# Thread: How do I explain this insurance benefits to patient.

1. ## How do I explain this insurance benefits to patient.

Hello,

I'm a provider for VisionCare insurance. The way they calculate the frame overage for patient is Wholesale cost - Frame Allownce = x dollars amount times 2 which is the patient's responsibility.

How do I go around telling patients their frame overage WITHOUT telling them what the wholesale cost of the frame?

Visioncare said that they tell the patient the frame retail allowance, so they know what to expect. But the way they calculate frame overage,, you have to tell the patients the frame whole sale price.

snv

2. Well just use the retail price as wholesale. The insurance co's are of totally top moral standards and want you to make lots of money like they do, so they will make sure they present their plan as honestly as possible so your job will be easier.

3. VSP (who I think you are referring to) has changed the system. They now allow you to quote a "retail allowance" of \$120, whatever, and the patient gets a 20% discount on the overage. That's the way to do it.

If you aren't talking about VSP, and you are forced to use that formula with another insurer, you can still take their WS frame allowance, multiply it by your standard markup multiplier (assuming you have one), and give them a "retail allowance" for your office. Then, the overage can be considered discounted by the amount that xxx is less than your standard markup multiplier.

Example: PURELY THEORETICAL
Standard markup xxx
Overages are discounted 20% (xxxx = 80% xxx)
Patient's WS allowance: 40
Frame to purchase: \$199 retail, xxxw/s

Patients "retail allowance" = xxx = \$100
Patient overage before discount= \$99
Patient overage after discount= \$99 - 20%, or \$80

Math Check:
xxx(ws)-40 (allowance)=40 (overage) x 2 (per rule) = \$80

After analyzing the math, VSP now allows providers to mark up xxxon the "totally covered" frame, and then asks you to provide a 20% discount on the overage, if frame is not totally covered. That is an improvement on both counts, because VSP's markup formula on the "covered" frame used to be xxxx, and the overage was xxxx as well.

Now, we are allowed quite a bit more latitude, and the retail allowance system is more friendly to use. You sound a lot nicer giving a 20% discount on a retail overage than quoting some formulaic overage, like we used to.

In essence, if you have a xxx markup, VSP is only asking you to take 20% off what the frame costs over and above the retail allowance, and the majority of the frame is at your U&C.

4. drk-

There is a vision care plan that's out there. It is alot like VSP, but not completely.

Vision care plan was started by some people who were higher ups at VSP and decided to launch their own company. They are based in Florida.

Just a little FYI... :)

5. You beat me to it Jana.

Their forms are extremly similar to VSP.

UFRICH:cheers:

6. Yes, their formula is very much like VSP, even with the extra optional add-on. I think it is much better than VSP since VSP won't allow you to use your own lab. Although their reimbursement for standard material is just a little more than the lab would charge you, but you can keep all of your optional add-ons (at their reduce rate of course, but still much better than the charge-back theory of VSP). They do actually have a big clientele such as bank of america, home depot, etc...

So, just get back to the question. Normal retail allowance is 2.5 x the wholesale allowance for VSP. I should use this as a method to determine the retail allowance overage for VisonCare?
snv

7. Are they also OD ownership ONLY insurance?
Could you post their contact info for us.

8. www.visioncare.com

or

1-800-749-5855

9. No, SNV.

You can just take a patient's wholesale allowance per this insurance, and use YOUR multiplier to determine a retail allowance.

Ex: Patient's WSA: \$35
Patient's "Retail allowance for your office":xxx

Then, the frame overage would be always (for this insurance) discounted off retail by xxx. Got it?

Ex: as above
Retail frame: \$200

\$200 retail -\$105 retail allowance = \$95 overage. "Your insurance pays \$105 towards your frame..."
"..now, I'm going to give you 33% OFF what your insurance doesn't cover!"
"Your out of pocket is \$95-33% or \$63. What a deal! You have great insurance, and with the additional discount, you can put that towards some good lenses! Now, let's talk about those high index-AR-transitions, hmmm...?"

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