Applying VCP benefits to multiple purchases

[drk]

We often have VCP patients who are interested in purchasing multiple pairs of glasses, or are interested in purchasing glasses and contact lens supply.

Almost always, a patient gets one benefit per benefit period, and we have to choose how to apply the benefit: to the glasses, to the CL supply, to the second pair, etc.

Here's what I think we are doing:

1. If multiple pairs of glasses, we will apply the benefit to the most expensive pair.
2. If glasses plus contact lens supply, we will apply the benefit to the glasses purchase (assuming it's not a spectacle lens-only order).

How do you do it?

Please critique our policy?

[Elvis Is Alive]

I've always tried to maximize the benefit and apply it where it saves the most money unless specifically requested to do something different.

VCP got rolled into EyeMed several years ago if I recall correctly. Most of these plans offer 20% discount on multipair purchases. I would always check to see which pair to use the primary benefit on and which to apply the discount for maximum savings to the patient.

In most cases, it was more beneficial to the pt to apply primary benefits to eyewear instead of contacts when they are purchasing both and only have benefits for one or the other.

[drk]

I meant "vision care plan". Thanks for the post.

[Elvis Is Alive]

Gotcha. All of the info still applies though.

[AngeHamm]

There really isn't a one-size-fits-all answer to your question. Some VCPs allow you to bill frame and lenses separately, and if they have a fairly standard RX and you have a decent package price on non-insurance lenses (we do poly w/AR stock SV for $129 and generic PAL for $229) it may benefit both your patient and your office to have them pay for the spec lenses OOP. So that ends up looking like:

Frame: use insurance benefit
Lenses: Patient pays OOP package price
Contacts: use insurance benefit

We're doing this less than just a few months ago because many EyeMed plans will no longer allow us to split up benefits that way.

[juno]

It seems like any time I do a "frame only" (that is, patient private pays the lenses for whatever reason, and we bill the frame), we almost INEVITABLY get audited and have to do the paperwork back and forth song and dance. At this point, I just tell them glasses or contacts, because my back-end time is not worth the hassle for that. YMMV

[NAICITPO]

I price out their insurance with glasses with contacts out of pocket and price out their insurance for contacts with glasses out of pocket and show them the difference. It's almost always better to use the insurance on contacts but just showing the customer you are trying to save them money is a good thing. With eyemed you can use insurance for frame and contacts, with VSP you cannot. So this makes the calculations a little more tricky.

What I find extremely annoying with VSP on eyefinity you cannot bill glasses and a contact lens fitting together. So I cancel the initial auth and do one auth for Exam and CL fit and one for Frame and Lenses. WHY VSP???

As far as using the insurance on the most expensive pair versus a lesser 2nd pair... Save the customer money and show them your work and they will appreciate it. Karma is a good thing IMO.

[drk]

Here's my thing, though.

When you look at the "dispensing fees" that you DON'T GET with many of these vision care plans, it doesn't even pay close to enough to have a decent conversation about lenses.

I certainly am not getting paid to do three math problems and show the patient how thrifty we are by doing it. I'm not getting paid to be their financial advisor, that's for sure.

I think the goal should be a decent rule of thumb that works the majority of the time, and stick to it and not waste time.

[Elvis Is Alive]

I disagree with that line of reasoning and am more in line with our backward optician :)

We also aren't their vision plan provider but will still have to explain the benefits to them in most cases and we don't get paid for that either. It is the cost of doing business with VCPs IMO. "The deal with the devil" so to speak.

If your issue is time vs reimbursement, is it even worth it to be a provider for that plan?

[drk]

Nope.

[NAICITPO]

Here's my thing, though.

When you look at the "dispensing fees" that you DON'T GET with many of these vision care plans, it doesn't even pay close to enough to have a decent conversation about lenses.

I certainly am not getting paid to do three math problems and show the patient how thrifty we are by doing it. I'm not getting paid to be their financial advisor, that's for sure.

I think the goal should be a decent rule of thumb that works the majority of the time, and stick to it and not waste time.

If you deal with insurance all day long like your opticians most likely do, the 3 math problems should take you 30 seconds at most. The fact that insurances pay jack doesn't have anything to do with how you take care of the people you have in front of you imo. You want the people they send you then you do your best for them. That's my stance anyway.

I disagree with that line of reasoning and am more in line with our backward optician :)

We also aren't their vision plan provider but will still have to explain the benefits to them in most cases and we don't get paid for that either. It is the cost of doing business with VCPs IMO. "The deal with the devil" so to speak.

If your issue is time vs reimbursement, is it even worth it to be a provider for that plan?

+1

[iD]

I do the math and show them the combo..."if you use your insurance on the frames and pay private for CL this is how much it is" or vice versa.

[Uilleann]

Keep it simple Doc. You're getting paid like NOTHING to service these managed care plans. And many will happily audit you into next Tuesday if they think you slighted them one red cent. Frame only claims are an audit waiting to happen. The respective companies made their policies - make sure your patients know that when things seem "restrictive". It'd be a great world if we got back to the old flat fee: "You get $400 a year from your 'insurance' to use for optical purposes. Use it how you will. The end". Then self-pay everything.

Better service, better margins allowing you to not only stay in business, but also hire [and retain] the best staff in your area.

[NAICITPO]

Keep it simple Doc.

KISS method, but maybe he is calling you stupid? :bounce:

[drk]

I don't mind truth
:)