VSP can anyone help me??????

[stephanie]

I like to think I am pretty smart, however; this is by far the most confusing plan I have ever witnessed in my life. HATE IT HATE IT!! Does anyone actually know how to figure out what the member pays and how to file this on-line. I didn't realize I was going to have to have a masters degree in code cracking to be an optician. My goodness. I am absolutely confused on this one. HELP ME SOMEONE!!! This is horrible. We took it in my old office but we always made the doc figure it out since he was the only one there who sort of knew how to do it...now I am on my own...really. No one shows you actually how to do it they just tell you your are doing it wrong. Well show me the right way. I wasn't born knowing how to do this. I hate all insurance!!! CASH PLEASE!!!!


Steph

[sparky]

i know the feeling, but once you get it figured out its not that hard. Have you contacted vsp and gotten your online id yet? it's much easier that way.vsp should have sent you all the info on overages for lenses and such. if not call them and request a plan book. To figure out the frame overage-take the wholesale frame cost(which you get from the FRAMES price guide) subtract the patients frame allowance and multiply that number by two. i think i'm doing it right since we do get paid and our audits are good. i hope that helps some.:D

[paw]

The practice I work at has about 50% VSP, so I am very familiar with it. Here is a SUMMARY of how it works:

1. Before the patient comes in, obtain an authorization. (This tells you what the patient is eligible for, his frame allowance, his co-payments, and what lens options he will pay an overage for.)

You can get the authorization over the internet or over the phone via an automated system. I recommend the internet - it is easy, quick, and you can print the authorization. If the internet is down, the automated phone method is our backup. If your office isn't signed up to get on-line authorization and on-line claim submission, get signed up NOW! (Call VSP.)

2. The on-line authorization tells you whether or not the patient is eligible for exam, lenses, and/or frame coverage. It will also tell you amount of the patient's co-payment. (There could be an exam co-pay, material co-pay, frame co-pay, and/or total co-pay. The type of co-pay(s) and the amount varies by VSP group, i.e., employer.)

If the patient isn't eligible for exam, lenses, or frame, the authorization will tell you month/day/year he becomes eligible.

3. Most VSP plans have exam and lenses eligible every year and frame every 2 years, a few diehard plans have exam and lenses eligible every 2 years. By the way, "lenses" refers to either spectacle lenses or contact lenses, but if the patient uses VSP toward contacts, not only uses up eligibility for lenses but frames too. Coverage of contacts is a bit more involved to explain. If you would like me to explain that, let me know.

4. Frame allowance: typical frame allowance is DJ. Easy to figure: A=1, B=2, C=3, D=4, E=5, F=6, G=7, H=8, I=9, J=0.
DJ = $40...get it? BE=$25 CE=$35, etc. The important part is to apply your markup formula to the frame allowance. Any amount over the frame allowance, the patient pays.

For example, patient picks $170 frame, his frame allowance is DJ:

If your markup is wholesaleX2, then (remember DJ=$40) frame allowance is 40X2 =$80. Patient pays amount over $80, which would be $90. If your markup is wholesaleX2 + $20, frame allowance is40X2 + 20 = $100. Patient pays amount over $100, which would be $70. Get it?

5. In addition to co-pays and having a frame allowance, the patient will also pay an overage for some lens options. This also varies by plan, but here are the common lens options that have usually have overages: polycarbonate, scratch coat, changing tint, solid tint other than Pink 1 or 2, and PAL. (One employer in our area provides VSP coverage where there is no overage for PAL. Imagine, PAL lenses for "free"!) There is a price list that tells you what you can charge for the overages. Get that from VSP.

6. VSP can be confusing when you first learn it, but like anything else, once you know it, it's not that bad. My best advice: CALL VSP WITH YOUR QUESTIONS! I still call them for clarification on stuff now and then, and they are very helpful and will never make you feel dumb.

[paw]

Oops! Sorry for the double post. I hit the back button and it made me Refresh and then it posted a second time

[Joann Raytar]

Steph,

If you have questions or run into a strange plan, call VSP and automatically press 1 then 3 at the message prompts. This will take you directly to a human being instead of the automated system. I have found that the reps at VSP are awesome at helping you figure out what to do with odd plans. They will literally talk you through everything. We also do a ton of VSP and most plans are basically the same except with different copays. The rare exceptions are exam only plans and deductible plans. Once you fill out one or two claim forms, you should find that VSP is actually one of the easiest plans to understand.

Like Sparky mentioned, call VSP and get their price sheet and provider guide. If you don't see a lens you want to dispense on the price sheet, call VSP or your VSP lab and find out what category code to use for the item.

[Texas Ranger]

Steph, I'm so blessed that VSP deems it unnecessary to allow independent opticians to be a provider in their network. I'm too busy dealing with real pts that understand their responsibility for their own eyewear.

[stephanie]

Thanks everyone for the help. This is way too much for my little head to absorb!! See the one problem I am having too is that we have no real way of mark up. We have a sheet that says what we charge for a frame if wholesale is say for example and then our sheet says what we charge for it. It doens't make any real sense. And see I was told that you take the DJ for example and subtract it from the wholesale cost for example we paid 49.95 the patients part would be 9.95. Obviously this isn't right. This is rough!! Yea I guess I get what you are saying. Still not completely sure of it. Why can't it be just ok we pay $120 and the patient pays the rest...too simple huh? I guess they want to make sure we are smart enough to take their stuff!! LOL!!

Steph

[Joann Raytar]

Steph,

Your best bet is to call VSP and speak with a person; they will answer your questions. While your at it, below is the VSP provider website. You need to phone VSP to get an access ID and a password:

• http://www.eyefinity.com/

[jcamp]

Like the others have said call VSP, they are very good at helping with problems. If you have questions about the eyefinity website and how to obtain authorizations and submit claims call eyefinity. 877-448-0707 press 1. They will do some online training so you can get the hang of it.
I use eyefinity everyday, not only for VSP claims but medicare, Cigna, Blue Cross Blue Shield and they process claims for many more. It takes some time and paperwork to set up some of these but it has been well worth the effort.
If you don't have hi speed internet service, get it. I had modem and then went with DSL and it made a world of difference.
A suggestion for frame pricing. We put the code on the price stickers that we put on frames. This will help with your pricing structure, because all you really want to know is what the Frame Facts price is for the frame. If Frame Facts says 39.95 round up to 40.00 and mark the frame DJ along with your normal retail price.
Hope this helps.

[Johns]

Stepanie,

I couldn't help but notice you said you were "on your own". Do you work for an OD, or are you an optician in your own practice ?


Johns

[MVEYES]

Do you use superbill's in your practice? You can get CPT codes from that. Everything else is spelled out in the VSP manual.




:cheers: Jerry

[stephanie]

When I said on my own I meant left to figure it out for myself. No one wants to bother to help me and if they do it is very very vague and not much help at all. Yes I do work for a practice with MD and OD.


Steph

[Di822]

Hi Stephanie!

Haven't heard from you in a while. Would you be working in the SAME place? Sounds like you have the SAME job with a DIFFERENT headache. Find out everything you can about this VSP monster so you can help me. We will be going on it in a few weeks. You should be a pro by then. Good luck! Di

[paw]

I agree and disagree.

I agree it's frustrating that docs take such a hit on the reimbursement, but if you can believe it, it's one of the better ones out there, and an important point to consider is that they PAY WHAT THEY SAY THEY WILL PAY. There is no haggling like with some insurances, to get the reimbursment you're supposed to get. Additionally, THEY PAY REGULARLY EVERY TWO WEEKS. No waiting months and months like some insurances who delay payment, whether purposefully or not.

I disagree that VSP is bad for the patient. We have companies in our area who pay most or all the patient's VSP premiums. On top of that, there is one company who's plan has no overage for premium progressives and a $100 frame allowance. It is possible for patients with such coverage to walk out of the office owing nothing but his $10 exam co-pay, and getting a decently nice set of glasses. That is not bad for the patient! :)

[Texas Ranger]

paw..employee benefits are great, but in most cases, if the pt had the money themselves, in lieu of the "benenfit" that restricts them from a free market, the market competition would be best for the pt. and the providers. look, eyecare is NOT a service that needs to be "insured". it is a reasonable expense for those requiring eyewear. It cost the average eyewear consumer about $75 a year for eyewear, less than that for exams, that's about the cost of taking the average family out for a decent restaurant dinner(one time). so the pts need a big time insurance co. to hold a gun to the head of the optical industry so we provide eyecare products and services, so we might "break even", bustin out buns, doing the jobs, plus filling out all the reimbursement forms, while the insurance co. gets the premium money from the employers. they contribute absolutely zero to our optical/client relationship, except to skew the free-market in favor of those who will be intimidated to participate in plans that they can't even make a profit doing. I think the real villans in this mess are corporate HR directors who are somehow "exploited" into believing they are doing something to "benefit" their companies employees. In the big picture, only xxx$ will be spent in the economy on eyecare (which we'd like to grow), now the client are doing the spending, and the recipients are the optical industry and the insurance industry. the insurance industry side has to hire folks to go to companys to market their "plan", print registration forms, member ID cards, computer systems to track members, etc, occupy large buildings to house large staffs of clerical personnel to handle claims, OBTW, those claim forms, etc, etc, that have zero to do with the optical /client, eye exams, contact lenses, and glasses. So, in the optical side, most opticians are paid less that the clerical staffs, but we have to provide all of the materials and services and facilities for the eyecare being provided for. and whats sad, we're all lining up to be providers!!!

[varmint]

Mr Texas Ranger,
Congratulations. I've never seen a better explanation in the VSP & insurance arguement.
I have a brother who recently called me while he was evaluating an offer from his wifes employer to take VSP for which they would have payroll deductions. I had to point out to him he was the only member of his family that wore eyewear, & secondly he always gets his at cost from me!!! He was actually prepared to sign up for their plan!!! I asked him to please just send me the payroll deduction each month & I would provide all his eyecare needs for free.
I'm afraid employers are just as naive concerning these plans as are the employees. This mindset has dramatically reduced our pt base & profit levels almost to the point of extinction.
Jim

[varmint]

Yea!!! You go Pete!!!:cheers:

[stephanie]

I agree with you, Pete 110%. I hate it and would never agree to take it if we didn't have to. I spend more time figuring prices and frames, filing on the internet(if it will let you) than I have ever ever taken with the average pt. I ended up losing 2 really great sales today because I was too busy with vsp people to get to them. Then I hate this...pt picks up frame and says PT: what is my cost? ME: well I will have to figure it out. PT: what do you mean? How do I know which frames vsp will cover etc etc... Now honestly how am I supposed to answer this question? Or this statement " I want to stay right in the limits of my policy" Now how do I make sure they do? It is just so aggravating. CASH ONLY PLEASE. I have enough to do being an optician I don't need the added headache of insurance especially one that MAKES NO SENSE!! Yes Pete I see your point...I as an optician am looking to make money so therefore...making no money off the pt makes no sense what so ever!!


Steph

[paw]

Yes, I agree with all of the above. I certainly am not trying to fight VSP's battles, just pointing out why the patient's love their VSP. I totally agree that vision insurance is unnecessary. For heaven's sake, there is no such thing as hearing aid insurance and they cost many hundreds per aid. Thousands, if the person buys the tiny, in-the-ear kind. I predict that once the baby boomers start needing hearing aids en masse, they will start demanding hearing aid insurance!

[varmint]

You didn't have to give the insurance co's the idea now, did you?:bbg:

[Joann Raytar]

Steph,

Once you start recognizing plans your response to the frame question will become easier. If they ask why you don't know, let them know that VSP has many plans, each one providing different coverage. VSP covers certain frames entirely but will cover a good portion of the cost of any frame in your store; they are only limited in selection if they don't want to pay anything out of pocket. Let them know that VSP requires you to call the insurance company prior to fitting your patients and you will be able to help them better after that. Once you get the hang of what certain plans' allowances are it is a snap to figure out what is fully covered.

Just up press 1 and then 3 as soon as you are connected to VSP when you call VSP's 1-800 number to get directly to a human instead of listening to the automated prompts. This will save you a ton of time when you are calling for an authorization on the fly.

[LENNY]

They do have a hearing ade insurances.
They pay pretty good

[Joann Raytar]

Pete Hanlin said:
VSP isn't evil, they're just a business making money as best they can on the backs of their covered lives and providers.

VSP proved to me they are a step above most insurance companies. I have had a couple of patients pass through who have lost their glasses in home fires, car accidents and other disasters. Usually, if they already received care or hardware during their benefit year or two years, that was that. The patient had to pay for new glasses out of pocket or if they were hard pressed for money the Red Cross would foot the bill.

About two months ago, we had a patient come in who had lost his glasses in a fire which started on the bottom floor of his house. He had been trying to get his three year old daughter out of the house when he lost his glasses. The intense heat had caused him to sweat and in crawling around so quickly his glasses fell off. He wasn't about to stop and look for them.

VSP has plans that allow multiple pairs in one year if the Rx is from the same exam so we called them to find out what kind of plan he had. We were told the gentleman had a standard plan then customer service rep asked if we would hold. Five minutes later she came back on the line with an authorization code for a new pair of glasses. She told her supervisor about the fire and the supervisor immediately approved a new pair of glasses.

Our second tip of the hat goes to Marchon. They replaced the frames at no charge after hearing that the fellow had saved his little girls life.

Sometimes, it isn't always about the money.

[paw]

Stephanie,

To make your life easier, please try this TOMORROW:

1. Get the person's VSP authorization before they come in for the exam. That way, when they start looking at frames you will have the info right in your hand. PT: "What frames are covered?" YOU: "The first $100" (or whatever) "of any frame is covered. You pay anything over $100."

2. If the person is a walk-in, as soon as you find out they have VSP, get their authorization while they are looking at frames.

Getting their authorization, epecially via on-line, is quick, and it tells you what their plan covers.

The key is to get their authorization BEFOREHAND.

[Joann Raytar]

paw,

That is a good idea!

We take insurance info down for all our patients when we make their appointments. We get authorizations and verify eligibility before the day of their exams; this saves us from quite a few headaches and saves time by having forms filled out in advance.