Insurances
For those who take all vision insurances. can you list which insurances you see the most of and have you seen an increase of some insurances and a decrease in others? my top Vision insurances are Davis, Amerigroup, VSP, Americhoice, Spectera and then Eyemed, followed by some smaller vision insurances. I have seen a decrease in VSP patients over the last couple of years. Anyone care to comment?
I would say the top 3 insurances I deal with are VSP, Davis and Eyemed. I also work with VBA, Opticare, NVA and Superior. I personally haven't seen any tangible increase or decrease in the number of patients with any of the insurances right now. I am expecting to see an increase with NVA down the road now that UPMC is going to start using them for vision plans
Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity
Your question asked for responses from people who take "all vision insurance". I doubt if there are many maybe any practices that take them all. I only have membership in 3 panels. VSP, EyeMed, and Superior Vision. We do take other, non panel insurance types where there is no requirement for panel membership, but not very many of those. One very good one comes to mind. A local business has a self funded plan that just wanted a hcfa form for one of their employees. Much to our surprise they paid us full UCR on every item including AR coating. Now there's one for the insurance naysayers. Anyway, to answer your question, it varies hugely by location, as the big plans are mostly paid for by employers, and those employers' locations will determine your local mix. In my case, VSP put a huge lab in my back yard so I had a huge increase in VSP employees coming to me. Eyemed lost Intel back to VSP and Intel is 3 miles from my office, so another big kick for VSP. Superior Vision has stayed stable since their main employer is the local school district. Eyemed has declined in my area due to Intel. Right now my mix is about 50% VSP, 15% EyeMed, 10% Superior, 5% misc. plans and 20% private pay.
I would appreciate to learn the basic of these insurance ....................
I would appreciate to learn the basic of these insurance plans and what they pay on your regular selling prices.
Is it similar to what I believe are the US medication plans?
Being a heart patient after a triple bypass and aortic valve replacement I take regular medications.
Important to me is my 0.4 nitroglycerin spray which costs me between $ 6.00 and $ 12.00 a small spray bottle in Canada.
When I need one here in Naples, the different drug stores ask for 295.00 at Costco to $ 350.00 at Walgreens.
Would a similar system apply for glasses in the USA through the involvement of an insurance ??
What a blistering commentary on the screwed up system we have for drugs compared to yours. Every conservative in the USA should read your post.
Last edited by Dr. Bill Stacy; 03-04-2016 at 08:28 PM.
We have a huge Highmark building across the street from us, so we take Davis and get all their employees. I can't stress enough how much I HATE Davis!!!! On top of that, we take some eyemed plans and some NVA plans.
How many of these plans are real insurance Vs discount plans. I distinguish between the two.
I didn't attend the funeral, but I sent a nice letter saying I approved of it. Mark Twain
I dropped Davis years ago; couldn't stand the cheap and old frame selection they gave us then. As i recall the lab (in Las Vegas?) was fairly decent. The reimbursement was pretty good back then, but we were obligated to show them the "tower of doom" frame selection that in the end was tossed into the dumpster at their suggestion. They did not want it back, but they wanted all their discontinued but cosigned frames returned. They may be different now. The one thing I like about Davis is they have out of network reimbursement. The patients get a pretty good deal.Originally Posted by mervinek
Yes, that's an important distinction. I love most discount plans because they usually allow us to use any brands, any lens types/options. With those it's important to point out that it is not insurance, it's a negotiated discount, usually better than most offices offer outright.
But not always. 20% is common, 30% is tough, 40% makes my stomach turn, and is my threshold for rejection. Contacts are always discounted much less, services 15 or 20%, lenses zero to 10% Exams are higher discounts, or a flat fee that is pretty sick. I've seen as low as $30 which in my office would represent an 80% discount.
Most insurers offer both "funded" and "discount" plans. Some are kind of hybrid. Important to read any and all of them thoroughly before joining or accepting.
Last edited by Dr. Bill Stacy; 03-05-2016 at 10:10 AM.
Still the Tower of Doom. Frames are not anything to write home about but for those not looking to spend money they are adequate for them. Lab service is mediocre at best. I have more issues with Davis Lab in New York than all the other insurance labs combined. Reimbursements are minimum at best, if anything at all
Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity
This would cause me to have to change jobs.
Caroline, L.O.
If you suffer from severe nonlinear waterfowl issues, you don't have your ducks in a row.
Our office fits the tale of our current economy. Hardly any middle class. LOTS.. I mean upwards of 40% ACA/Medicaid type plans, and then a good blend of Davis, Eyemed, and VSP. VSP's numbers are a bit skewed for us, since they also are the vision subcontractor for a couple of the risk based state payers. We have less than 10% private pay at the moment. Hoping to change that soon with some promotions.
Love the union plans. Most here are a straight dollar amount on a rolling basis.
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
Our ophthalmology office takes VSP, Eyemed and Davis. I was recently looking at what Eyemed reimburses for exams and noted that a lot of the time they paid $30-40. I really don't understand how any office could survive with that. I assume that the only way to break even or make a profit is to provide frames and lenses. Even then, we have to use their lab and there are chargebacks. We could do better with this if we were allowed to edge our own jobs but my understanding is that Eyemed allows that only for single vision lenses and nothing else. Would love to know how others here handle eyemed. VSP tends to be somewhat better for us in that they reimburse better for the exam but not by a whole lot. Also, VSP in-house finishing program still doesn't allow us to edge our own progressives.
The only good thing about eyemed is you can make some money on the materials and their on line claim system works fast. The exam reimbursement stinks. Yes, both eyemed and vsp allow IOF SV lenses only, and stock SV at that (no grinders). If I were an OMD I'd not mess with optical at all, because I'd know I didn't know anything about optical at all. ODs today know less about optical than they used to. So cheer up all you opticians, you'll end up with all the optical when the old timers like me are gone. Probably how it should be. OMDs doing only invasive eye surgery, ODs doing only medical and noninvasive surgical, and opticians everything else, including probably refraction for those who can refract properly. We'd need a bit fewer OMDs, more ODs and a lot more skilled opticians.
My two cents worth...... I do not belong to any vision plans, therefore i don't have to deal with the claims, the low reimbursement and especially, i don't have to artificially inflate my prices in order to stay in business. Almost all the major employers in our small town offer their employees Eye Med. Word has spread nicely that they can come to my office get the exact same pair of lenses and frames and still pay less out of pocket than they would at one of the in-network opticals.
I keep hoping that some day all of us O's will kick all of the vision plans out of their offices..... End result: Less headaches, go back to regular mark ups, less employees tied up all day working insurance plans, better care and pricing for our customers and best of all, No third party persons getting rich off of someone elses hard work and livelyhood!
Are you sure about that? I just got an eyemed check for $100 for 2 boxes of oasys spheres. The patient share on her plan was $120 which she paid on ordering the CLs. So I got my full price, $220 for the CLs, she's happy and Eyemed is happy. What would you have taken from her for 2 24 packs of oasys lenses without "using" her insurance? Less than $120 for 2 24 packs? How much less? I think not.
BTW the claim took about a minute to process in our office on line, and the date of service was 03/05/2016; I'm not much of an eyemed fan, but let's not exaggerate, ok?
My experience with Davis's New York lab is horrible! Tons of incorrect orders received. Wrong specs sent with wrong orders, gaps, powers off... you name it. And a lot of orders are incorrectly shipped. At least once a month I get an order from another Dr's office because it was sent to them by accident. We get a lot of jobs in a timely manner, but a ton of orders that take a month or longer. We also take their Affinity discount plan, which is not great. (at least we can have them made locally) I would drop Davis in a heart beat (but it's not up to me to make that decision) and the fact that we have Highmark across the street. I'm sure they would go to VisionWorks (owned by Davis) which has 2 locations that are close to us. As for the Tower of Doom... they are bad...cheap junk. Most of our patients do not choose from the Tower, but a few still do. Most of those are employees of Highmark that are told to pick from the tower because they are free. They walk in the door asking for them. Kills me.
I must admit i do not dispense contacts, so good deal or bad deal I have no experience with that. One thing i might mention though, How much had this lady paid in premiums over the course of 1 or 2 years? Did she really come out ahead or could she have just paid you out of pocket and gotten the same deal or better? As far as exaggeration, I am telling it how it is in my community and my office based on my customers real world comparison's. (Eyeglasses)
Most real vision plans (funded, not just discount plans) the premiums are paid by the members' employers or other group, some fully, some partly. I don't know about hers, but I run into very few where the premiums are fully paid by the member. Those are called "private" plans, and are expensive for people who don't need much eye care, fairly cheap for people whose families do. But I actually answered your question already. Out of pocket would have been her cost=$220. I'm thinking that's a worse deal than the $120 she paid. Of course it wouldn't matter to me, I get the same amount either way and the paperwork is pretty much nil. If she paid more than $100 a year for the coverage, it was not a good deal for her. In my next example I'll do one where I know who pays the premiums, and will factor that in.
Optical ONLY here
We see lots of VSP out of network. Next are Eyemed and Davis Vision. I know everyone think Spectera sucks, but we still take it here.
We take VSP and pretty much any discount plan I can sign up for. Other than that its private pay.
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