VSP Patient Responsibility Question

[KrystleClear]

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. :)

[Fleyed]

To be perfectly honest my Savings Statement hardly ever reflects my actual total... (usually not a significant difference). The receipts that we use at our office reflect their insurance savings anyway so we never actually give them the Savings Statement from VSP because it is never correct. VSP doesn't even seem to quite understand it either so they never argue with our billing department, they just trust our numbers. Still definitely do a dispensing fee and deluxe frame fee as well and they don't even factor that stuff in. Hope this helps!

Corey

[Uncle Fester]

Welcome to Optiboard Fleyed!

Saving statement discrepancies are not uncommon here as well but I think you would do your office a favor by looking at the bottom of the reports page after submitting and match the 2 letter code to the Signature or Choice VSP Charge list.

Doing that, much more often than not, you should find matches the savings statement.

Don't get me started on the "No Savings Statement Available" though....

Hi Krystle-

"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?"

Yes- They can and do when you are audited.

[DanLiv]

A couple years ago VSP changed the savings statement to be unavailable until after a claim is submitted, and ever since then the pricing system is completely broken and inaccurate. All PRICED claims if you check them on the claims search are wrong, and I've talked to VSP and they confirm the pricing system is wrong. Only once the claims are processed and PAID are the numbers accurate, and then you should find they match the pricing on the enhancements sheets.

"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?"

Yes- They can and do when you are audited.

Your contractual responsibility is to abide by the final pricing on the EOB, not the savings statement. If what you charge is what the final EOB says the patient owes you are fine. Everything else is just "estimates".

Also, once upon a time VSP used to require you provide the savings statement. Since the change they are clearly aware of the faultiness of their system, so it is no longer required. In the section of the manual they "recommend" you use the savings statement and ask that you "please" provide the patient with the statement. I do only what my agreed-upon contract requires, I don't do VSP any favors.

[KrystleClear]

Thank you so much for your responses! I just joined yesterday and already I have learned so much from this forum! Sadly, my would-be mentor and predecessor for my current position passed in November so I have been trying to teach myself as much as possible and get back up to speed.

I am going to just collect the listed copays for anything not covered in full and just ignore the Savings Statement. I thought we were still required to give them to the patient, so knowing we don't have to is good news. Also, I hadn't realized it was often incorrect. It is a shame they are aware of the issue yet do not resolve it.

VSP is such a mess - and now with the new eInsurance/eClaim tab you have to use we are running into more issues with the site not letting us print packing slips, etc.. Unfortunately I don't have access to the Explanation of Payments until we get the quarterly report and our biller asks us to go over it and try to figure out what we did wrong. I did learn from the VSP rep that some plans have an "AR Allowance" - which apparently you deduct from their AR copay (whatever category AR it is). I have never seen this AR allowance on any of the authorization reports, so it only confused me more.

I just want to make sure I am not overcharging or undercharging the patients. It would be nice if everything was clear and straightforward but vision insurance never is. I came from an office that accepted almost all the vision insurances and navigating that was a nightmare - especially Eyemed and Spectera (aka Spec-terror). Thankfully, aside from Medicare after-cataract billing, we only have to worry about VSP at my current office.