It is my understanding that effective 7/1 VSP will no longer provide out of network benefit verification. For the OON suppliers how do plan to overcome this?
It is my understanding that effective 7/1 VSP will no longer provide out of network benefit verification. For the OON suppliers how do plan to overcome this?
Same trouble here. No way to verify eligibility since 7/1. Would love to find a work around to be able to explain what coverage members have available.
Oh yeah! It is confirmed. The last time we called they said that phone number was going to be "turned off". I wonder if that was because we called so many times?
How do we obtain authorization, to bill and submit claim to VSP OON? We used to do all the billing for the member.
As an out of network provider we just do a straight percentage discount. Same for any plan we aren't in network with. Specifically with VSP, we will also provide the form for reimbursement. Not sure if what you guys are doing is discounting more or less but it has worked fine for us for years. No one asking us to get them any special discounting through VSP directly.
Are you getting something back from them?
Have I told you today how much I hate poly?
We received 21 checks from VSP yesterday. Don't know why they have to write a check for each one instead of 1 check. Out of network.
I got through the OON line (800)877-7195.
I asked if OON providers can still submit a CMS1500 form to bill for frame and lenses, and if we need an authorization number. She said NO, we no longer need to obtain an authorization. As long as the claim is submitted correctly. We can still hold on the line to speak to a representative. They will let provider know if frame and lenses are eligible, but they will NOT provide the reimbursement amount or breakdown.
I hope this helps. If you know more information, or how we can overcome this new change, please let us know!
When I call that number I get disconnected and I'm told to have the member call
So I guess there are no more authorizations
Are you still able to get through to determine eligibility? We just tried and they will not provide any info, although the representative said there "is a 3rd party software that will determine eligibility for OON providers but she did not know where or what." Anyone heard of this?
I believe that would be 'Patch'
I wonder if Patch will be blocked by VSP?
From a thread started in 2006, they charge $50/month + 0.50 per lookup and $8.00 per filed claim.
May I ask how everyone is doing with the changes to VSP OON? Are you still going to submit the claim for the patient?
Yeah, not cheap at all. However, with enough volume it's not too bad (per claim anyway). I thought it was ridiculous until I did the math and with the number of claims we do it would have been much, much more expensive with that 'old' pricing structure. I'm certainly nervous about the whole situation and hoping Patch proves to be a worthwhile investment.
Last edited by Quig; 07-12-2018 at 02:57 PM.
Call to Action for eye care professionals. www.getpatch.com
What to do next
If you want to help hold VSP accountable for any wrongdoings they may have committed in this action, please send complaints to ALL of the following agencies. Remember, VSP has actively removed benefits from the member portal and also shut down their provider benefits phone line.
Office of the National Coordinator (ONC) - 21st Century Cures Act: http://www.healthit.gov/healthITcomplaints
Office of the Inspector General (OIG) - 21st Century Cures Act: 1 (800) 447-8477
California Department of Managed Healthcare - Whistleblower Hotline: 1 (888) 466-2219
Consumers interested in submitting a complaint regarding their right of access or discrimination based on disability can do so with the HHS Office of Civil Rights:https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf
Honestly, it's too early to tell at this point. I'm still learning how to use it and until checks start rolling in consistently and quickly and accurately I won't be doing any celebrating. I will say it hasn't been horrible implementing it and their support has been very good thus far. I have been pleased with customers' response to the system when I can show them their benefits on a computer screen rather than what I used to scribble down on a post-it note after sitting on the phone for a few minutes. They seem to 'trust' that computer screen.
As far as 'what it is doing' for me? Well, at this point I can log on and check benefits and reimbursement amounts and submit bills. All without the hassles of the phone... which VSP just pulled our ability to use. Not to mention the convenience of simple online billing. I agree, $200 a month is NOT cheap. But, you want to know whats more expensive? Losing customers. And I don't have the time or patience to have to explain, multiple times a day that I no longer have ability to check someone's benefits on the phone and then frustrating them with a VSP OON homework project and expecting them to keep their business here. Although I suspect many would out of sheer loyalty. If my spending this kind of coin makes us more efficient, and improves the customer experience then I'll say it's money well spent. Time will tell. I didn't see other good alternatives so I jumped in with both feet. It's just how I do things...
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