Rudy Project and VSP?

[Andrew Weiss]

Are any of you folks dealing with Rudy Project eyewear (either opthalmics or sunglasses with Rx inserts) for VSP patients? If you are, we're interested in how you bill VSP for the sunglass plus insert, and how profitable it is for you. Please send me a private message on this. Thanks.

[spartus]

We don't do Rudy Project RXs, but we do some--a fairly small amount--Oakley and Maui Jim RXs that are billed through VSP, which both work out the same way as Rudy Project (I think).

Bill it on Eyefinity as a private lab job (Lab 0100) and enter all the RX info as normal. Enter the charges as whatever you charge retail for Rudy Project RXs--I'm guessing here that they have set pricing like Maui and Oakley--and submit it.

Then, obviously, you place the order through Rudy as you normally would. When you receive the glasses, make a copy of the invoice, attach it to a VSP Post Authorization form (which you can get off Eyefinity's site to download and print out) and mail it to VSP.

The charges...aye yi yi. Call VSP to confirm this (and correct me if necessary), but as far as I understand it, you compute the frame benefit as you normally would, and the lens under a wonderfully complicated formula that, after having it explained to me by the infinitely patient VSP customer service reps, is as follows:

Take the Retail RX Lens Price and discount by 20%. Subtract the VSP dispensing fee (which is different for SV and PALs, and I would assume FT bifocals, but Maui/Oakley don't do 'em, and I'm assuming Rudy doesn't either), which I'm not going to mention here because I'm not sure if it's against the rules. VSP can tell you what they currently are anyway. That is your lens price. Add it to whatever (if anything) they are paying for the frame and that's it.

To recap, since I get needlessly complicated sometimes:

Frame - as normal
Lens - Retail, discounted 20%, minus dispensing fee.

So you see how the math works out, here's an imaginary job, with pricing pulled directly out of my butt (but the math works):

Patient's retail frame allowance: $120, SV poly polarized
Frame retail: $200
Lens price (again, from my butt): $200

Frame ends up as $64 ($200-$120 less 20%)
Lens ends up as $120. ($200, less 20%, less dispensing fee, for which I'll make up an imaginary value of $40)

Patient's total cost for a $400 pair of glasses: $184.

Looking at this, I'm less sure the lens isn't (retail - disp fee) (discounted 20%), since that's more VSP's way of doing things, but the actual difference in dollars collected is pretty minor--maybe $10 or so in most cases).

Forgive me for going all math-crazy here, but I just did a related spreadsheet in Excel for this (for Maui, unfortunately), so I'm hung up on the details.

Reimbursement...not really my department, but I don't think you make as much as you would if they just paid retail, but it's VSP--what else is new? You certainly don't lose money, and patients tend to feel they got a great deal, particularly on the higher-end specialty lens stuff.

[Andrew Weiss]

Thanks Spartus. I'll check out the information with VSP just to be sure I understand it, but it sounds right. Have you had success in having VSP actually pay you for the lab fees you incur on those jobs? I admit that our office's experience is that VSP usually finds a way not to reimburse us.

[spartus]

That's why you send them post auth form with the outside lab invoice. It shows VSP that you did, indeed, order the patient's glasses and aren't just making up charges for which you'd like to be reimbursed.

As far as I know, there's been no problem receiving payment from VSP, but because there's actual paper involved in the claim, there is a little bit more of a time lag before it shows up.

[Andrew Weiss]

Spartus, on the Post- Authorization Form, what box do you check off on the line that starts, "I request approval to provide the following materials/services for this VSP patient"? If you check "other", what do you write in? And where it says "Reason for request", what do you write there? I'd be really glad to learn from your experience here :)

Thanks for pointing me in this direction; you're being very helpful.

[spartus]

I've just put "Specialty lens" or "Special lens manufacturer", which I would hope clues 'em in that it's not a lens VSP or its affiliate labs could offer. With reasonably well-known names like we're dealing with here, I don't think it's much of a problem.