Davis Vision Verizon Contact Lens Benefit

Please help.

I have a patient with the Davis Verizon plan that offers an annual supply of contacts for some absurd $20 copay. The plan actually covers only Davis-supplied contacts (i.e. very old designs such as Acuvue 2) at this price, but the verbiage on the plan is vague, leading to much patient (and optician) confusion. You can tell this is a Jurassic plan because the prefix is BEL, for "Bell Atlantic." There is a form to fill out and send in for reimbursement for non-plan contacts, but if I send it in it will be considered submitting a claim, and I don't want to do that before I can tell the patient at least a good guess of what the coverage is going to be. And I really don't want to spend seven hours on hold with Davis Vision today.

Please, dear sweet baby Jesus, let there be someone on OptiBoard with an idea what I can tell my patient Davis is going to cover on their annual supply of Acuvue Oasys One-Day contacts.

Note: Please feel free to miss me with the "Just don't take Davis" hot takes. I don't get to make that decision.

The unheard cry

I know a person
Who now cries underwater
To hide his sorrow!

So essentially you are trying to discern what is Davis's benefit for a "off-forumulary" contact lens?

Here's one way to guess: how much do you get paid for "on-formulary" lenses? I'm thinking it will be about the same to the patient, less the copay.

I don't think enough of us who post (drk excepted) at this point take Davis and/or would try to help this wearers no win situation for your office Andrew. I hope someone can prove me wrong!

Any chance you can explain to the owner your dilemma?

And point out to them the tied up phone line and what you are doing for no profit.


Meanwhile- If you really want an answer you may want to call now for an answer before 5.:frown:

I haven't worked somewhere that accepted Davis in awhile but when I did the doctors pretty much stuck to what was within Davis' contact lens formulary because we never got paid fairly for the off formulary contacts. I know that doesn't help. You may have to just tell the patient, "It looks like it might be [this much] out of pocket but I won't know for certain until your insurance processes your claim, at which point you may receive a bill if there is anything they didn't cover." I know from experience the Davis customer service reps will tell you one thing but when you go to bill, it's wrong.

I actually just had a patient of our MD call and say VisionWorks told her Davis won't cover the ground in prism she needs in her lenses. What?!? Why would they not do that? This particular patient refuses to order with us because she'd have to pay out of pocket and isn't confident that Davis will reimburse her fairly, which is a completely fair concern. Especially since she is a Medicaid Davis plan patient. They don't pay well when you're in network, so out of network benefits are next to nothing.

Krystle, I'm sure you didn't mean this, but never, ever dispense CLs without payment in full. We don't even ORDER them without payment in full, actually.

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Originally Posted by drk

Krystle, I'm sure you didn't mean this, but never, ever dispense CLs without payment in full. We don't even ORDER them without payment in full, actually.

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Sure never dispense contacts without full payment, but you can order contacts without full payment. Most contact lens retailers will return unopened contacts for 3-4 months after purchase. I find it's a little bit easier for people to stomach the $800 year supply of dailies if they pay when they pick them up, at least it is something tangible. We do offer to ship year supplies to their house and in that case we do require payment in full up front.

I think she was meaning the CL benefit is different for CL's in their formulary versus out of their formulary. If Eyemed or VSP says they have a $200 allowance I have never had a claim where they don't pay out on it. So when factoring what to collect from the customer you would take $200 off the total retail of the contacts. The same thing doesn't apply to Davis for non-formulary contacts and that is the problem I think she is talking about.

First thing you need to check if you are getting paid for fitting if supplying CL from Versant. I think the only way is to try to almost submit the claim. If you are not you can charge patient a fitting fee since they go out of cl formulary covered by Versant. If there is NO out of network CL allowance you are getting $0 for contacts from Versant!

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Originally Posted by AngeHamm

Please help.

I have a patient with the Davis Verizon plan that offers an annual supply of contacts for some absurd $20 copay. The plan actually covers only Davis-supplied contacts (i.e. very old designs such as Acuvue 2) at this price, but the verbiage on the plan is vague, leading to much patient (and optician) confusion. You can tell this is a Jurassic plan because the prefix is BEL, for "Bell Atlantic." There is a form to fill out and send in for reimbursement for non-plan contacts, but if I send it in it will be considered submitting a claim, and I don't want to do that before I can tell the patient at least a good guess of what the coverage is going to be. And I really don't want to spend seven hours on hold with Davis Vision today.

Please, dear sweet baby Jesus, let there be someone on OptiBoard with an idea what I can tell my patient Davis is going to cover on their annual supply of Acuvue Oasys One-Day contacts.

Note: Please feel free to miss me with the "Just don't take Davis" hot takes. I don't get to make that decision.

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Originally Posted by Uncle Fester

The unheard cry

I know a person
Who now cries underwater
To hide his sorrow!

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Love it!! Bravo!!

People here FREE and think that applies to every contact, but it only applies to certain covered contacts. With covered contacts you only get $25 for fitting fee. On noncovered, you only 80% of the contacts allowance. Specterable and Superior and Davis trick the providers

So, you get whatever they allow you as a supply fee, for the covered CLs, or they cap your professional fee if the member doesn't get formulary contacts?

And they allow a higher patient responsibility for professional fees for non-formulary contacts? But then drop your CL supply reimbursement by 20% of the allowance? In other words, whatever additional professional fees the patient is likely to pay for "non-formulary services" and non-formulary materials is counterbalanced by a penalty on the reimbursement for non-formulary.

So, the point is, if you "upgrade" Davis members to better CL services and materials, Davis wins by having less payout? But you are paid the same, on- or off-formulary?

I'd sure hope that the benefits for upgrading for both the doctor and member and Davis all balance.

It almost seems like junk plans like Davis are pulling the wool over the eyes of the buyers of their plans--that is, the employers and groups--by offering a bait-and-switch to undersell the VCP market.

Man, from a provider standpoint, Spectera and Davis aren't great. From a consumer's standpoint, however, it probably seems pretty solid. Let's look at a poly Varilux X with Sapphire and Transitions. GM/UAW plan, that patient is paying 365 for the lenses, which seems pretty eminently reasonable. Sure, our end sucks monkey-nuts, but the consumer doesn't know or care about that. Spectera plans all seem to involve a lot more variation, but even theirs don't seem that bad from a consumer standpoint. Eyemed and VSP by comparison are all over the place. And as far as Superior goes, I don't know who it's superior for, because every plan I've seen on them has been hot raw sewage. So assuming you as the buyer of the Davis/Spectera plan have relatively pleased plan participants, how many waves you gonna make?

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Originally Posted by juno

Man, from a provider standpoint, Spectera and Davis aren't great. From a consumer's standpoint, however, it probably seems pretty solid. Let's look at a poly Varilux X with Sapphire and Transitions. GM/UAW plan, that patient is paying 365 for the lenses, which seems pretty eminently reasonable. Sure, our end sucks monkey-nuts, but the consumer doesn't know or care about that. Spectera plans all seem to involve a lot more variation, but even theirs don't seem that bad from a consumer standpoint. Eyemed and VSP by comparison are all over the place. And as far as Superior goes, I don't know who it's superior for, because every plan I've seen on them has been hot raw sewage. So assuming you as the buyer of the Davis/Spectera plan have relatively pleased plan participants, how many waves you gonna make?

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People are starting to catch on the Davis sucks. When I explain to our patients who have Davis that we don't take it, I hear a lot of negative comments about Davis's frame selection, the Davis lab, and how many times the Davis lab "lost" their frames. I feel bad for the Medicaid patients who have Davis because if they do pay out of pocket with us, they really won't get anything back as reimbursement from Davis, since, from what I remember, they only paid something like $20 for a frame that was not in their selection (for Gateway/Amerihealth Caritas plans at least).

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Originally Posted by juno

Man, from a provider standpoint, Spectera and Davis aren't great. From a consumer's standpoint, however, it probably seems pretty solid. Let's look at a poly Varilux X with Sapphire and Transitions. GM/UAW plan, that patient is paying 365 for the lenses, which seems pretty eminently reasonable. Sure, our end sucks monkey-nuts, but the consumer doesn't know or care about that. Spectera plans all seem to involve a lot more variation, but even theirs don't seem that bad from a consumer standpoint. Eyemed and VSP by comparison are all over the place. And as far as Superior goes, I don't know who it's superior for, because every plan I've seen on them has been hot raw sewage. So assuming you as the buyer of the Davis/Spectera plan have relatively pleased plan participants, how many waves you gonna make?

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That's fine for Mr/Mrs. Customer, but have fun finding the locations that still take Davis in my neck of the woods. Attachment 15072

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Originally Posted by NAICITPO

That's fine for Mr/Mrs. Customer, but have fun finding the locations that still take Davis in my neck of the woods.

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Walmart, Sam’s Club or Costco?

Yes, you may check for your provider on our member
websiteatwww.davisvision.com to confirm. The Davis
Vision provider network includes many regional and national
retail locations, including Walmart, Sam’s Club and Costco.

https://www.roanoke.edu/Documents/Da...rochure(0).pdf


Andrew- Maybe send the patient to one of them? Of course it's better if you can get Specterrible out of the office as my Doc's did years ago with ZERO effect on the bottom line!

Update: I found a document online, not on Davis's website, but using Google, that specifies in black and white that Davis will contribute precisely $125 for provider-supplied contacts with this plan.

You'd think that would end the story, but noooooooo.

Patient is still convinced that she has full coverage for an annual supply of one-day contacts. I encouraged her to call Davis, but warned her that she could speak to three different people over there and she'll get three entirely contradictory answers, and that regardless of what they tell her they cover, we have to make our business decision based on what money they actually provide us. She called them, and had them contact us. The Davis associate who spoke with my manager assured us that they had paid in full for her annual supply in 2020 (our records show that this is untrue; we mis-charged her and simply wrote off the balance), and that they would again this year. So I have knocked it up the ladder to my boss, who has taken ownership of this clusterhump.

There needs to be a better word for "The Worst."

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Originally Posted by juno

Man, from a provider standpoint, Spectera and Davis aren't great. From a consumer's standpoint, however, it probably seems pretty solid. Let's look at a poly Varilux X with Sapphire and Transitions. GM/UAW plan, that patient is paying 365 for the lenses, which seems pretty eminently reasonable. Sure, our end sucks monkey-nuts, but the consumer doesn't know or care about that.

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So you're saying patients only have to pay half price for lenses as long as the optical doesn't want to make any money on the transaction? What a shock. Anyone owner/doctor contracting with these schmucks deserves the pennies they get.

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Originally Posted by Kwill212

So you're saying patients only have to pay half price for lenses as long as the optical doesn't want to make any money on the transaction? What a shock. Anyone owner/doctor contracting with these schmucks deserves the pennies they get.

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Not super helpful. What we actually deserve is the money we're contracted to receive, and customer service who give consistent, accurate information on a timely basis.

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Originally Posted by AngeHamm

Not super helpful. What we actually deserve is the money we're contracted to receive, and customer service who give consistent, accurate information on a timely basis.

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It wasn't meant to be helpful, and wasn't in response to you or your question. Also, I clearly stated doctor/owner which I'm pretty sure doesn't apply to you since you said you don't get to make the decision. I'm not sure how it could be misconstrued that way.

Everyone deserves for the other party to honor their contractual services. BUT, if an owner/decision maker chooses to continue to do business with a party that consistently doesn't live up to their contact, that is their own fault.


Let's say a person lives near 10 restaurants. One of these restaurants gives them food poisoning every other time they eat there. Every time they get food poisoning the restaurant gives them a free meal coupon. So they continue to go there frequently and have never reported them to the department of health. I would think that person is crazy, and I would say they deserve to get food poisoning for their poor choice of eating there repeatedly. Should a restaurant be allowed to operate like this? No, of course not. But am I going to be sympathetic to this person's complaints about their repeated food poisoning? No chance.

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Originally Posted by AngeHamm

Update: I found a document online, not on Davis's website, but using Google, that specifies in black and white that Davis will contribute precisely $125 for provider-supplied contacts with this plan.

You'd think that would end the story, but noooooooo.

Patient is still convinced that she has full coverage for an annual supply of one-day contacts. I encouraged her to call Davis, but warned her that she could speak to three different people over there and she'll get three entirely contradictory answers, and that regardless of what they tell her they cover, we have to make our business decision based on what money they actually provide us. She called them, and had them contact us. The Davis associate who spoke with my manager assured us that they had paid in full for her annual supply in 2020 (our records show that this is untrue; we mis-charged her and simply wrote off the balance), and that they would again this year. So I have knocked it up the ladder to my boss, who has taken ownership of this clusterhump.

There needs to be a better word for "The Worst."

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In the rare event that we have "covered CLs" we simply order them to our office, and hold them until the third party payer pays us. It's a long wait, sometimes.

But it's a smart policy: "No contact lenses can be dispensed until paid in full". Or drop-shipped.

The margins on CLs are too low to eat cost of goods sold. And CL patients are too flakey to trust. We only will order CLs without cash in the bank in the case of VSP and EyeMed allowances. We feel they're reliable enough.

But if it's a "covered CL plan" even with trusty VSP, we don't dispense until VSP pays us.

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Originally Posted by drk

In the rare event that we have "covered CLs" we simply order them to our office, and hold them until the third party payer pays us. It's a long wait, sometimes.

But it's a smart policy: "No contact lenses can be dispensed until paid in full". Or drop-shipped.

The margins on CLs are too low to eat cost of goods sold. And CL patients are too flakey to trust. We only will order CLs without cash in the bank in the case of VSP and EyeMed allowances. We feel they're reliable enough.

But if it's a "covered CL plan" even with trusty VSP, we don't dispense until VSP pays us.

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Solid.