VSP charges on poly polarized

[ajonesgirl]

So, I had a patient today that purchased SV Experio poly polarized. What I charged the patient didn't add up to the VSP savings statement, so we called VSP. Apparently now, we can't go by the co-pays listed on the lens enhancement charges that we print out with the patient's authorization number. If they are purchasing poly polarized, you add your office's charge for poly to the charge for polarized, then take off 20%. Then add the co-pay for the Experio.

While I had them on the phone, I asked why we can no longer see the patient savings statement without submitting. She said too many people were just pulling up the savings statement and then trying to make the charges fit. They apparently were getting a lot of calls from people having to redo the claim. That excuse really made no sense to me, but what do I know? We always used the PSS to verify we had the right amounts. Now without that, seems like they'd be getting a lot more calls.

Ah, the joys of working for an office that takes insurance.

[Uncle Fester]

We've touched on this in other VSP threads lately but here is what the Efinity site, VSP online tab, says straight from the horses (or other related equines) mouth...

Updates to the VSP Savings Statement
In June updates to the Patient Lens Enhancement Charges report went into effect. With the changes to the report, the VSP Savings Statement (VSS) was also updated to ensure the accuracy of the information.
It's come to our attention that the VSS tool was being used to calculate and estimate patient costs. The VSS is used as a resource for your patients to refer to and understand their expenses, which is why it is now only accessible after a claim has been submitted.
To help calculate patient expenses going forward, resources such as the Calculators on VSPOnline and pricing list on the Lens Enhancement Charges report via eClaim are available.

What they've done is rather than us calling them when we find a discrepancy when first saving the order (a very handy check as we've found out), then viewing the savings statement to be sure the costs match, is to first submit, then force us to call our VSP lab to void back to doctor when we see and need to fix a discrepancy.

They will only listen to our Doc's. Our OD's very much need to raise a unified stink that this unnecessarily delays orders and argue that many of us find and fix cost discrepancies without calling them!!!

Of course then there are the ones even VSP can't tell us why the numbers don't match- but we're used to that or should be by now.
Got busy- Below needs further clarification probably tomorrow----
Also- Be aware of the less common situation where a patient goes to a higher priced redo within their redo time frame- if the lenses cost more and are under "Enhanced" options co pays- you are being charged privately by the lab and besides collecting the enhanced copay charge should also charge the difference on the lens discount list and send a form to VSP to get credit that you will otherwise lose.

Example: Patient upgrades from sv to Progressive cat. F lenses. The Enhanced co pay says to charge only $20 for the upgrade but the lab is going to charge your office for the lenses at what they charge VSP. So if VSP says the charge is $90 and the patient only pays $20 and you do not submit the First -Time redo form to VSP then you will lose out. We can't talk costs here but you can see where it is important to follow up for this rare occurrence.

If Len Enhancement charges don't apply it's a moot point as we're collecting the $90 anyway.

Clear as mud? Thought so!!!