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Thread: VSP Out of Network (OON) Discontinued?

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    Optical Janitor OptiBoard Silver Supporter peyes's Avatar
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    VSP Out of Network (OON) Discontinued?

    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?

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    Quote Originally Posted by peyes View Post
    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?
    Is this really true?? Have you confirmed with VSP Out of network provider services??

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    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.

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    Optical Janitor OptiBoard Silver Supporter peyes's Avatar
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    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?

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    How do we obtain authorization, to bill and submit claim to VSP OON? We used to do all the billing for the member.

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    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?

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    Optical Janitor OptiBoard Silver Supporter peyes's Avatar
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    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.

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    Quote Originally Posted by peyes View Post
    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.
    We have been billing and submitting claims to VSP OON, and also receive individual payment checks. But now that the OON of telephone line is discontinued, how can we continue to do the billing for the patients??

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    Quote Originally Posted by optician2601 View Post
    We have been billing and submitting claims to VSP OON, and also receive individual payment checks. But now that the OON of telephone line is discontinued, how can we continue to do the billing for the patients??
    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!

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    Optical Janitor OptiBoard Silver Supporter peyes's Avatar
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    Quote Originally Posted by optician2601 View Post
    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!
    Thanks.

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    Ghost in the OptiMachine OptiBoard Silver Supporter Quince's Avatar
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    Quote Originally Posted by peyes View Post
    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.
    Good to know. Not sure if it would be worth handling more flaming insurance hoops to jump through but worth looking into. Thanks!
    Have I told you today how much I hate poly?

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    When I call that number I get disconnected and I'm told to have the member call

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    Quote Originally Posted by colleen26 View Post
    When I call that number I get disconnected and I'm told to have the member call
    Just stay on the line. Enter the members information.

    Please 0 (zero). you might have to wait for awhile. The representative said this is all very new. Im sure they are on the phone explaining to OON providers.

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    So I guess there are no more authorizations

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    Optical Janitor OptiBoard Silver Supporter peyes's Avatar
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    Quote Originally Posted by optician2601 View Post
    Just stay on the line. Enter the members information.

    Please 0 (zero). you might have to wait for awhile. The representative said this is all very new. Im sure they are on the phone explaining to OON providers.
    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?

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    I believe that would be 'Patch'

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    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.

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    May I ask how everyone is doing with the changes to VSP OON? Are you still going to submit the claim for the patient?

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    Quote Originally Posted by Alex Camblor View Post
    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.
    I signed up with patch yesterday. Training and going live tomorrow. The pricing structure is much, much different now. It's basically a monthly $200 or you can pay for the entire year and get a bit of a discount. I did the latter.

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    Quote Originally Posted by Quig View Post
    I signed up with patch yesterday. Training and going live tomorrow. The pricing structure is much, much different now. It's basically a monthly $200 or you can pay for the entire year and get a bit of a discount. I did the latter.
    Wow, very pricey!

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    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.

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    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

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    Master OptiBoarder LENNY's Avatar
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    Quote Originally Posted by optician2601 View Post
    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
    So are you saying that even members cant see their OON reimbursement benefits online?

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    Quote Originally Posted by Quig View Post
    I signed up with patch yesterday. Training and going live tomorrow. The pricing structure is much, much different now. It's basically a monthly $200 or you can pay for the entire year and get a bit of a discount. I did the latter.
    So what is Patch doing for you now????
    What is that $200 a month doing for you?

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    Quote Originally Posted by David_Garza View Post
    So what is Patch doing for you now????
    What is that $200 a month doing for you?
    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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