VSP filing and VDT EyeCare

[snv]

Hello,

I'm fairly new to the VSP insurance, so please take it easy on me :). Just have a simple question. One of my patient has a $300 allowance plus a 15% discount off the contact lens exam (fitting & evaluation)
He has $180 allowance toward frame. He also eligible for the VDT Eyecare plan. Can he use his benefit toward contact lens exam and also get a VDT eyecare plan (a single vision glasses when on computer). If so, does VSP reimburse us for both contact lens exam, and vdt exam?

Thanks

snv

[drk]

Of couse, the easiest way to do this is to call VSP and ask. They're pretty good with provider services.

If the member has a CL allowance of $300, that goes towards the CL service (usual and customary -15%) (not "CL exam": you have to separate the routine exam from the fitting) and the CLs to be purchased. Usually on that plan you will also have benefits to cover the routine eye exam.

With the VDT plan, that usually only pays for a second pair of computer glasses. If there are eye exam benefits available on the VDT plan, I would suppose you could submit a claim for a "VDT exam", but it couldn't be done on the same day as the routine eye exam. What exactly is a "VDT exam", anyway? I never have heard of one, unless it's that PRIO stuff.

If there are no eye exam benefits on the plan that has that high CL allowance, submit for the routine exam on the VDT plan.

[Andrew Weiss]

We've never processed a claim for a VDT eye exam; I also have no idea what that would be.

It's difficult to use the VDT benefit for regular eyeglasses because of the number of items that the patient can't even get. One thing to remember about VSP is that if the item is not something available through their plan, the patient can't pay to get it done privately (unless, of course, it's something like a coating or tint, which could be added on later, but those are usually available). Also the frame allowance is usually lower.

One hint in working with VSP and making money: 1) mark your frames up at 3x plus $6; and 2) get the patient to buy up, even by $5, above their wholesale frame benefit. Because VSP uses slightly less than 2.5x as its markup in determining the retail frame benefit, you can make a couple of extra bucks. And, because VSP cuts the profit margin by roughly 50% on eyeglass jobs, every extra dollar helps. We see mostly $40-$55 wholesale frame benefits in our office, and I've put our median frame price in our collection at about $55. It works.

[snv]

Hello all,

My staff made a call about the VDT exam. From the example above for my patient, he can choose to use his benefit for contact lens, and another exam for VDT. VSP told us that they will reimburse us a fee for the VDT exam (70% of the normal exam), and the patient is also able to obtain a computer glasses in addition to the $300.00 benefit contact lens allowance.

I also have a question on a side note of VSP. This is very much confusing to me. Hope someone can answer it. I hope my staff don't have to spend all day to figure out these extra options.

Non-covered Options

When providing materials not covered by the patient's group, charge the patient according to the VSP Standard Plan Patient Options List or your adjusted U&C fee, whichever is lower.

[drk]

Welcome to VSP. What's the question, though?

[snv]

sorry for the confusion.

My question is that for the non-covered option of the plan, how do we actually calculated it to charge the patient? and how much do we actually receive from VSP for that.

Another question regarding COVERED option. Example of my patient above. If his covered options included Hi-index, and photochromatic lens, and he decided to get both. I understand that you would not charge him anything, but on the VSP paper, it said that VSP will give us a "service fee". Is it one service fee for each option? or is it one global service fee for both hi-index and photochromatic lens.

thanks

snv