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Thread: How to calculate patient copay for Xperio UV - VSP choice

  1. #1
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    Confused How to calculate patient copay for Xperio UV - VSP choice

    How do I calculate what to charge the patient for Xperio UV. They are polarized and category C AR according to our Vision Source Essilor VSP guru. He says to bill them as polarized and a Cat C AR. I assume that means I need to split the Xperio UV UC between polarized and AR....but how do I do that?

    How do I do this with the VSP choice plan? Say for example it's a CAT O PAL in trivex

    Copay calculation -
    Cat O PAL $150
    Trivex 80% of UC
    Polarized - ???? do I use DA (plastic polarized) or DA+DB (trivex polarized) - both are 80% of UC. - assume since all of my polarized options are the same price it doesn't matter - but i'd like to know for proper understanding
    Cat C AR ???? $69 per lens enhancement chart or 80% of UC, whichever is lower

    We have one fee for Xperio. How do I split out what component is the AR and what is the polarized? Our Xperio is higher than just a regular polarized lens.

    If anyone can shed light, I'd appreciate it.

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    In order to figure out Xperio UV pricing, it depends on whether the plan for VSP is Choice or Signature.

    If it's choice, which I'm assuming it is, the AR pricing on Xperio UV is for the backside sunshield coating on the lens, so you would charge the C pricing for AR and 80% of the upgrade cost for polarized lenses.

    You have a few variables in this circumstance as well:
    1. Cost of CR39(A) lens - base rate
    2. Cost of Trivex(B) upgrade [B-A]
    3. Cost of Polarization(C) [C-A]

    So lets go with your example:

    Copay calculation -
    PAL - $150.00
    Trivex - 80% of Trivex upgrade
    Polarization - 80% of polarization upgrade
    Xperio UV - AR Category C + $10 UV charge

    Hope that's helpful!

  3. #3
    My Brain Hurts jpways's Avatar
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    To reword the previous explanation (because I had to read the last one a few times to make sure we were going to be saying the same thing)

    To this calculation you have to know a few things before you start
    1. How much do you charge for the lens design in clear plastic
    2. How much do you charge for the lens design in clear trivex
    3. How much do you charge for the lens design in polarized trivex without an A/R
    4. Your total charge for the package

    You should have prices for 1,2, and 3 without having to do any more work, but ask the person who determines prices for them if you don't (though I will provide an option for the exception)

    As rai.de.soleil said the patient's copay for the progressive lens is fixed at 150 for VSP Choice
    Your charge for trivex is 2-1
    Your charge for polarization is 3-2
    Your charge for Xperio UV is 4-3

    However, there is an exception for VSP choice pricing if you look at VSP choice rules most options have a limiting charge. The full rule on VSP choice is you charge 80% of your U&C or the limiting charge, whichever is less. So on AR C the limiting charge is $69 (+10 for UV) so unless your U&C is less than $98.75 you have to charge the $79. Polarization and Trivex do not have limiting charges so you always charge 80% of your U&C

    Now for my exception for determining prices (and use this as a threat if you are unable to get an answer for the person in charge of pricing) use a similar option at the same VSP level, so if you can't get an specific price on Xperio UV, Crizal Alize with UV is also an AR C, are they generally different costs from the lab, yes, but sometimes you have to use the data that you have when you can't get data that you need. Then if you know the price of the clear plastic lens (P), the trivex price (T), and Alize price (A) your polarized price=Total price for the package-P-T-A. Note: I am the one that determines all the pricing for the office I work in and I'm also the insurance person, so it's a moot point for me.
    Last edited by jpways; 11-19-2018 at 11:36 AM.

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    The fact that some of you choose to deal with this BS of VCPs, and the fact that some of your are forced by your employer to deal with this BS, on a daily basis, astounds me.

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    Haha Kwill212, it brings in a large portion of patients and many of them end up getting multiple pairs. Nothing wrong with having to put a little bit of thought into the work that you do, and it's fun for us puzzle solvers to find the answers. I think it's a solidly great idea to deal with VCP and get the necessary understanding of how it works, most people have them now and they're looking for offices that take the coverage they're paying for.

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    We use an EHR that has a VSP estimator built in. Here is what it came up with: (side note, my screen shot isn't working)

    Patient Copay for base lens = $25 (to pretend)
    V2750 Xperio UV (AR Coating C) = $69
    V2781 Patient copay for PAL Lenses = $150
    V2782 Patient Trivex "Copay" = 20% off UC

    In our office, the patient would have paid $349 + frame costs.

    Really wish my beautiful screen shots would have worked!

  7. #7
    My Brain Hurts jpways's Avatar
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    Quote Originally Posted by rai.de.soleil View Post
    Haha Kwill212, it brings in a large portion of patients and many of them end up getting multiple pairs. Nothing wrong with having to put a little bit of thought into the work that you do, and it's fun for us puzzle solvers to find the answers. I think it's a solidly great idea to deal with VCP and get the necessary understanding of how it works, most people have them now and they're looking for offices that take the coverage they're paying for.
    For my sanity and and I bet a lot of other people on Optiboard can we not have thie why you should/shouldn't take vision plans conversation again. That horse was beaten so many times the last time this conversation was made it's a pancake.

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    Quote Originally Posted by jpways View Post
    For my sanity and and I bet a lot of other people on Optiboard can we not have thie why you should/shouldn't take vision plans conversation again. That horse was beaten so many times the last time this conversation was made it's a pancake.

    Come now, we all know you can't keep your sanity and work in optical.

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    My Brain Hurts jpways's Avatar
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    Quote Originally Posted by Kwill212 View Post
    Come now, we all know you can't keep your sanity and work in optical.
    Actually I believe it's, if you work in the industry it automatically disqualifies you from defending your sanity

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    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by jpways View Post
    For my sanity and and I bet a lot of other people on Optiboard can we not have thie why you should/shouldn't take vision plans conversation again. That horse was beaten so many times the last time this conversation was made it's a pancake.
    +1. I work where I work and that's that. We take insurances. I need resources and support here, not snark and superiority.
    I'm Andrew Hamm and I approve this message.

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    Quote Originally Posted by AngeHamm View Post
    +1. I work where I work and that's that. We take insurances. I need resources and support here, not snark and superiority.
    It wasn't meant as snark and superiority. It was meant as, I'm sorry your employers make you deal with this, reading it makes my head want to explode.

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