Hello, My name is Pam.
I have just started my second career as an optician. I’m feeling pretty comfortable so far with everything EXCEPT reading insurance benefits! Can anyone help guide me somewhere that I can learn better about the different plans?!
Thank you in advance!!
Websites of the VCPs.
Typically it's not uniform across every state and every office. Wherever you are starting, they should have someone experienced with the insurance to go over that with you and help out until you're comfortable. Just remember, always double check your eligibility and copays
It can also help to look at old quotes from the previous year. For difficult insurances I will look at the claim and see what the insurance company paid us as well.
Insurance benefits are the worst. Just when you think you have it figured out, it changes! The suggestion to look at the previous orders and quotes from that is helpful. Also, the recommendation to watch out for co-pays is a good one too. (I say that since I totally missed a $10 copay this am!) Also, depending what insurance it is, you can print out an extra benefit sheet and write up a bunch of fake orders to get used to pricing them. For example, if the insurance is Davis, every time you get an auth and have to print the Vision Service Record form, print a second one (with no patient information on it) The you can sit down and create a bunch of fake orders on paper... what if the pt ordered SV... what if they ordered a high end progressive 1.74 AR etc. I often have extra plan sheets for Davis and NVA. I use them for training and also if the office needs to adjust charges we can decide what is best price wise.Originally Posted by NAICITPO
If the insurance is Davis, take pen, insert into your eye, then repeat for the other eye.
Good suggestion on the extra benefit sheets though and writing up fake orders. You should do absolutely do that until you feel comfortable!
Ha! Yes! Although we have a contract where we don’t use their lab or materials. So far it seems to be working well…knock on wood!
Thank you! That’s a terrific idea
Lol!!!! This actually makes me feel better!
Just going to take a couple months to start feeling comfortable. Our office is 80% VSP Choice or signature, I can tell you those copays for everything in my sleep. But when I get a blasted eyemed plan I have to look on their formulary sheet to see what a tier 2 progressive vs a tier 3 progressive and what is a tier 3 AR.
You are going to make mistakes! Heck I still make mistakes, I sometimes have to call and say hey I forgot a copay for materials or I forgot to charge you for the optos. Most of the time it is not a problem, they are pretty understanding. The only time you really have to put your tail between your legs is if you didn't check the eligibility and charge them for glasses like their insurance is paying for it and then you go to bill it and they don't. I have our front desk people HIGHLIGHT any non-eligibility so I don't make that mistake but it does happen. Every now and again you have to call and say, "I am so sorry but your insurance does not cover your frame until X date. It will give you a 20% discount though on the frame. If you wanted to go ahead with the order we could charge you that when you pick up the glasses."
Can you talk to me about VSP CHOICE?
And Signature ? What is the difference. These ( and the contact coverage on a total plan plus MESSA!
VSP is pretty straightforward in comparison to some other plans - you can print an authorization and the next tab over from the authorization report is a list of all the patient copays for various options. You will need to look at their formularies (which can be found in the VSP manual on the website) and figure out which letter your progressives and coatings fall under. Even if two patient both have VSP Choice these amounts can differ from employer to employer so I always print that second tab off. The VSP savings statement they want you to print is usually wrong and is useless.
Krystle
Signature is now the "cadillac" version (if you can believe it). "Choice" is the economy model.
Thank you for all of the replies!!
I find this is the exception and not the rule and can be manually adjusted if needed. Be prepared to defend your adjustment if audited (Like when "No Savings Statement" provided).The VSP savings statement they want you to print is usually wrong and is useless.
To verify charges print the "Doctor Service Report" when printing the Savings Statement and Shipping page.
Note at the bottom "VSP ENHANCEMENT CODES"
The 2 letter code will correspond with charges and will say either "Covered" or "Covered with Additional CoPay".
If the later go to your Choice or Signature Lens Enhancement Description you printed (3 pages) from the VSP Online portal.
To the left are the 2 letter codes that apply and should be charged (and chased after if you missed it with a quick call of the balance due and a mea culpa that you did not catch it to the patient).
These codes are especially helpful if "No Savings Statement" pops up. Always try to add a charge when in doubt as it is much easier to tell them they have a refund than to say they have a balance!
What fries my nose is the authorization saying "Covered- Custom Progressive Charge with Custom Measurement" charge. You would assume that the $10 fitting fee (Wrap Panto Vertex specified) is covered- but as often as not the charge does apply but you will not know this without looking for the 2 letter code explanation stating "covered" or "covered with additional copay" where it now does apply regardless of what the authorazation page says. I believe the lab gets $8.00 of this $10 charge whether you charged it or not. Call VSP and they will tell you it is a glitch- but it makes you think they may keep a non kosher set of books.Sure it's only a couple bucks to you but the lost $8.00 can add up!
Try like heck to use only VSP owned Unity products such as progressives (Elite!) Sunsync photochromics and TechShield Elite UVR AR for max profit.
Familiarize yourself with the VSP Online tab site. They list products you can use. Never ever ever offer the rare lens products not supplied by them. You will lose money as you spend hours chasing them for partial reimbursements that sometimes will not cover your cost.
Watch the current wholesale frame cost as they will sometimes (especially lately) allow a charge where the old Frames Data cost would fit the wholesale allowance.
Safilo is infamous these days to adjust best sellers costs monthly.
Kind regards,
Fester
Last edited by Uncle Fester; 02-15-2022 at 09:57 AM. Reason: further tweaking...
Patients can judge how cheap their employer is accordingly;)!
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