VSP question

[morinput]

Ok, so I'm going back and forth with VSP over this and I don't remember this being an issue last year. I have several signature plan authorizations from 2014 that used this benefit to purchase contacts. On the 2014 form it clearly states "if the patient chooses contact lenses their frame will next be available in 01/15" Yet when I pull their new 2015 auth the frame isn't eligible until 2016. Is this a new thing or am I missing something?

[Boldt]

Call VSP may just be a glitch

[Uncle Fester]

This is common.

When a plan is exam and lenses every year (forget about what the authorization says about contacts), be it date of service or calender and the frame is 24 months or following year- the patient effects the frame benefit when contacts are ordered in the odd exam and lens only benefit year.

I try to point this out to my patients as VSP does not make it obvious in their literature or authorization.

When benefit is every year for all services it doesn't matter.

[fjpod]

yes...many VSP plans give a yearly exam and lens benefit, but frame is only every two years.

[Jubilee]

The devil is always in the details..

There are THOUSANDS of variations of the Signature plan. What makes Signature.. Signature.. is the level of reimbursement to the doctor, and the ability to use a (slightly) wider network of labs. Otherwise the differences comes from the employer/contractor for the benefit end.

Some of the plans will do lenses of some sort every year, and frames every 2 years. You could have gotten a complete pair in 2013, contacts in 2014, and do a complete pair again this year. I have several patients who keep that schedule.

However, some companies don't want to pay VSP the higher premium that comes with that plan. However they still want to give the illusion of a better benefit and choice to the beneficiary. So they will have a contact lens benefit that when used will also use the frame benefit to limit the charges. They might cover contacts every year, but that frame will always be reset as well, and in the end it usually costs less for them to pay the allowance for contacts than paying for the lenses to be made, the wholesale allowance and all dispensing fees.

Normally there is a line on the authorization that states that using the contact lens benefit will also reset the frame benefit.