Vision insurances
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"Best" probably isn't a good word. "Least horrible" might describe it a little better. For me, the least horrible is VSP.
Also, they aren't insurance. They are discount plans that pay (poorly) for an eye exam a discount on glasses/contacts.
Also, they aren't insurance. They are discount plans that pay (poorly) for an eye exam a discount on glasses/contacts.
I've heard a lot of ODs say on here that VSP isn't as bad as the others. We don't take VSP at our office because it reimburses us next to nothing. I don't know a lot about insurances but I'm assuming it has something to do with location. Wal-Mart is the only place that takes it where I live.
"Next to nothing" is relative I guess. VSP is probably the best vision plan out there, but that isn't saying much. In general, vision plans play considerably less than medical plans that have vision coverage. As for Wal-Mart being the only place that takes VSP where you live, you are most likely thinking of a different vision plan. I don't believe any Wal-Mart can accept VSP because of the doctor not owning the optical. Plus I have never heard of any area where no private practice accepted VSP.
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I agree.
VSP is the least "bad" and usually only private practices qualify to take it.
The worst of our worst around here are Spectera, Blue Vision, and Davis.
Eyemed is quite a bit worse than VSP.
We only accept VSP
VSP is the least "bad" and usually only private practices qualify to take it.
The worst of our worst around here are Spectera, Blue Vision, and Davis.
Eyemed is quite a bit worse than VSP.
We only accept VSP
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(excuse my butting in as I'm not in OD school or even pre-OD)
I've seen this stated before and I'm a little confused. I have a vision plan (what I would call "vision insurance") and paid nothing for my eye exam and nothing for my glasses. I don't see how this squares up with your statement. Was I given a 100% discount? Surely the optometrist must have been paid something for performing my eye exam and the optician must have been paid something for that glasses that I got.
Sure, but it's not like medical insurance, which you can use throughout the year pretty much as often as you need it. Vision plans don't work that way. You get one exam and a discount on glasses (in your case a 100% discount) per year and that's it. It would be like having a yearly routine physical covered and calling it "Yearly Routine Physical Insurance". I guess it's really a semantics issue that isn't all that important, I just like to argue.
And you're right, the doc probably got paid, but most likely not very well. I know I take a big hit on exam fees with even the least horrible (best) vision plan I accept. But hey, I'm the idiot who accepts it, so I can't bitch too much.
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Thanks for the explanation. I didn't realize that the only thing covered was one exam per year and my glasses. (I've only been to the OD once, and it was for a routine exam.)
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Heh, flynnt, no exam is routine, finding no medical condition is a finding =). Sorry had to say it, had a professor that always said that and it brought back memories 🙂
Who? I don't remember such a person at IU.
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Nova2010,
I think we should readjust our perception of what vision insurance really is. In general, vision insurance are really prepaid vision care and not really insurance at all. Insurance means that you are paying for the prospect that you might nor might not get a problem. However, in vision care, it is almost a certainty that eye sight will change. Thus, the concept of vision plans.
Therefore, vision plans were never meant to encompass medical problems and optometrists and the public should be dissuaded into thinking that the two shall mix.
I think we should readjust our perception of what vision insurance really is. In general, vision insurance are really prepaid vision care and not really insurance at all. Insurance means that you are paying for the prospect that you might nor might not get a problem. However, in vision care, it is almost a certainty that eye sight will change. Thus, the concept of vision plans.
Therefore, vision plans were never meant to encompass medical problems and optometrists and the public should be dissuaded into thinking that the two shall mix.
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Actually this is a great point and after practicing for 8 years it just hit me. The biggest difference between insurance and vision plans is that insurance is there when you need it whenever you need it. Vision plans are a one shot deal and that is the biggest difference. You get one exam of a specific type and hope that you don't have any medical problems because they are SOLEY there to determine a prescription for glasses/contacts. If you have problems 30 seconds after that exam, you're on your own.
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"Best" depends on whether you are the patient or the office. Most "vision insurances" pay crap. We get paid the most by people that have vision coverage with their medical insurance, the best I have seen is BCBS. The next best-paying is sadly Medicaid. VSP is definately the best "vision coverage," although not amazing is definately way better than the rest. Also really easy to verify and file, saves tons of time. My least favorite is Spectera, there's is hard to understand and barely pays anything.
I am not a provider for Spectera. I am, however an Eyemed provider because I'm currently at Lenscrafters and they require it in the owning doctor's contract.
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Next to nothing?
How much do they reimburse?
I know most insurances wont pay a lot, but I thought VSP was one of the decent ones.
Again, it's really better thought of as varying degrees of bad. At my office, VSP pays $63.50 for exam and refraction, not great, but better than other plans like Eyemed, which will pay as low as $35. Medicaid pays me more than any vision plan, somewhere around $70 I think.
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When I did billing at Dad's office back in 2005, eyemed was just awful. At the time, even lower reimbursement for exams than Davis.
Most vision plans like Davis, Spectera, Superior, etc. will reimburse a maximum of $45 for a "routine" exam/refraction. However, if you fit the pt. for CL's, you can charge a "fitting fee" and that fee is deducted from their total CL coverage available. Also, plans like BCBS and United Health usually will reimburse more. For example, at my optical, Dr charges $55 for a routine exam, BCBS will pay in full but Spectera will only pay $45. Personally, I think that most vision insurances suck but without them people probably would not get their eyes checked on a regular basis. However, there is a misconception about vision insurance - it was not meant to cover everything. The patient should not expect "full coverage." If we could get them to understand this, we would be a lot better off.
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Wow, $55 is REALLY low. Lower than most womens' haircuts. How much does a local dental exam cost?
I really wish Docs would quit accepting these plans.
I was just about to say the same thing about the $55 exam, but then decided not to post it out of fear of starting another commercial vs. private s#$tstorm. Oh well.
Also, I think senorwes1 brings up an interesting point. How many of these people with crappy vision plans would be getting eye care if they didn't have that crappy vision plan?
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I thought VSP would pay more than that, since when you COB they give you 71 for the exam.
Anything less than 60 is ridiculous though. All the resources an office puts towards that patient seems like money would actually be lost unless the pt orders stuff above and beyond their coverage.
Best Buy charges 100 dollars to reformat a hard drive, Jiffy lube charges 40 for an oil change, hell, the waitress easily makes 20 dollars tip waiting 1 table of 6.
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This discussion brings back bad memories of vision plans. They were (are) all bad but Davis was the worst and EyeMed was the best. You could only hope that you could upsell the px or have the px buy a second pair. Fortunately, I am in a medical practice now and see 80% Medicare. Good luck.
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Holy crap good point. A fellow IU grad of ours pays $200 plus to get her hair done. My dentist got me for $175 on a new pt exam, not that I'm complaining. Thats with a $30 new pt discount! The same hair girl got charged $360 dental exam new pt "routine".
Okay, so, basically all we take at our office is Davis and EyeMed. We take others but those are the main ones. We don't take VSP, it isn't popular at all in our area. I sat down with the doctor yesterday and asked him about it, and he said he doesn't take VSP because they would only reimburse him about 30 bucks for an exam. He also said that they won't let you take any other insurances that reimburse more than they will. (?) We get a lot more from EyeMed, normally about 50 bucks I believe.
Sounds like your doctor doesn't know what he's talking about.
I agree. VSP pays more than $30 and there is no rule that states you can't take any insurance that pays more than VSP. I get paid about $78 for a VSP exam and I also take plans that pay double that. Is this a commercial or a private office?
We just dropped Humana yesterday FWIW. They decided as of the beginning of the year they were not going to pay us on certain plans for the CL fits. Patient pays $0 co-pay and we get reimbursed... $0.
I called Humana to check that it was some kind of clerical error. Heck, you paid me for them last year. Humana's response.. that's the "way it's supposed to be".
Basically.. tough ****-sky.
Last night I filed the paperwork to get off of their plan. I don't see patients to get paid about $45 dollars for a $160 exam !!
And yes, VSP pays WAY MORE than $30.
I called Humana to check that it was some kind of clerical error. Heck, you paid me for them last year. Humana's response.. that's the "way it's supposed to be".
Basically.. tough ****-sky.
Last night I filed the paperwork to get off of their plan. I don't see patients to get paid about $45 dollars for a $160 exam !!
And yes, VSP pays WAY MORE than $30.
I don't know, all I'm saying is I asked him about it and that's what he said. He also said it does depend on location, and that's why there are very few VSP providers where I live.. we get calls all the time from people who have it saying that they can't find anyone who takes it. And he owns the Pearle I work at... I suppose that means it's still commercial even though it's a franchise? I was always a little confused about that.
As I understand it, you can only be a VSP provider if you own your own optical. I don't believe you could be a provider at Pearle vision.
thanks for all the information you all have shared everyone. Could someone give me an insurance that pays for getting glasses every 1 year? since most insurances only pays for new glasses every 2 years (example: blue cross blue shield does 2 years).
Also, eye exams are covered every 1 year across all insurances, is that correct?
thanks!
Also, eye exams are covered every 1 year across all insurances, is that correct?
thanks!
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You can...but more often than not, it's a take it or leave it affair. Especially if you have a small office, or there are a host of other providers in the area. Most increases in fees that you can expect from negotiating are minimal, but every little bit helps.
You can try to negotiate your fee reimbursement but in the end it's all up to the insurance company. It usually depends on how many providers there are in your area and if there is a large concentration of people in your area with that particular vision plan. In our area, I know a Dr. that re-negotiated his contract with a large vision plan and got it increased $15. Also, BCBS of AL will pay for exam and glasses and/or contacts every year, not every 2 years. However, most plans will only allow frames every 2 years and lenses or contacts every year.
From what I've seen selling glasses at Pearle, most insurances (or most that we take anyway) do allow you to get glasses every year and use your benefit. We take mostly EyeMed plans though. We also have a LOT of people with BlueView, most types of which are discount plans and not insurance so they can get as many pairs as they want and use their discount. I don't know if this is an EyeMed thing or not, but most of those plans give you a discount if you get multiple pairs.. for example, we had a guy in today who had used his benefit for contacts so he wasn't eligible for new lenses, just a frame. But he got 40% off of his lenses because his plan has a "multiple pairs" benefit.
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I'd propose a different way of thinking about vision plans.
Essentially, these patients on vision plans aren't your patients. Legally they are of course, but not realistically from a practice building standpoint. You agree to be paid less than your normal fees, much less usually, for the honor of getting your name put in a book or on a website. If it is a "good" company like eyemed, they may list their own optical shops ahead of your office when patients search for providers even if your office is geographically closer. In any case, you get some advertising out of the deal and hopefully a greater proportion of patients than you would otherwise.
Now, you also need to remember that some plans only allow you to buy or stock certain frames. Some plans require a discount on your wholesale costs, others on your retail costs. Others only allow you to use certain labs (their own, oddly enough) to produce their frames. Others specify that you must be open certain hours, list certain things in your answering machine message, have a certain type of rail in your public bathroom, stock a certain minimum number of frames, or whatever else they can think of at the time.
Don't forget that these patients who come in often have real medical complaints, but not having been through any type of medical training are usually poor at reciting a chief complaint. They expect and have been sold on the notion that their "routine" exam covers everything under the sun. Diabetic with glaucoma, macular degen, bilateral cataracts, multifocal RGPs, with allergic conjunctivitis complicated with contact lens and multiple-medication-induced dry eye.... yep, VSP expects this to be a routine exam and is covered. Try convincing a patient otherwise if their medical copay is $20 and vision copay is $10.
Different plans have varying degrees of reimbursements. Huge corporations that have good reimbursing plans one year can suddenly have a lower reimbursing plan the next, even if the name remains virtually the same. These companies don't actively educate on this, but rather leave it up to our offices to explain and deal with the resulting confusion and irritation amongst plan participants.
In order to make any type of profit at all for a lot of these plans you must artificially inflate your usually and customary prices in order to take the hit. Can you imagine how attractive this makes your office to those silly private pay patients??? Not very, so they must search and search for some type of savior from the high prices of the private practice. Luckily, the vision plans are starting to advertise directly to consumers now so even those without plans through their employers are allowed to get in on the fleecing, I mean deal.
Bottom line. Vision plans are boarderline fraudulent in that many of the things the advertise covering would actually be covered by their health insurance, which they are already paying for. Redundant. Redundant. If that isn't bad enough, now vision plans are teaming with REAL health insurance companies in the hopes that eye doctors are stupid enough to do medical work for vision discount plan prices. Often times pride, ignorance, or something worse wins out and this occurs. Is it because every Tom and Sally graduating from optometry school these days wants to practice to their highest level, mode of practice be damned?
Cigna now requires all ODs to go through VSP for medical billing. Let me repeat, Cigna requires all ODs to go through VSP for medical billing. No one yet has pointed out to me what those medical reimbursements will be, or how much lower they are than the previously established provider/health insurer fee schedule agreements that are now apparently void. VSP requests medical diagnoses to be recorded when submitting vision claims. EYEMED requires medical diagnoses to be recorded when submitting vision claims. The choice for a provider is to fraudulently submit the claim, ignore it and not get paid anything, or fill it in "correctly" and provide these vision plans with further data on "our" patients which we be used to some as-yet-unknown end.
Mind you, these are the "good" vision plans. I'll leave the rather of garbage like spectera, cole, etc to someone else. Be assured that reimbursement can vary quite drastically depending on the region.
It is prepaid, meaning the companies already have your money or your employers money. They've already collected even if the services are never provided or the materials are never fabricated. Any wonder why they are listed as some of the best companies to work for in the nation? Imagine similar savings when setting aside that money in a tax-deferred health savings account and paying out of pocket for your routine exam and glasses AND you can go anywhere you choose because you are not limited to a manipulated provider list.
Shall I continue?
Essentially, these patients on vision plans aren't your patients. Legally they are of course, but not realistically from a practice building standpoint. You agree to be paid less than your normal fees, much less usually, for the honor of getting your name put in a book or on a website. If it is a "good" company like eyemed, they may list their own optical shops ahead of your office when patients search for providers even if your office is geographically closer. In any case, you get some advertising out of the deal and hopefully a greater proportion of patients than you would otherwise.
Now, you also need to remember that some plans only allow you to buy or stock certain frames. Some plans require a discount on your wholesale costs, others on your retail costs. Others only allow you to use certain labs (their own, oddly enough) to produce their frames. Others specify that you must be open certain hours, list certain things in your answering machine message, have a certain type of rail in your public bathroom, stock a certain minimum number of frames, or whatever else they can think of at the time.
Don't forget that these patients who come in often have real medical complaints, but not having been through any type of medical training are usually poor at reciting a chief complaint. They expect and have been sold on the notion that their "routine" exam covers everything under the sun. Diabetic with glaucoma, macular degen, bilateral cataracts, multifocal RGPs, with allergic conjunctivitis complicated with contact lens and multiple-medication-induced dry eye.... yep, VSP expects this to be a routine exam and is covered. Try convincing a patient otherwise if their medical copay is $20 and vision copay is $10.
Different plans have varying degrees of reimbursements. Huge corporations that have good reimbursing plans one year can suddenly have a lower reimbursing plan the next, even if the name remains virtually the same. These companies don't actively educate on this, but rather leave it up to our offices to explain and deal with the resulting confusion and irritation amongst plan participants.
In order to make any type of profit at all for a lot of these plans you must artificially inflate your usually and customary prices in order to take the hit. Can you imagine how attractive this makes your office to those silly private pay patients??? Not very, so they must search and search for some type of savior from the high prices of the private practice. Luckily, the vision plans are starting to advertise directly to consumers now so even those without plans through their employers are allowed to get in on the fleecing, I mean deal.
Bottom line. Vision plans are boarderline fraudulent in that many of the things the advertise covering would actually be covered by their health insurance, which they are already paying for. Redundant. Redundant. If that isn't bad enough, now vision plans are teaming with REAL health insurance companies in the hopes that eye doctors are stupid enough to do medical work for vision discount plan prices. Often times pride, ignorance, or something worse wins out and this occurs. Is it because every Tom and Sally graduating from optometry school these days wants to practice to their highest level, mode of practice be damned?
Cigna now requires all ODs to go through VSP for medical billing. Let me repeat, Cigna requires all ODs to go through VSP for medical billing. No one yet has pointed out to me what those medical reimbursements will be, or how much lower they are than the previously established provider/health insurer fee schedule agreements that are now apparently void. VSP requests medical diagnoses to be recorded when submitting vision claims. EYEMED requires medical diagnoses to be recorded when submitting vision claims. The choice for a provider is to fraudulently submit the claim, ignore it and not get paid anything, or fill it in "correctly" and provide these vision plans with further data on "our" patients which we be used to some as-yet-unknown end.
Mind you, these are the "good" vision plans. I'll leave the rather of garbage like spectera, cole, etc to someone else. Be assured that reimbursement can vary quite drastically depending on the region.
It is prepaid, meaning the companies already have your money or your employers money. They've already collected even if the services are never provided or the materials are never fabricated. Any wonder why they are listed as some of the best companies to work for in the nation? Imagine similar savings when setting aside that money in a tax-deferred health savings account and paying out of pocket for your routine exam and glasses AND you can go anywhere you choose because you are not limited to a manipulated provider list.
Shall I continue?
Great post, orangezero. Depressing, too.
