, it is "provider supplied," & you must warranty 1 year for defective. Be careful about discontinued frames, because if it is "defective," then you are required to provide both a new frame & lenses at your cost. There is a "Spectera contact lens collection" - again Spectera provides the contact lenses - patients pay a copay - you get a CL fitting fee of about $60. If contact lenses are outside the collection - then there is a $110 allowance & you are able to charge your U&C contact lens fitting fees + contact lenses then subtract off $110 for patient to pay.

Thank you! This is exactly what I was looking for. I guess I can't get on their panel anyways since I don't own the optical side of things at the moment and only provide services. I will hopefully taking ownership of the optical within the next two years. I think more vision plans are requiring providers to accept both benefits these days. Can you tell me if VSP and Davis work the same way? Require you to accept both the exam and materials benefits as a provider? I know Eyemed allowed me to pick and choose what benefits to accept when I signed on with them.

[FL-Opt]

I think you can become an "exam only" provider, whether or not they want to allow you to sign up for "exam only" is another issue. It's all up to them to decide. I know some Dr's are exam only providers here in Florida, so it's a possibility. You may look into Superior Vision also, not sure if it's a common plan where you are or what their reimbursements are but they used to be fairly easy to file and had quick reimbursements. Good luck!

[teach4]

VSP requires 51% ownership of the optical. VSP is the best of the plans. You can consult often with the same reps at the VSP labs - for troubleshooting and problem solving. VSP offers the most choice with additional lens options & frame selection. Where you will make $$ is educating your staff on promoting these higher end frames and additional lens options, like premium AR coats, free form progressives. If your staff only promotes what the vision plan covers, your profit margins will be slim to none. I'm not sure if you can do only exams & contact lenses through Davis. Davis has a "tower" frame collection that they will ship to your office if you become a provider. Frame exchange & defective frame warranties only apply if patient chooses a frame from the tower. Again, with their own lab providing frame & lenses, dispensing fees are kept low. Lens options are more restrictive. There is a "contact lens" collection with a copay. Both VSP & Davis pay well for "medically necessary" contact lenses (keratoconus, anisometropia greater than 3D, ect).

I think you're doing the right thing with medical billing. Your optical is better off staying "private pay" - offer both "low end" & "high end" - so that there's something for everyone.

[DrDL]

I think you can become an "exam only" provider, whether or not they want to allow you to sign up for "exam only" is another issue. It's all up to them to decide. I know some Dr's are exam only providers here in Florida, so it's a possibility. You may look into Superior Vision also, not sure if it's a common plan where you are or what their reimbursements are but they used to be fairly easy to file and had quick reimbursements. Good luck!

Thanks. I may not even bother anymore from all the bad things I've heard about them. I have heard of Superior Vision but it's not very common here in MA. And that seems to be the only good thing about Eyemed - easy claims and quick reimbursements (even though they are small).

[DrDL]

VSP requires 51% ownership of the optical. VSP is the best of the plans. You can consult often with the same reps at the VSP labs - for troubleshooting and problem solving. VSP offers the most choice with additional lens options & frame selection. Where you will make $$ is educating your staff on promoting these higher end frames and additional lens options, like premium AR coats, free form progressives. If your staff only promotes what the vision plan covers, your profit margins will be slim to none. I'm not sure if you can do only exams & contact lenses through Davis. Davis has a "tower" frame collection that they will ship to your office if you become a provider. Frame exchange & defective frame warranties only apply if patient chooses a frame from the tower. Again, with their own lab providing frame & lenses, dispensing fees are kept low. Lens options are more restrictive. There is a "contact lens" collection with a copay. Both VSP & Davis pay well for "medically necessary" contact lenses (keratoconus, anisometropia greater than 3D, ect).

I think you're doing the right thing with medical billing. Your optical is better off staying "private pay" - offer both "low end" & "high end" - so that there's something for everyone.

Thank you. As of now I don't own the optical side at all - I just provide services so VSP is out. I will be taking ownership of the optical within the next two years though but I think it is better keeping it private pay with competitive/slightly lower prices compared to the other opticals nearby. Plus doing the claims for the materials sounds like a pain in the azz to me and not something I will want to deal with. And I've heard of the Davis Vision "tower of glasses". Lol pretty crappy selection from what I hear. Claims for services have become relatively easy since everything is basically electronic. The downside to med claims is reimbursement is slow, average is about 3-4 weeks until I receive payment. Off topic: I didn't realize anisometropia > 3D would be considered 'medically necessary'....some health plans will cover, at least in part, medically necessary contacts. I'll have to look into that a bit more. I don't see too many keratoconus patients - mostly soft lens fits and few RGP fits.

[David_Garza]

I think you can become an "exam only" provider, whether or not they want to allow you to sign up for "exam only" is another issue. It's all up to them to decide. I know some Dr's are exam only providers here in Florida, so it's a possibility. You may look into Superior Vision also, not sure if it's a common plan where you are or what their reimbursements are but they used to be fairly easy to file and had quick reimbursements. Good luck!

And you can only be an Exam Only provider if you don't have an optical (you work in a Doc in the Box/Commercial setting).

[DrDL]

Doc in the Box/Commercial setting

Lol. This made me laugh. How true it is....