So a pt has to have a half diopter of correction in at least one eye or VSP rejects the claim because MONEY MONEY MONEY.
Idiots.
Been a while since I've run into one of these, but will the system automatically kick a claim thats a -0.25 +0.25 x XXX or +0.25 -0.25 x XXX? I know both either minus or both plus and no issues. Just wondering if it's "smart" enough to kick back on the above?
Tanks!
+0.37-0.37
Hmmm, it may let you submit the claim but then they could just not pay anything or charge you for it down the road, or do an audit. I'm not sure how sophisticated the "modern" e-claim is now with all it's bugs and errors.
Krystle
I wouldn't. But I have to answer to others if 3 months later the EOB charges the office for the rejection.
I don't see where +0.25 -0.25 anywhere equals a total of 0.50 diopters in any meridian. Or 0.37 for that matter.
Am I missing something?
A better question would be what happens to an rx of right 0.00 and left 0.00 -0.50 then a Dr changed rx after dispensing to 0.00 -.25.
It is obvious to everyone what VSP is trying to prevent. No?
Is it +0.50 per meridian? Thanks.
How about 1/2^ BI OD, OS?
I wouldn't make a habit of this, but if your doctor writes an Rx of plano -0.50 x 90 and the later they come back and get a new Rx of plano -0.25 x90 that would be allowed. Because it was billed under the half diopter rule, and any remake done after the fact doesn't have any bearing on the billing.
And yes Fester, VSP is trying to prevent people from getting non-rx glasses, especially sunglasses. Why would you give the cow away for free when you can charge for the privilege of using the frame benefit for plano sunglasses? I'm sure we have all had VSP plans where everyone comes in to get plano sunglasses at the end of the year. We stock up specifically for that reason, it is strange that we get wiped out of sunglasses in December.
Still don't don't understand why a plano lens with an accommodative bump like eyezen + or relieve or sync III etc is not allowed under VSP plans though.
That's getting too cute by half:)Originally Posted by drk
From another place I worked about forty years ago our big city shop got audited by the state and the manager called the owner to tell him he needed to quickly cut a $150,000 check to the state.
We had an OD nearby this shop who for years was feeding us patients on state aid as we acted as his receptionist.
Many had a 0.00 -0.25 x 180 OU rx*and we filled that and billed the state for the glasses as well as any job that required decentration as rx glasses with prism due to the need to decenter.
It goes deeper but suffice to say the office made over the years a lot more than what was paid back.
Then a goody two shoes Greek governor came along and put the kibosh on this however.
* Yes- he knew what the 180 power was ergo---cut the check!
Last edited by Uncle Fester; 06-02-2022 at 01:04 PM. Reason: tweek...
It has been months since I billed VSP for plano sunglasses following a patient's LASIK surgery. Submitted the claim the way the VSP manual says to and also included the date of surgery and surgeon (it was our MD). The VSP rep assured me they would indeed cover the frame without RX lenses because they had LASIK. We have received multiple VSP payments since then and that claim has yet to be paid. BUT they continue to tell their members that yes, they can use their frame benefit for plano sunglasses after LASIK (they just leave out the part where they won't pay the provider for services rendered). Never got a denial or anything yet and when I call they give me another excuse. I have heard that this is often the case when you bill for frame only to replace a broken frame and use the existing lenses.
Yeah, I've done the "Dr Rx change" thing in the past, and in reality it doesn't come up that often at all. Just wondered what the rest of yinz might have found in your daily travels down the road to hell (VSPland). :)
I've only billed for plano sunglasses after LASIK once like 3 years ago and I don't remember having an issue with it then but I was less involved in the billing 3 years ago. Do you have a VSP rep you can talk to? I have found that bugging them is better than calling the customer service center. Because at least there is one person you can consistently direct your ire at until it is resolved.
If we have a specific rep for VSP, I have never seen or heard from them. We probably only get 4-5 VSP patients a week at most who are ordering glasses so we probably aren't high on their priority list.
If you have a local VSP lab maybe call them and ask who the rep is for the area. You will most likely have to listen to a presentation on why you should sell Unity everything, but they'll bring you food and you will get your claim paid
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