How to make money from accepting vision plans!?!? Eyemed VSP. would love guidance

[chronometre]

could really use the guidance of any members out there with any tips on insurance mechanics within a doctors office. looking at the reimburse amounts for Eye Med and VSP for our office, it is quite dismal. For a $400 retail frame at cost $200, the reimbursal to our office is $170. If the frame is over the allowance, we are required to give the patient a 20% off discount on the amount that is over! the lens portion we are only able to gain margin from the premium luxury coatings the labs offer. It seems the only profit a doctors office is allowed to make is the eye exam, the co-pay and the premium coats! if we offer a discount from retail on the frame to promote sales our office may lose quite a bit on servicing the patient. I see some of the local doctors offices doing services like botox, elective surgery or other supplements in order to make money. Ive even seen some offices operate completely out of network. Is there any way an office can increase the amount of margin with these insurances?

thank you for taking the time to read this thread.

[pbrownlee]

I have been doing this for 17 years. The only way is to mark up your frames more. Insurance does not let you make any money. The only other way is to sell another frame and lens. Online kills you as people think that is what you pay for lens and frame. Optometry is on its way down because of the internet

[chronometre]

thank you so much for your contribution and insight. The insurance claims ask for the make, model and the actual cost of the frame😵*💫😵*💫 it’s crazy… even with our markup they would only reimburse the same, the only thing the markup does is have the patient come out of pocket more however, when they find out online what the actual MSRP is, they would feel a bit frustrated

Yes, optometry is getting very tough

I have been doing this for 17 years. The only way is to mark up your frames more. Insurance does not let you make any money. The only other way is to sell another frame and lens. Online kills you as people think that is what you pay for lens and frame. Optometry is on its way down because of the internet

[Elvis Is Alive]

And when you start marking up frames artifically because of insurance reimbursements, you will lose many of the high disposable income self-pay pts. Then you will be stuck in the hampster wheel of only servicing managed vision care pts with all its restrictions and always decreasing margins. My advice is don't take any of them.

[optical24/7]

And when you start marking up frames artifically because of insurance reimbursements, you will lose many of the high disposable income self-pay pts. Then you will be stuck in the hampster wheel of only servicing managed vision care pts with all its restrictions and always decreasing margins. My advice is don't take any of them.

This^^

The best way to make money off insurance is to be an “out of network provider”. When asked if you take xxx insurance, you don’t say “no”, then watch them walk out. You say “Yes!” We’re an out of network provider for their insurance! ( yes, exclamation !)

”You get special discounts on lenses and frames AND you can get some reimbursement from your insurance company with this simple form!”
Give them further discounts on multi pair and discounts though the year on any other purchase. Give their spouse and kids the discount too. Their insurance may not do that…More differentiation on why you’re better than a location that accepts their plan. ( It helps if you’re a personal, people person that communicates well…Out of the realm of some..)

You don’t wait for reimbursement from insurance companies, you don’t have the hassle of verification, you simply fill out an out of network form for them, and a nice touch, give them an addressed, stamped envelope for them to send to their insurance provider. Easy peasy…

[Elvis Is Alive]

This^^

The best way to make money off insurance is to be an “out of network provider”. When asked if you take xxx insurance, you don’t say “no”, then watch them walk out. You say “Yes!” We’re an out of network provider for their insurance! ( yes, exclamation !)

”You get special discounts on lenses and frames AND you can get some reimbursement from your insurance company with this simple form!”
Give them further discounts on multi pair and discounts though the year on any other purchase. Give their spouse and kids the discount too. Their insurance may not do that…More differentiation on why you’re better than a location that accepts their plan. ( It helps if you’re a personal, people person that communicates well…Out of the realm of some..)

You don’t wait for reimbursement from insurance companies, you don’t have the hassle of verification, you simply fill out an out of network form for them, and a nice touch, give them an addressed, stamped envelope for them to send to their insurance provider. Easy peasy…

Yup, thats exactly what we do. Because we aren't in network, we can offer package pricing on all lenses as well. Everyone gets AR and Trivex standard. We match the out of network reimbursement as an additional discount also. In some cases, they pay less than what the out of pocket charges would be with vision ins. Several of our pts have dropped their vision plans because of this.

[AngeHamm]

A couple other ways to make money with these plans:

Edge in-house if possible. It can save you $10-20 per job.

Take advantage of the "in-house finishing" options and order stock lenses rather than have labs supply your lenses. Nassau Optical, Cherry Optical, etc.

Talk with your lab rep about package-priced house-brand progressives. They are usually un-branded versions of quality lens designs, and labs often discount them when combined with poly and an AR coating. These are not only excellent for pricing second pairs, but sometimes your package price will be better for the patient than their insurance benefit.

Use insurance-friendly budget frame companies like Modern Optical or New York Eye for entry-level frame needs.

[EyeManDan]

Get your maximum discount from your frame suppliers. If you can get them below list, set your price based of off list price. Your making money on the supply side.

[chronometre]

wow - thank you all for your contributions and guidance! you guys are AWESOME - this is a wealth of information and paths we can choose from. we used to be able to use our own brand of lenses and edge in house to improve margins. however eyemed we must use nassau lenses to complete the claim.

the out of network advice is amazing - i think the only drawback for the patient is the upfront out of pocket (some patients we have are very.... frugal) and then the hassle of following up on the claim with the insurance provider.... i know the out of network reimbursal in a lot of cases is less than if the patient went in network.

[Elvis Is Alive]

There are ways you can file out of network claims directly for the pt as well. Either through each vision company's portal or a service like Anagram.

[optical24/7]

There are ways you can file out of network claims directly for the pt as well. Either through each vision company's portal or a service like Anagram.

You can, but I don’t recommend it. You might as well be a panel provider if you’re gonna jump through the hoops and wait for an “expected” reimbursement. That’s the whole point of staying OON. You’ve already gone the extra mile filling out your portion of their form, provide an itemized receipt and a stamped envelope.

[Elvis Is Alive]

We send the OON reimbursement to the pt. Pt pays the normal retail price minus any matching benefit discount we have provided. It takes all of 20-30 seconds to file a claim thru Anagram. Some pts come to us specifically because we file the claim for them.

[AngeHamm]

The other thing you need to factor in is that joining a panel will drive new patients to your practice. How you maximize revenue from them is up to you, but if you need new patients, adding an insurance is a tried-and-true way to get them.

[chamilun]

The other thing you need to factor in is that joining a panel will drive new patients to your practice. How you maximize revenue from them is up to you, but if you need new patients, adding an insurance is a tried-and-true way to get them.

but until more offices say NO, they will continue to get away with murder. The VSP/Eyemed etc reimbursement has not changed in many years except by a very small amount. A 10-piece Mcdonalds combo meal is now $9.50 or something like that.

The true answer is, these companies need to be held accountable.

[chronometre]

but until more offices say NO, they will continue to get away with murder. The VSP/Eyemed etc reimbursement has not changed in many years except by a very small amount. A 10-piece Mcdonalds combo meal is now $9.50 or something like that.

The true answer is, these companies need to be held accountable.

thank you so much for your contributions. Totally agree that they need to be held accountable. I believe on IMed there is a column which actually asks you what the COST of your frame is. The insurance companies have succeeded in taking away practically all of the rx lens margins for an optical shop😵*💫. There is zero accountability. The larger companies Costco and Sam’s Club just refuse to use insurance laboratories all together and use their own laboratories.

then there are insurances like Kaiser, which offer more coverage, but only within their network and have a very difficult out of network program. Has anybody had good success with Kaiser patients?

[Barry Santini]

I preter to say we are out of network for all insurances. For many of our clients who do have vision plans, we provide a detailed receipt and complete an OON claim form. If they walk, so be it. We feel that if insurance and discounts are their most important concern, they’re probably not our customer.

[drk]

If I were an independent optical, I would do out of network only (and not even fill out the forms, to be honest).

The only way to "make money" in vision care is to be a vision care practice. Not an optical.

Opticals should be cash only, and people should come to them because they're superior to other optical services.