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We're a private Optical that only accepts cash pay only. We have promotion for insurance holders but they would rather go somewhere that accepts their insurance. I just applied to get accredited with Eyemed, Spectera, NVA and VSP Global.
Question: What's the advantage and disadvantages for being a provider for these insurance companies?
My clinic contracts with Eyemed and VSP Global while our sister store contracts with Spectera.
I was actually talking to our billing specialist today about Eyemed and she said the owner regretted taking it on the moment he saw the pitiful reimbursement for the exams. Eyemed's reimbursement for optical hardware varies wildly - some plans might offer a small discount to the patient and literally provide no payment to the provider while some plans actually reimburse fairly well.
VSP offers a large patient base with a better exam reimbursement than Eyemed, but you do have to contract with a VSPOne lab for certain plans. For example all patients with the Choice plan or the Advantage plan must have their work done at the VSP lab. Overall, our experience with VSP has been generally positive.
What I know about Spectera is that if you're not part of a group practice, you may want to steer clear of it. Spectera forces you to use their lab for all of their orders and from what I hear, there's a high frequency of jobs that take a long time to get back to the clinic. The Spectera benefit for exams is actually one of the higher ones among managed care plans, but the way they calculate charge backs for optical hardware will actually have you paying them in some instances. If you're part of a group practice of five or more clinics you can negotiate a contract where you could use a lab of your choice for the glasses, but it sounds like this wouldn't apply to you. See if you can contract for exams only?
I don't know anything about NVA, so I'm not at liberty to put in my two cents.
We use Spectera's opt out contract. We like to keep our patients, yes they do charge us back but in the long run it has worked well for us.
Thank you so much for the replies, it helps a lot :)
This is a little of a tangent, I just heard that Eyemed has approved HOYA lens for use. We don't do Eyemed, so just curious if this is true.
Spectera does now offer the freedom to use and Essilor lab, but i wish we did not take it. Pay out is horrible.
It really depends on where you are in your practice's growth. If you have a bunch of empty slots in your schedule, managed care provides a pipeline for at least some business.
Remember that it isn't necessarily the difference between limited reimbursement and a full-price private pay transaction, it's the difference between limited reimbursement and zero. The patients with Davis weren't going to come to your office and pay full price, they were going to go to someone else's office that takes Davis.