VSP Public Acknowledgement: Opticians Provide (Reduced) Benefits

**sharpstick777** · 10-21-2010, 10:43 AM

"VSP to Allow Opticians to Provide Services Out-of-Network
Representatives from the Opticians Association of America (OAA) recently met with VSP at Vision Expo regarding participation of opticians in VSP. VSP agreed to allow opticians to provide services on an out-of-network basis. This is a positive first step for the participation by opticians in the VSP insurance program. An optician can now complete the reimbursement form and submit it directly to VSP instead of having the customer submit it. So now, if a customer calls and asks if you take VSP the answer is yes.
When I read this notice, I decided to check it with VSP to ensure that it was accurate. These are the questions I asked VSP:
· Is this information correct?
· Can’t opticians have the patient fill out the paperwork themselves now and get their reimbursement directly from VSP instead of the optician filing it for them?
· What the significance to opticians of being in and not being in the network?

Here is the reply I received:
· VSP recently began allowing providers not on our network to bill on behalf of patients with VSP coverage.
· This was something that VSP was already required by law to do in several states and we have expanded it as a convenience to the approximately 5% of VSP members who are choosing to go out network for services today.
· Members going to a VSP doctor continue to get a better overall benefit than those who choose to visit a non-network provider.
It would seem that the Ohio newsletter was right on target.
Come to the ORBA blog and discuss this issue with your fellow ORBA members!
Ed De Gennaro - Executive Director, ORBA

**kcount** · 10-21-2010, 12:35 PM

How is this new?

Now, if VSP would let us file electronically that would be great!

**sharpstick777** · 10-21-2010, 01:31 PM

Originally Posted by kcount

How is this new? Now, if VSP would let us file electronically that would be great!

You're correct, its not really new as VSP secretly created an "Out of Network, Network " over a year ago (but the Opticians involved, some on this forum, were sworn to secrecy). Although the term "Out of Network" is used to keep the panel OD's happy, its really a "Secondary Network" with only slightly lower reimbursements, and yes, you will be able to use Eyefinity as the test Opticians are already doing. Payment has been quick according to those using the current "secret" system.

What is new is that VSP publically acknowledged the new network for the first time, and will allow opticians to publically advertise that they are official VSP providers (VSP opticians can't advertise the fact now).

**Barry Santini** · 10-21-2010, 02:44 PM

"Reduced benefit...?" For whom?

I'll take a crack: VSP!

So how long do you think it will take for panel OD's to desire "secondary" status so they can bill the fee schedule THEY WANT TO, and let the participators continue to empty their pockets?

Mmmmmmmmm...

B

**kcount** · 10-21-2010, 04:23 PM

Went to the ORBA website but don't see anything about this news.

**LENNY** · 10-21-2010, 05:49 PM

So I am still confused!
Who gets the check?
How does an optician know what benefits are covered under different plans?

**sharpstick777** · 10-21-2010, 06:18 PM

Originally Posted by LENNY

So I am still confused!
Who gets the check?
How does an optician know what benefits are covered under different plans?

It will work just like it does for the OD's, full Eyefinity access, they see the plan and eligability, and bill exam and glasses under Eyefinity, and receive a check every 2 weeks. The check will be slightly smaller though for the dispensing fee and exam.

**kcount** · 10-21-2010, 06:24 PM

Originally Posted by sharpstick777

It will work just like it does for the OD's, full Eyefinity access, they see the plan and eligability, and bill exam and glasses under Eyefinity, and receive a check every 2 weeks. The check will be slightly smaller though for the dispensing fee and exam.

I called VSP. The obviously didn't alert their staff to this as they didn't have a clue.

**sharpstick777** · 10-21-2010, 06:36 PM

Originally Posted by kcount

I called VSP. The obviously didn't alert their staff to this as they didn't have a clue.

They have not yet set a start date... as far as I know. It could depend on how Marchon sales are this quarter. The test Opticians were all required to stock Marchon and Altair frames.

**pezfaerie** · 10-22-2010, 12:39 PM

The reimbursements to the optician/optical retail chain are a lot less than to the doctor. No dispensing fee and no transition kick-back (oops did I say that out loud?). Yes the payment to the optician/optical chain is fast. You find out benefits and eligibility of different plans by calling the "secret" hot line (which I'm sure after the "start date" won't be secret anymore). As far as having the ability to submit a claim for a patient we've done that for them as out-of-network for as long as I could remember but the pt gets the check that way.

**vintagetie** · 10-22-2010, 01:01 PM

under this arrangement do these "out of network" providers have to follow vsp price caps for overages, also are they able to get auth's for new access plans that have a higher -ownership by doctors- requirement (our office, a standard vsp provider, cannot currently bill these plans.

**pezfaerie** · 10-22-2010, 01:22 PM

As a complete out of network optical the only thing you can do is somehow find out the pts reimbursement (pretty much have the pt call vsp) then submit a receipt to VSP for them so the pt gets the check. So in that respect no cap on prices. The other "secret plan" pretty mich the same, the optical sets its own prices, but can call the secret hot line to find out what the reimbursement is and the check comes directly to the optical (like it did pre 2003). Again there is no cap on pricing at all, the optical can charge what it wants. And as far as I know there isn't any plan restrictions on what we can take.

**LENNY** · 10-22-2010, 03:08 PM

So the member must be very stupid if they are covered for progr trans poly AR lenses let's say with 50 copay from a OD Vsp provider to go to optician and get a $100-$150 break on $600 lenses!?!?

**pezfaerie** · 10-22-2010, 03:50 PM

Stupid, no. If they choose an optician they get excellent care, fast turn around time (unlike some VSP labs at least here in Cali), broader selection of frames, lenses and coatings. And if the optician is competitive in their pricing (much lower than a doctors usual and customary prices) then the patient isn't really putting that much more out to be able to have the choice of where to shop.

**drk** · 10-22-2010, 04:25 PM

I hope you all enjoy VSP!

VSP patients can get out of network reimbursement for online CLs as well; why not chain opticals or private opticians? It's the enrollees money. This just adds up to more choice for the member.

Being in-network, I get a whole boat load funnelled in my office. The only way a discount plan is going to work is to make it up on volume, or additional services. Not a fun game, but at least you're in the game.

All this is one more example of how VSP doesn't serve optometry anymore, but rather optometry now serves VSP.

They'll get theirs, though, soon enough.

**pezfaerie** · 10-22-2010, 04:38 PM

Originally Posted by drk

All this is one more example of how VSP doesn't serve optometry anymore, but rather optometry now serves VSP.

They'll get theirs, though, soon enough.

Doesn't VSP let ophthalmologists participate and sell eyewear now. I really think that undeminds the Optometrists ability in giving the exam. Most if not all of the ophthalmologists in my area have their techs do the refraction (redos overflow-ith)and the dr gets paid for it. Not fair to optometrists which is who VSP says they were created by and for.

**kcount** · 10-22-2010, 04:50 PM

VSP stopped being for OD's years ago. DRK is correct that its now OD's for VSP. When one company funnels 80% of your clients to you your working for that company.
VSP is grasping at straws, they see a problem comming in the form of the health reform bill. So suddenly they want to onboard as many doors as they can to maintain marketshare. Eyemed figured this out years ago adn has consistantly grabbed marketshare.

**optical24/7** · 10-23-2010, 05:41 AM

Originally Posted by drk

I hope you all enjoy VSP!

.

+1

We don't take it and don't need it.

**Barry Santini** · 10-23-2010, 08:36 AM

Re: eyewear and Insurance - and helping John Q "get his max benefit when purchasing eyewear."

We need to define what is meant by "max benefit". I believe for most this means lower prices and/or (the appearance) discounts.

If you agree with the above, then insurance devalues all eyewear. 'Nuff said there.

Our discussions have already proven on this forum that there are so many choices for Mr. John if he wants to save primarily money on his eyewear, without sacrificing service and getting the selection he wants.

Yes, our old pal, Mr. Commoditizer...The Internet.

Why, oh why would someone pay a co=pay of $50 or more, when "similar" eyewear can be delivered to your door for less, including shipping.

If you *make* it about money, you're goin' to lose. That's a fact.

The smartest consumer players do the following:

1. Buy the frame of their choice online.
2. Go to Costco for the lenses

Sweet!

B

**racethe1320** · 10-23-2010, 10:13 AM

Originally Posted by Barry Santini

Re: eyewear and Insurance - and helping John Q "get his max benefit when purchasing eyewear." We need to define what is meant by "max benefit". I believe for most this means lower prices and/or (the appearance) discounts. If you agree with the above, then insurance devalues all eyewear. 'Nuff said there.

So you're implying here and to your customers that maximizing their benefits means lower prices and discounts? Why wouldn't you help your patients realize their "best value". People don't buy strictly on price. People buy when there's perceived value. I see patients all the time that walk in stating firmly that they want to get only what their insurance covers and end up leaving with the very best eye wear and options that help them see and look their best. I train my staff and talk with the patients from the moment I begin seeing them in the exam room about value and quality.

Our discussions have already proven on this forum that there are so many choices for Mr. John if he wants to save primarily money on his eyewear, without sacrificing service and getting the selection he wants. Yes, our old pal, Mr. Commoditizer...The Internet. Why, oh why would someone pay a co=pay of $50 or more, when "similar" eyewear can be delivered to your door for less, including shipping.

I see my share of patients asking about online deals and products, but in most cases that question is just the initial objection. It's not the "real" objection. In many cases there isn't one. They are simply asking how the products compare. If in fact they are identical, etc....Even if they are, I usually combat that by being competitive in price and allowing them to try them on and even return them without issue. I also talk to them about replacements and ease of doing business should the frames be broken or damaged in the lab. Some of it's FUD, but in the end, I see very little patients walk out without frames. I did have just this week, but when they received their "online" frames and brought them in, they could see a difference in the finish and pattern on the frame vs the one I had to offer. The in turn purchased mine and are returning the online clone.

If you *make* it about money, you're goin' to lose.

Depending on how you approach it, you might be right.

**Now I See** · 10-23-2010, 10:42 AM

Originally Posted by sharpstick777

You're correct, its not really new as VSP secretly created an "Out of Network, Network " over a year ago (but the Opticians involved, some on this forum, were sworn to secrecy). Although the term "Out of Network" is used to keep the panel OD's happy, its really a "Secondary Network" with only slightly lower reimbursements, and yes, you will be able to use Eyefinity as the test Opticians are already doing. Payment has been quick according to those using the current "secret" system.

What is new is that VSP publically acknowledged the new network for the first time, and will allow opticians to publically advertise that they are official VSP providers (VSP opticians can't advertise the fact now).

I recently heard that Costco is a VSP provider? True? Ehh, who knows....

VSP is one of those "insurances" that I called before I opened and tried to get involved with....found out real quick that they weren't interested in my office. I've always said that if they ever allow it, I would get involved....but the part I hate is that, seemingly, when insurance is involved, the self-pay person is the one that takes it in the shorts. I'm tempted to stay out of insurances and cater to self payers only.

**Barry Santini** · 10-23-2010, 11:45 AM

I have no reason to doubt that clients who are interested in learning about differences in quality and value will continue to patronize their local ECP.

To bring this discussion around, I just saying that insurance is really no help in this regard. If anything, it works against it.

B

**racethe1320** · 10-23-2010, 12:43 PM

Originally Posted by Now I See

I recently heard that Costco is a VSP provider? True? Ehh, who knows....VSP is one of those "insurances" that I called before I opened and tried to get involved with....found out real quick that they weren't interested in my office.

Costco is an out of network VSP provider that has always been part of the out of network offering to those covered by VSP insurance. The only thing that has changed as of recent is that they are allowed to file claims for a very small number of employers and their employees. This was done to pull the employers away from EyeMed who offer a retail based option. The fact that if you’re on Optician Owned practice and they won’t support you is nothing new. It’s been that way since day one. My guess is that may evolve through some type of change as time goes on.

seemingly, when insurance is involved, the self-pay person is the one that takes it in the shorts. I'm tempted to stay out of insurances and cater to self payers only.

How are the self payers taking it in the shorts? Not trying to argue or fight, I just don’t see what you’re trying to say.

Originally Posted by Barry Santini

To bring this discussion around, I just saying that insurance is really no help in this regard. If anything, it works against it. B

Perhaps with others such as EyeMed and Davis, etc., but not so with VSP. They are clearly still directing employees and employers to private practice vs retail which supports your above statement.

**Barry Santini** · 10-24-2010, 12:18 PM

I think the whole concept of *directing* clients is manipulative & self serving.

Why not try making people *want* to come because they value what you do.

The steeper road, but one that is less traveled.

I also think online/internet will pull back the curtain on these vision ins tricks.

What will be left will max 35% margins againt online, or take and deliver the high road for maximum profits.

No b&m can survive in eyewear on 35%.

So it'll be online, costco and the high line
My prediction...

B

**racethe1320** · 10-25-2010, 06:00 AM

Originally Posted by Barry Santini

I think the whole concept of *directing* clients is manipulative & self serving.

Why not try making people *want* to come because they value what you do.
B

That's our job as independent ECP's. I think VSP is doing their part. Currently they give members lots of choices. They can go to independents or retail / out of network and have a myriad of choices in terms of products. Some available to just the independents and some available to all channels.

Of course any managed care is going to direct their patients. After all they are the ones who created the discounts programs the patients are using. It wouldn't be a very prudent business model to offer patient all the perks and in no way benefit in return to cover costs or keep the model going forward. I'm not sure what you mean in terms of online pulling back the curtain on insurance though ?