I left the optician world for several years and am now back, so forgive me if I am completely missing something obvious. The office I work for does not do any vision insurances except VSP - but there is a lot of ambiguity - no one seems to be on the same page about the patient copays/responsibilities. Our biller is not as versed with VSP as they haven't been dealing with it all that long. My coworker wasn't even tell the patient what they will owe for their glasses until after submitting the claim through VSP, because they didn't know about the VSP manuals and Lens Enhancement sheets.

I always print the lens enhancements price sheet with each authorization. I was always told previously that we have to charge the patient the amount that is calculated on their VSP Savings Statement, and very often this differs from the amount that is shown on the lens enhancements price sheet. For example, the Progressive F might say $105 patient responsibility on the lens options sheet, but after submitting the claim, the VSP savings statement might say $102.50. When I submit a claim/lab order for a job with Crizal EZ, almost always their copay on the lens option sheet will be $51, but the savings statement says something completely different - sometimes $17.50. Where is that number coming from? Our biller is saying to just collect the copays as stated on the lens options sheet, but I hate to charge them one amount and then hand them the VSP Savings Statement that shows they should have paid a lower number. Am I missing something?

I am using the Formularies and making sure I select the correct Progressive category (like Progressive F or J) and AR category (like AR B for example). When we get the EOBs it shows the patient responsibility as the original copay amount that was on the lens options sheet, so the biller says that's what we should collect. When I call VSP the reps are completely clueless and unhelpful. If we just collect the copays as stated on the Lens Enhancements price sheet, barring anything covered in full listed on the authorization report printout, could VSP come back and say we are overcharging the patient if the saving statement said they owed less?

We use Luzerne and VSP pays them directly for the lenses and just gives us a service fee where applicable. Often we end up owing them something back when we get the EOBs. I don't even think it is worth it for a small optical like ours to accept VSP when the only thing we can profit from is the frame, and that's only if the patient picks a higher end frame, as VSP can go off of the wholesale cost if it is low enough. We stopped accepting NVA for this same reason.

Thank you in advance. Again, sorry if this ends up being something obvious. No one had even printed out the VSP manuals before I started. I am so happy I found this forum with so many experienced and knowledgeable ECPs. :)