Non vsp approved specialty lenses or coatings

[tx11]

Does anybody use any of these to increase margins without increasing pts normal in network out of pocket fees ? Can it be done?

[tx11]

come now....no takers?

[Paul Smith LDO]

Just curious, why and what products.

[tx11]

Just curious, why and what products.

No specific products...an eyecare business consultant stopped by today and said, in essence, that by ordering lenses or coatings that are NOT VSP approved that it automatically makes the WHOLE lab order fall under specialty lenses. Using the VSP specialty lens calculator with usual and customary prices for these non approved products that the combination of VSP reimbursement, what the pt owes (which shouldn't be any more than what their in network copays would be) and the lower private transaction bill from the lab...your will increase your margin. And that it is all ok under VSP contract.
Anybody heard of this?

[Paul Smith LDO]

I was under the impression that the reimbursement program for non covered specialty lenses and or frames through VSP was kaput. This according to our rep, as we were trying to get one of our patients into a new Kawasaki; which we had done a couple of years before.

[tx11]

Hmmm..

[Jubilee]

"Special Lenses and Proprietary Lens and Frame

The Special Lens Procedure was discontinued in November 2013. Most Special Lens products aren’t available for use with VSP benefits. If dispensed, VSP benefits can’t be applied to the lens OR frame. This is a private transaction between you and the patient. Some proprietary products are available for use with VSP benefits under a new Proprietary Lens and Frame Procedure. Please refer to the Guidelines below for information:"

Typically the only special lens categories left are products that need to be manufactured at their proprietary specialty lab, Maui Jim, Bolle, Serengeti, Oakley, etc
Lenses that require a proprietary frame mounting that can not be done at a VSP lab: Kawasaki, Eyephorics, Swiss Flex, etc

You can check their product index and it will tell you if it will qualify.

[Framebender]

We use it for Rx Maui Jim & Oakley suns where pt wants proprietary lenses. Other than that, we don't use it. Not looking to raise any red flags.

[tx11]

We use it for Rx Maui Jim & Oakley suns where pt wants proprietary lenses. Other than that, we don't use it. Not looking to raise any red flags.

But doesn't that raise the pts out of pocket costs? A digital wrap poly with mirror and backside ar cost less with the VSP copays does it not?

[Paul Smith LDO]

But doesn't that raise the pts out of pocket costs? A digital wrap poly with mirror and backside ar cost less with the VSP copays does it not?

For these situations I enlist the patients desire for a second pair and bill a suitable pair toward the insurance. Eyeglass wearers should have at least 3 sets of eyewear.

[Framebender]

Yes. Their out of pocket is more. I'm not sure we make any more though.