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Thread: VSP + MD Required Plano...

  1. #1
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    VSP + MD Required Plano...

    Attention VSP providers-

    A local MD has sent the other office a monocular child with an Rx for plano glasses. VSP says we need to enter the code for monocular to process. (Does anyone know what that is?) Then submit it with a comment that they are medically necessary.

    Our lab (Luzerne) says that as far as they know we will not be able to enter this through Eyefinity as it must show power in the script area.

    I think this also would require an ansi saftey approved frame as well. Yes?

    Does anyone have any experience with this situation? We've been chasing our tails for 2 days now trying to figure this out. But then again it's VSP so what else is new:hammer:

    Thanks-Fester

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    Fester: I don't know your codes but years ago when we had monocular children the plan was to not Rx anything unless required for visual correction. The idea was to do nothing to call attention to the problem and cause the patient to be self concious possilblely cause them to withdraw from normal activities. Now in the days of "attorney fear" every child I see with a prosthetic eye is accompanied with an Rx for plano poly's. Whether we fill this or the doctor's in house dispensary does, it is always just a regular child's frame no Z stuff. I think this is just the doctor's covering his **** more than anything the child actually needs.

    The Rx is "Plano" on the seening side and "Ballance" on the non-seeing side. If your lab is nice the "Ballance" is 1/2 price, we pass this savings on to the patient. You may or may not.

    Chip

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    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Hello Fester,

    Is this one of those situations where you have to get pre-approval? I've never heard of a code for plano lenses either.

    Say hi to the gang for me. I can imagine the steam coming out of Laurel's ears over this :)

    Best, Andrew.
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    Call VSP and explain the situation. They are pretty good about resolving issues. They are either going to approve it or not (I believe not)and they will give you an answer either way probably while you are on the phone. There may be a reference to this in your provider manual which is available on the Eyefinity site or you probably have a paper version lying around.

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    Doesn't the form have a space for Plano to -2.00 or something. If so just write plano in.

  6. #6
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    Quote Originally Posted by chip anderson View Post
    Doesn't the form have a space for Plano to -2.00 or something. If so just write plano in.
    There is no form, it is electronic and the program is pretty good with kicking back anything unusual. I think +0.00 would not make it through but one could give it a try.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Call VSP and explain the situation.
    We're doing that and I agree they are often helpful but this one has VSP telling us to do one thing and the lab saying it can't be done. Looks like I'll be working the problem tomorrow

    Anyone have a HIPPFA (sp) code for monocular?

    Optiboarders RULE:cheers:

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    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Quote Originally Posted by Uncle Fester View Post
    Anyone have a HIPPFA (sp) code for monocular?
    I couldn't find that, but the code for "specialty" lenses is V2786. I suppose this could be considered a specialty lens under the circumstances.

    The ultimate test, of course, is whether Eyefinity will accept the job.

    Have fun, Fester
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    Rising Star walleye's Avatar
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    VSP+Plano

    Had the same situation with VBA the other day. Wanted plano with 2 base in for each eye. The computer keeps spitting it out as an exam only-won't recognize plano. I called the lab and told them they will get the job with a +0.50 sph OU and 2 b in prism but flag this ahead of time and make it plano. They said no problem. Perhaps this can work with your situation-but with a big lab like Luzerne it might be a hassle. Good luck.

  10. #10
    Rising Star Optowoman's Avatar
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    Try to paper claim it. I know it is a pain but it has worked for me in the past. Good luck.

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    Bad address email on file OptiChick21's Avatar
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    Quote Originally Posted by cocoisland58 View Post
    There is no form, it is electronic and the program is pretty good with kicking back anything unusual. I think +0.00 would not make it through but one could give it a try.
    No, +0.00's never make it through VSP filing site Eyefinity, they always kick it back. But I would call VSP and ask how this can be covered as if the doctor deems it medically necessary they should cover it.

  12. #12
    Master OptiBoarder TLG's Avatar
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    If this is a valued customer and you happen to have an edger, how about ordering a pair of +.12 and then replacing the good eye with a plano yourself. You would have very little into it and keep your relationship strong. Of course, you always have to consider an audit by vsp and whether it is worth getting busted.
    Or...maybe the doc would simply rewrite the Rx for +.12. I would think almost any 'child' could accommodate the difference and he/she was likely tested for accommodation during the exam so the doc may know for sure.
    Or...if it were me, I would call vsp and talk to them. I have found them to be
    1.) Very easy to work with and
    2.) Very responsive to the needs of their members

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    Quote Originally Posted by TLG View Post
    If this is a valued customer and you happen to have an edger, how about ordering a pair of +.12 and then replacing the good eye with a plano yourself. You would have very little into it and keep your relationship strong. Of course, you always have to consider an audit by vsp and whether it is worth getting busted.
    Or...maybe the doc would simply rewrite the Rx for +.12. I would think almost any 'child' could accommodate the difference and he/she was likely tested for accommodation during the exam so the doc may know for sure.
    Or...if it were me, I would call vsp and talk to them. I have found them to be
    1.) Very easy to work with and
    2.) Very responsive to the needs of their members
    Vsp requires at least a .37 rx in one eye.

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    Unless I have been cofused forever. If the child were to have to accommodate, a minus lens would be required. While + or - .12 or even .37 is so little as to be insignificant, I suspect one would use less than normal accomodation with + in the Rx.
    But actually one has such an Rx so seldom and a plan poly blank costs so little, why not just give the kid the lens?

    Chip:cheers:

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    OptiBoard Apprentice Thomas's Avatar
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    If one eye is a balance lens order it with the .37 power and the seeing eye with plano.
    Seems simple and maybe has been tried.....
    Just my .02.....:cheers:

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    Master OptiBoarder TLG's Avatar
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    Quote Originally Posted by chip anderson View Post
    Unless I have been cofused forever. If the child were to have to accommodate, a minus lens would be required.
    I believe accommodation is simply the ability of the eye (crystalline lens) to adjust to clear vision at varying distances. I don't believe it has anything to do with +/-. :cheers:

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    As long as we are on this subject. If the non-seeing eye is prosthetic (this hasn't been established in this thread) but if it is, remember that if the prosthetic eye is a little large, - can be added to lens to make is smaller or + can be added if the opposite is true. Once and also increase length or width with cylinder, no add'l expenseof consequence but cosmetics will be increased and will conform to insurance guidelines better.

    And I think accomodation is the ability of the crystaline lens and accompaning muscles to add plus for near, there is no negative accomodation, and if distance is corrected all accomodation is + added by this mechanism. Have you ever seen a minus add? I think not.

    Chip

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    Bad address email on file OptiChick21's Avatar
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    Hmmm

    Quote Originally Posted by Happylady View Post
    Vsp requires at least a .37 rx in one eye.
    I have always gone by VSP's manual, which states:

    Minimum RX Requirements
    -Combined power of +/- 0.50 diopters or more in at least one eye.
    -Necessary prism of 0.50 diopters or more.
    -Anisometropia of 0.50 diopters or more.
    -Cylinder power of 0.50 diopters or more.

    So ig you only had 0.37 in one eye, would that be enough??

  19. #19
    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Hmmm -- if the kid is monocular, why not put a -0.50 sphere over the prosthetic eye and plano over the other? That'll satisfy VSP. :bbg:
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    Rising Star ShuString's Avatar
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    But

    You have to go with the Doctors rx ? He wants plano in both.
    Last edited by ShuString; 08-29-2007 at 09:37 AM. Reason: ?

  21. #21
    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    Quote Originally Posted by ShuString View Post
    You have to go with the Doctors rx ? He wants plano in both.
    Call the doctor. In my experience, most are willing to accomidate in situations like this once it's explained to them.
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

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    You probably don't have to go with the doctor's Rx on a non-seeing eye and I am sure you don't on a prosthetic eye. Amoung other things he is only Rx-ing this so the kid will have protection. He sure didn't determine the Rx with retinoscopy or any other "skillfull medical exam." He just wants a piece of poly in front of the seeing eye to keep the rocks and lawyers out. And I am sure he would tell you this if you asked. You might also tell him that if the Rx is written as "ballance" instead of actual numbers it won't cost you or the kid nearly as much.
    Has anyone realized here that we are making a tempest out of a teacup and the amount of time we have spent discussing this is worth far more that the damn lens is gonna cost?

    Chip

  23. #23
    Bad address email on file Dougfir8's Avatar
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    Maybe the child has English ancestors, and would enjoy wearing a monocular! Then he can grow a little moustache and wear a little bowler hat.

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