# Optical Forums > General Optics and Eyecare Discussion Forum >  Vsp insurance- take it or leave it?

## K Dog

We are a company in Wisconsin that does not take VSP insurance at this point and have been approached about joining again. I say again, because we where part of there plan about 7 years ago and then where dropped because we did not fit "their definiation of a provider owned location/s" We tried to get them to icrease their reimbursement for our network. We are provider owned, but you don't tell VSP what to do- they tell you. Best thing that ever happen to us. We had the largest increase in net profit. Saw less patients nad made more money.

So, I wanted to know has things changed? I want to keep an open mind?

Are they great to work with?

Frames? Do you need to carry high margin frames to make a profit?

Lenses?

Insurance processing?

Overall?

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## chip anderson

Near as I can tell it's a toss-up on whether you want to do a lot of junk work for little or no profit with a lot of paper hassel or whether you will be upset when you have patients come in, shop, find what they want and then ask: "Do you take VSP?" and leave.

Chip

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## K Dog

> Near as I can tell it's a toss-up on whether you want to do a lot of junk work for little or no profit with a lot of paper hassel or whether you will be upset when you have patients come in, shop, find what they want and then ask: "Do you take VSP?" and leave.
> 
> Chip


Thank you- We do provide a discount for VSP customers and also provide them with the stamped evelope and forms to fill out for "out of network" coverage.

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## cocoisland58

> So, I wanted to know has things changed? I want to keep an open mind?


Some things have changed namely VSP has dropped the "independently owned by a doctor" criteria for being accepted although mere opticians are still banned.
You can make a profit on frames if you buy selectively for lower cost than list price.
Were they ever great to work with?
Insurance processing?  Now that they are very good at.

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## Fezz

Try using the search function!

We may have discussed VSP a time or two before!

You will get many opinions, and I'll leave mine out of it! Hopefully Racethe1320 will chime in and give a different opinion from what many have!

Good luck on your decision!

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## finefocus

We take VSP, and do a lot of it, because without it our surgery business would fall way off. 
If we want to see (and ultimately provide surgery and medical treatment for) a teacher, or a nurse, or a Caltrans engineer, or.....we need to be a VSP provider.

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## racethe1320

> Hopefully Racethe1320 will chime in and give a different opinion from what many have!
> Good luck on your decision!


I smell that I'm being set up but I'll chime in with an opinion anyway.   The decision to accept and work with managed care is all up to you and opinions as such will very across the board.  Given the demographics on Optiboard, it appears many don't like working with the various plans.   That's okay, as you and many others have, a living can be made and in some cases quite a good one.  

I've taken VSP from nearly the onset of their plans and have a very large thriving practice that I do attribute much of the success from having made the choice to work with managed care.   I work all the plans to their fullest extent and from a profitability standpoint do very well.  Key is to utilize their programs and balance out any ego or emotion with providing the patient good products at a fair cost yet still maintain he profits you are looking to have.

I say emotion as many of the posts here are filled with it.  In the end, I'm here to run a business that cares for patients.  I have very little room for worrying about the emotions, cares and dramas that tend to make discussions interesting.  I sense by the tone of your post and interest in profits you will see where I'm coming from.

In the end, it's your call.   I have a significant staff among several locations and I have since moved onto insuring that my people enjoy a happy profitable work environment too.  So long as they do, their service level stays high, patients are happy and together we all deal with the ups and downs of managed care.  No big deal.  Of all the programs out there, VSP it's my opinion they are the best to work with.  Others may say otherwise and go down a completely different path, but that's okay as thankfully they run their own businesses not mine.

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## Fezz

> I smell that I'm being set up but I'll chime in with an opinion anyway.


No, not at all. I have grown to appreciate and respect your viewpoint on the topic. I also feel that if more of us would kick the grudge, that we may be able to learn from you and make our practice stronger and more profitable.

Thank you!

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## DragonLensmanWV

I think VSP would have more approval here if they would OFFICIALLY drop their requirement that the place be OD owned. They make so many exceptions (and it only takes one) that it damages their credibility in this respect. Besides, if they'd open up to more opticians, they would be an even bigger beast. Isn't that what they want in the end?

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## Uncle Fester

I'm trying very hard to drop the term insurance for any Managed Care plan. 

We take Eye Med and VSP and make an ok profit. I think their main advantage is the patient base they provide my doc's. We also are in a demographic that has a significant percentage of patients working for companies or in insurance plans that have it. We dropped Davis and Specterrible years ago and never regretted it for a moment.

What's the down side of taking it again and the dropping it if it doesn't work out?

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## kcount

Alright, after the first year with Eyemed and VSP out of network,  VSP payed 3X's as an 'Independent Provider' what Eyemed paid as an in-network provider.  By the way, VSP out of network is rather profitable if you have purchased correctly. Should you take VSP?  Yes, VSP brings volume with volume comes word of mouth and growth.  Besides, in the end you'll simply ween off the vision plans.  I took Eyemed, VSP and Spectera, this year Spectera is out and I'm opting out of many of the Eyemed programs. (turns out its better to bill Aetna directly)  My approach is not new many of done this especially in the dental world.

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## racethe1320

> I think VSP would have more approval here if they would OFFICIALLY drop their requirement that the place be OD owned. They make so many exceptions (and it only takes one) that it damages their credibility in this respect.


exceptions are just that, not the rule.  every business has them.    life isn't just black and white so you can't fault them for making exceptions where it makes business sense.  IMO, they already have way too many providers and heck, enough rabble rousing occurs in the market with people complaining about them, so why make exceptions for folks that don't truly support VSP?  That doesn't make sense.  IMO they should cut half the providers they have.   So many speak ill of them yet gladly see their patients and cash their checks....that to me is the real lack of credibility that needs squashed.




> Besides, if they'd open up to more opticians, they would be an even bigger beast. Isn't that what they want in the end?


I wouldn't say they are out to be a bigger beast.  Again, if you think VSP is the 800# gorilla, you're quite mistaken.  I can name 8-10 other companies in the is industry that are much larger and more controlling in the market place.   If you look at what they are really doing out there, it is supportive of their key practices not hurting them as much of the spin masters try and lead you to believe.  I'm supporive of their new private label products because they are solid designs that benefit the patient, they pay me more and they are unique in the market ie..not the same old Essilor, Zeiss and Hoya designs the mass sheepel out there offer and build their business on.  Bottom line is I see very little in the way of others stepping up to help support me, the independent, like VSP Does.

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## AustinEyewear

> Alright, after the first year with Eyemed and VSP out of network,  VSP payed 3X's as an 'Independent Provider' what Eyemed paid as an in-network provider.  By the way, VSP out of network is rather profitable if you have purchased correctly.


I'm curious how this works, being an out of network VSP provider?  Do you file, or does the patient?  Can Lenscrafters do this?  

What if a VSP patient wants to get glasses at some place that does not offer VSP?  Can they get the glasses and have VSP reimburse them?  What will VSP reimburse them I'm wondering?

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## kcount

I take the insurance as an out-of-network provider and file a CMS-1500  with VSP.  VSP typically has a check in my hands within 2 weeks.   The 'Independant Provider' program is a way of relaxing the patient. Typically I'll match the in network benefits on my eyewear. The exception being covered options such as PAL and ARC.  The patient is happy because they get the glasses and the benefit they want, I'm happy because I get the business and the dollars.  After a year I have found the loss to me is 30% of the retail dollars.  Thats an easy pick-up by simply buying better. Lenscrafters may be able to do this but it would probably fail. The patient can submit a form for reimbursement rather easily. There is a form provided on VSP's website for just this thing.  Google VSP reimbursement and something should pop up.   Realize this works on 95% of the plans out there, I have one person who is barred from using my office.

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## anthonyf1509

We do exactly what kcount does, with exception to matching. Pays quick and easy (online) and patients understand difference.
Those that feel they're losing out on benefits usually are who want free junk.

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## bigeyejim

> you will get many opinions, and i'll leave mine out of it! Hopefully racethe1320 will chime in and give a different opinion from what many have!
> 
> Good luck on your decision!


lol

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## bigeyejim

I would say if you are doing fine without them, don't join back up.  We are a VSP provider, but not Eyemed, and Eyemed does pretty well as far as reimbursing the patients for their "stuff."

If you can get the patients similar reimbursements from VSP, then do so and stay out of network.  

If you can get patients/customers without insurance sending them to you, then you'll be fine.  We rely on patient referrals, and don't need the insurance plans sending them.

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## drk

Taking VSP is not an optical decision, it's a optometry practice decision.  Capice?

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## Dr. Bill Stacy

I'm back here after a few years off.  I'm a VSP doc for 35 yrs + (since almost the very beginning of VSP).  Not being on the vsp list of course saves you from having to discount your services and materials on a regular basis, but that's also true of EyeMed, the other big plan here in CA.  The thing is, VSP is about 1/3 of my practice, EyeMed another 1/3 and the remaining 3rd is a mix of private pay, misc. plans, medicare, etc.  I know I could drop off the panel and tell my patients I can still see them, but unless I offer the same discounts as they now get, I'd probably lose at least half of them.  

Having said that, I have a new problem here that I'll bring up.  Maybe someone can tell me if there's a better place to post this>  I now have patients bringing me frames that were given to them, or that they purchased on line.  I see this as an increasing phenomenon that I must deal with.  My take is that since HCPCs codes don't split frames from frame services, i.e. V2020 is the code for frames, including supply of the frame and all associated services, I should be able to just bill the V2020 code and deduct the wholesale price of the frame from my UCR price for providing that frame. 

Initially VSP people say I can't do that, and that I could "get into trouble" doing it, but I've yet to claw up the ladder of authority there.  Any ideas?  (I've had 3 of these cases in the past 30 days).

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## Barry Santini

Frames, no matter what price point, are a commodity in the eyes of the consumer. When we sell a frame only to a client, often at just a keyston, and they are putting in lenses elsewhere, we ask if they wish to purchase the service bundle now or later for the frame. We explain that since frames are available on the internet, we'll price ours (not all, however) to be competative with frames only.

Most wont take the service package at intial buy in. Only if they have a problem/ need help later. Many providers will extend some frame service to lenses-only purchases ( frames not purchased here) in the lens costs.

Can't see any other way to do it.

B

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## Dr. Bill Stacy

Not sure what a keyston is but I take it you disagree with the idea of just subtracting the material out of my fee when I'm doing everything but buying the frame.  I see frames as a much more service intensive item than say soft contacts, which obviously allow separate materials from services.  By my count, when we furnish spectacles there are at least 11 steps we do, some of which are recurring (adjusting, replacing pads, screws, etc).  I do see soft contacts (not rigid) as commodity items.  I am moving to again lower my "sale" price for the contact materials down to actual cost and adjusting my contact service fees upward.  At that point I really don't care if the patient "buys" the contact lenses from me or from Costco or the internet.  Frames are more like rigid contacts, more custom and fitted, and actually do take some talent to fit properly.  Anyway, I'm taking this as far as I can with VSP and will report back my results.  BTW I could envision handing a patient a pair of finished lenses to go with his/her frame, and wish him the best of luck.  Maybe not.  I hate the pain whenever I shoot myself in the foot.

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## Barry Santini

Retail margins are typically a Keystone (2x) like the plano RayBans.

B

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## AustinEyewear

> Maybe someone can tell me if there's a better place to post this>  I now have patients bringing me frames that were given to them, or that they purchased on line.  I see this as an increasing phenomenon that I must deal with.  My take is that since HCPCs codes don't split frames from frame services, i.e. V2020 is the code for frames, including supply of the frame and all associated services, I should be able to just bill the V2020 code and deduct the wholesale price of the frame from my UCR price for providing that frame. 
> 
> Initially VSP people say I can't do that, and that I could "get into trouble" doing it, but I've yet to claw up the ladder of authority there.  Any ideas?  (I've had 3 of these cases in the past 30 days).


Dr. Stacy - Thanks for pointing this out.  After spending 2 hours looking into this this morning  (like we don't have better things to do, this is one thing I can't stand about VSP, its a decoding process to figure out what occurred and if you were paid properly), I think you may be on to something here.  Need more time to look, still not done, please keep this thread alive or feel free to PM me on this issue.  I intend to follow thru with this as well.

BTW : Interestingly, I am finding quite a bit pts are using lens benefits for one purchase, and frame benefits for another.  Need to verify if we are at getting dispense fee for at least one of these.

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## Dr. Bill Stacy

> Retail margins are typically a Keystone (2x) like the plano RayBans.
> 
> B


Yes, I get that, although I rarely, I mean RARELY have anyone buying a regular ophthalmic frame for filling the Rx somewhere else. My pricing structure on frames consists of a modest markup for the materials and a service "bundle" that I have never separated out, esp. in writing.  I can see having to change that now, esp. if I'm gonna be successful billing anything for patient supplied frames. I'm considering taking the "markup" component down to zero except for those rare cases where a patient is having the Rx done elsewhere, or in the slightly less rare case of a non-Rx sunglass. A guy named Joe Farrington, O.D. preached the importance of separating services from materials 40 years ago and all his predicitions seem to be coming true.  I still get some pushback on charging contact lens refitting service fees, but considerably less than when I started that 25 years ago, when few of us did.

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## Dr. Bill Stacy

I think VSP no longer breaks out dispensing services from either frames OR from lenses.  The EOMB doesn't even mention "dispensing" on lens items any more, and frames are now called "frame/disp." Worse yet, they do not allow us to charge anything for re-dispensing a patient's old frame (they used to, but quit that a year or 2 ago).

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## Dr. Bill Stacy

Here's my list of costs associated with fitting frames vs. just selling frames as a commodity.
Costs associated with handling spectacle frames.



Evaluating the fit, style, and     optical suitability of a frame for the patient's spectacle Rx,     his/her facial characteristics, and intended use of the glasses.Measuring and determining the     proper sizing of the frame.Specifying all the frame     parameters on the lab order and claim form, if any.Submitting and/or printing the lab     order.Shipping the frame with the order.Inspecting the frame on receipt     back from the lab, or physically inserting the lenses into the frame     in cases of lens only orders.Initial adjusting of the frame for     the patient's head.Re-adjusting the frame throughout     the life of the frame (usually 2 years)Minor repair/replacement of wear     items (nose pads, screws, etc, also for ~ 2 years)Handling warranty replacement of     defective frames for ~ 2 years. 


 Of course in addition to these, there is the cost of maintaining a show room fully stocked with different sizes, colors and styles of up-to-date frames.

So I maintain that when I provide a <wholesale pricing removed as per forum rules>.

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## AustinEyewear

Good list.  May want to add tracking and verifying insurance reimbursements were accurate and honored.

Also, selling a commodity i.e. contact lenses doesn't not require other risk factors such as:

1. Potential issues once frame is dispensed i.e remakes, which requires you to run thru most of those steps again
2. Risk of losing a different patient (potential more profitable one) because your dispensary is too busy.  (a frame or lense sale can take hours, a contact lense sale is usually a 5-10 minutes)
3. Risk of frame being broken

These factors are big considerations with dealing with pts who bring in their own frame, especially with a patient who orders a "covered" lense.  Now you are performing the entire process for nearly free (actually losing money) with the potential risks mentioned.

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## opticianbart

> I think VSP would have more approval here if they would OFFICIALLY drop their requirement that the place be OD owned. They make so many exceptions (and it only takes one) that it damages their credibility in this respect. Besides, if they'd open up to more opticians, they would be an even bigger beast. Isn't that what they want in the end?


Near as I can tell they don't seem to see opticians as any sort of eyecare professional - Last time I had to figure out a reimbursement question with them, they sent me in neverending circles of "call this number" or "we'll switch you over to this number" always with the same result of "Ask the doctor at your location they'll know the answer."  To which I generally replied "Why would the doctor know? He pays me to know more about glasses than him!"

For those wondering, it was a question about what a specific plan considered to be a "Standard progressive."  Turned out the answer was "Whatever progressive is cheap enough to be covered by the few measly dollars they paid for it."  Which, the more I work with them, the more I realise that should have been self evident.

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## Dr. Bill Stacy

Thanks, yes those are good and will add them to my letter to my VSP liason.  Will report status/result here. (reply to Austin post).

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## Dr. Bill Stacy

> Near as I can tell they don't seem to see opticians as any sort of eyecare professional - Last time I had to figure out a reimbursement question with them, they sent me in neverending circles of "call this number" or "we'll switch you over to this number" always with the same result of "Ask the doctor at your location they'll know the answer."  To which I generally replied "Why would the doctor know? He pays me to know more about glasses than him!"
> 
> For those wondering, it was a question about what a specific plan considered to be a "Standard progressive."  Turned out the answer was "Whatever progressive is cheap enough to be covered by the few measly dollars they paid for it."  Which, the more I work with them, the more I realise that should have been self evident.


Yeah, the problem with having opticians on the list is they dont' usually offer eye exams, and the plan was set up mostly for eye exams.  But that's ancient history.  VSP has actually done a little deal with Costco for goodness' sake.  So regular opticians can't be far behind.

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## Greg Hazard

VSP is now putting dispensaries, with VSP OD's and their VSP frames, in the corporate HQ's of 3M, Medtronic, and Best Buy here in Minneapolis.  Several area clinics depended on those VSP customers.  They are going to be in a hurting business mode.  It is their own fault taking pennies on the dollar and giving their services and products away.  They thought VSP would be loyal to them.they are not.  They thought they would be better off taking VSPnow theyre not.  Will VSP help them with their Going Out of Business Sale..probably not.

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## racethe1320

> VSP is now putting dispensaries, with VSP OD's and their VSP frames, in the corporate HQ's of 3M, Medtronic, and Best Buy here in Minneapolis.  Several area clinics depended on those VSP customers.  They are going to be in a hurting business mode.  It is their own fault taking pennies on the dollar and giving their services and products away.  They thought VSP would be loyal to them….they are not.  They thought they would be better off taking VSP…now they’re not.  Will VSP help them with their “Going Out of Business Sale”…..probably not…….


Actually, it's the other way around.  The clients have been soliciting vendors, namely VSP to put these clinics in place.  Yes, they are VSP Clients and were on their way to ex-clients either way.  VSP Made a move to retain their business.  You can't fault them for that as doing nothing is a rather dumb option.   I won't repeat all my posts about how doctors in the area were asked to participate...especially at Cisco and all said no.  

I'd also like to know where you heard they are giving away services and product for pennies on the dollar.  Show me proof as if you're interested, I'll gladly connect you with the folks that run the dispencaries, again, namely Cisco and you can find out first hand that such a statement is not true.  In fact, please, contact them and come back with the details.

You do realize what would happen to the business in that area should VSP Have said no right?    The clinics were going up regardless, but they would be serviced by another managed care provider.

Bottom line is if you feel you're being cut out somehow, I suggest you find out why a patient would rather go to an onsite clinic vs you.  Why wouldn't they go to you if all else was equal?  That's most certainly not VSP's doing or fault.  No different than if a patient goes to Costco or any other provider for that matter.   You own that, not VSP.

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## EyeCare Rich

Oh, the hard learned truth.  Some folks need to hear it the hard way racethe1320.  I agree, VSP didn't have much of a choice, either put in the clinics, or loose the client to someone who would.  The way of the world.

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## racethe1320

> Oh, the hard learned truth.  Some folks need to hear it the hard way racethe1320.  I agree, VSP didn't have much of a choice, either put in the clinics, or loose the client to someone who would.  The way of the world.


It's not even just that VSP would lose a client and all their employees, it's in turn then, the private practice OD's would then also lose a VSP Patient.  Either they would go retail via another managed care provider or for those that did stay with their existing ECP, the reimbursements would drop thanks to said Managed Care plans.  Not to mention what message it would send to the marketplace that VSP wouldn't step up to support a long term client coming to them.

Again, no surprise all the clinics are popping up.  It's how the market is going in terms of large companies needing to better managed their own costs and control more of their own destiny.  Large companies have been doing it for years.

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## David_Garza

WITHOUT VSP.......



> We had the largest increase in net profit. Saw less patients nad made more money.
> 
> Overall?


If you are happy with current patient revenues and profit then why even consider adding one or any additional Vision Plans to you office??????

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## AustinEyewear

> It's not even just that VSP would lose a client and all their employees, it's in turn then, the private practice OD's would then also lose a VSP Patient.  Either they would go retail via another managed care provider or for those that did stay with their existing ECP, the reimbursements would drop thanks to said Managed Care plans.  Not to mention what message it would send to the marketplace that VSP wouldn't step up to support a long term client coming to them.
> 
> Again, no surprise all the clinics are popping up.  It's how the market is going in terms of large companies needing to better managed their own costs and control more of their own destiny.  Large companies have been doing it for years.


Well, to be fair, those pts might just change to another plan - a plan that we may carry and still come to see us.

I wonder what VSP would do if they could not get into these campuses?  Would they build a "VSPCrafter" in the mall?

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## kcount

The Local hospital is about to open an in-house optical with in-network VSP.  OD's for the exams?  Nope. Preminate Corneal specialist in the nation sits in this hospital her office is all MD based with one very part time OD for CL work.  10,000 people in the hospital group need eyecare and VSP could either play ball or lose the contract.  They chose wisely.





> It's not even just that VSP would lose a client and all their employees, it's in turn then, the private practice OD's would then also lose a VSP Patient.  Either they would go retail via another managed care provider or for those that did stay with their existing ECP, the reimbursements would drop thanks to said Managed Care plans.  Not to mention what message it would send to the marketplace that VSP wouldn't step up to support a long term client coming to them.
> 
> Again, no surprise all the clinics are popping up.  It's how the market is going in terms of large companies needing to better managed their own costs and control more of their own destiny.  Large companies have been doing it for years.

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## David_Garza

> The Local hospital is about to open an in-house optical with in-network VSP.  OD's for the exams?  Nope. Preminate Corneal specialist in the nation sits in this hospital her office is all MD based with one very part time OD for CL work.  10,000 people in the hospital group need eyecare and VSP could either play ball or lose the contract.  They chose wisely.


No way the MD is doing ANYTHING other than signing his name to the vocational technicians findings.....okay and maybe doing a quick spot check of the posterior pole just so the patient sees a doctor in the exam room.

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## racethe1320

> Well, to be fair, those pts might just change to another plan - a plan that we may carry and still come to see us.


True, but statistically it's going to be EyeMed which will drive them to retail and continue to do so, thus in the end, it's just a matter of time before you lose the vast majority.  Besides that, VSP does run a business and are wise to have stayed in the fight.




> I wonder what VSP would do if they could not get into these campuses?  Would they build a "VSPCrafter" in the mall?


Doubt it.  Why would they open a retail store?  It's not their model.  EyeMed is a lost-leader Managed Care plan to fund the well established retail branding that Lux has built their business upon.  It's a very expensive model to maintain, thus their need to drive sales as their stores do.  VSP already has a slew of retail locations in all of their panel providers.  They don't have the product side yet but they also have none of the overhead, so in the end the model works for them.  The difference is they are moving into the materials space and sharing the profits with their panel docs.  EyeMed/Lux has never and will never do such a thing with any independents. The _only_ reason Lux _tolerates_ their own supporting of independents on their plans is to have the Ace card of 82% overlap in providers, which is their pitch to benefit managers.

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## Dr. Bill Stacy

> True, but statistically it's going to be EyeMed which will drive them to retail and continue to do so, thus in the end, it's just a matter of time before you lose the vast majority.  Besides that, VSP does run a business and are wise to have stayed in the fight.
> 
> 
> 
> Doubt it.  Why would they open a retail store?  It's not their model.  EyeMed is a lost-leader Managed Care plan to fund the well established retail branding that Lux has built their business upon.  It's a very expensive model to maintain, thus their need to drive sales as their stores do.  VSP already has a slew of retail locations in all of their panel providers.  They don't have the product side yet but they also have none of the overhead, so in the end the model works for them.  The difference is they are moving into the materials space and sharing the profits with their panel docs.  EyeMed/Lux has never and will never do such a thing with any independents. The _only_ reason Lux _tolerates_ their own supporting of independents on their plans is to have the Ace card of 82% overlap in providers, which is their pitch to benefit managers.


Well now this is interesting.  I'll throw in some of my take on this, as both a vsp and an eyemed provider.  One thing I haven't seen on this thread (I'm brand new here after quite a long hiatus), is the IOF thing with VSP.  In Office Finishing is a new thing I bought in to a year ago, and VSP allows me to finish single vision lenses in my own office, and even multifocals on some plans (RNP, State of Calif., etc).  It's another little bone they threw us and I kind of like it.  I put in a Santinelli setup and it works pretty well.  

As for Eyemed, I have learned that they really allow the provider to make money, mostly at the expense of the patient.  

I have to admit to loving their 80% of UCR for most lens options.  I'm still not quite used to getting that much for those things.  

I concur that Eyemed mostly tries to push members to their own stores, but as the examining doc, I can control most of that.

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## David_Garza

Dr Bill,

I still don't under stand why you would reconsider taking VCP when you even stated that after dropping the 1st time your profits increased with less volume.....That's a home run so why would you want to go back????

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## kcount

> No way the MD is doing ANYTHING other than signing his name to the vocational technicians findings.....okay and maybe doing a quick spot check of the posterior pole just so the patient sees a doctor in the exam room.


But it works. Oh, and those vocational technicians give one hell of a refraction by the way. I have been saying for years now. the biggest threat to optometry is not from vision plans, retailers, or opticians. It's the Technicians.  If PA's get stand alone exams in texas (?) how long do you think it would take for a smart MD to set up satelite offices and have a COMT do the exams and refer all medical findings to the MD?  COMT ~$70G per anum depending on market.  OD ~100G per annum again depending on market.

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## Dr. Bill Stacy

> Dr Bill,
> 
> I still don't under stand why you would reconsider taking VCP when you even stated that after dropping the 1st time your profits increased with less volume.....That's a home run so why would you want to go back????


I think you confused me with someone else.  I have always been a VSP doc since 1971.

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## David_Garza

> We are a company in Wisconsin that does not take VSP insurance at this point and have been approached about joining again. I say again, because we where part of there plan about 7 years ago and then where dropped because we did not fit "their definiation of a provider owned location/s" We tried to get them to icrease their reimbursement for our network. We are provider owned, but you don't tell VSP what to do- they tell you. Best thing that ever happen to us. We had the largest increase in net profit. Saw less patients nad made more money.


Sorry I was asking the OP why they would go back when profits increased after dropping them....

----------


## Barry Santini

In today's LI paper NEWSDAY, it was announced in a story that Marchon (VSP):

1. Will be hiring approximately 53 people.
2. Opening an "ophthalmologic" clinic here (in the US, probably near their home office on LI)

????

B

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## AustinEyewear

> In today's LI paper NEWSDAY, it was announced in a story that Marchon (VSP):
> 
> 1. Will be hiring approximately 53 people.
> 2. Opening an "ophthalmologic" clinic here (in the US, probably near their home office on LI)
> 
> ????
> 
> B


Very interesting Barry, thanks for pointing that out.  Here is the link and part of the article :

http://www.newsday.com/business/marc...n-li-1.3122187





> Marchon Eyewear Inc. plans to reorganize its office and warehouses in Melville and to open a laboratory for making lenses and filling prescriptions, officials said Thursday. 
> 
>                                 The lab would add 25 jobs to a workforce of 528, leading Suffolk  County Thursday to give preliminary approval for a sales-tax break of  $600,000 on construction materials and equipment for the project.The  maker and distributor of fashion eyeglasses, sunglasses and 3-D glasses  hopes to move into rented offices at 201 Old Country Rd. That's about  three miles north of the current headquarters at 265 Spagnoli Rd., also  in Melville.
>                                 Marchon also will upgrade buildings at  35 and 50 Hub Dr. that were purchased in January by its parent, VSP.  Both will be used as warehouses and 35 Hub Dr. will be home to an  ophthalmologic lab for lens making.
>                                               Cost of the reorganization is $27.5 million, including $16.8 million in rent.
>                                 The county's Industrial Development  Agency acted Thursday in part because Marchon is considering whether to  locate the lab here or elsewhere.
>                                 Thomas Stringer, a consultant to Marchon, said the lab could be located in Columbus, Ohio, and Sacramento, Calif. He added work done in Melville could be moved to China and Montreal.
>                                 "They are looking for a level of  certainty," Stringer told the IDA, referring to a request for freezing  property taxes for several years.
>                                 Citing the move from New York State by another Long Island  eyewear business, IDA vice chairman David Rosenberg said Marchon's  threatened departure was credible. "Knowing what Luxottica has done, it  makes sense to try to keep [Marchon] here," he said.
>                                 Last year, Luxottica Group closed a Port Washington  warehouse, moving the work to Atlanta and California. About 136 jobs  were eliminated out of a total of 428. However, the company will keep  its continental office here."

----------


## AustinEyewear

> But it works. Oh, and those vocational technicians give one hell of a refraction by the way. I have been saying for years now. the biggest threat to optometry is not from vision plans, retailers, or opticians. It's the Technicians.  If PA's get stand alone exams in texas (?) how long do you think it would take for a smart MD to set up satelite offices and have a COMT do the exams and refer all medical findings to the MD?  COMT ~$70G per anum depending on market.  OD ~100G per annum again depending on market.


Interesting.  I suppose O.D.s could do same thing.  I would think that the MD must be in the office and the PA must be working under the supervision of the MD in order for this to work.  They must be available at notice, not hours later. Not sure if that is true, but makes sense, so I don't see how satellite offices would work if that is true.

 I'll point out a PA is not an optometrist, nor could they replace one, they are, PAs.  Otherwise, there would be no need for the focused, higher education that an OD receives.  While we're at it, why don't we just go ahead and eliminate the incentive for higher education and subsequently all universities in this country and become a 3rd world country, let China and India to continue to pump out PHD's and we'll all soon be begging them for military protection.  :Help:

----------


## racethe1320

> Well now this is interesting  In Office Finishing is a new thing I bought in to a year ago, and VSP allows me to finish single vision lenses in my own office, and even multifocals on some plans (RNP, State of Calif., etc).  It's another little bone they threw us and I kind of like it.


It is a good program.  We've been doing in office work for years and I'm glad I can move into it with my VSP Patients where it makes sense.   It's good for them and the market overall too.  It's a way for them to pinch the other competitve labs even when they don't get the lab work thus forcing everyone to become more efficient.  It also puts pressure on Essilor and the others that are in total control of the materials space.  For us, they leverage their buying power to get good pricing and yes, I can earn $10-$32 more (my average) per fit than before.  I already have the staff and business model, so now it really adds up to making sense.




> As for Eyemed, I have learned that they really allow the provider to make money, mostly at the expense of the patient.  I have to admit to loving their 80% of UCR for most lens options.  I'm  still not quite used to getting that much for those things.


Yep, everyone is out to push it to the consumer and client level aren't they?  It often appears EyeMed may pay you more, but keep in mind they don't pay your lab bill Like VSP Does, so that money may be yours to do spend as you wish, but lab bills need to be paid with it too. 




> I concur that Eyemed mostly tries to push members to their own stores, but as the examining doc, I can control most of that.


I disagree in terms of your not having control.  Sell in the lane and handoff those patients to your staff in the dispensary.   Like or not, we're in a business where retail is a huge portion of our money source.  Perhaps it's just me, but I always assume the sale and move the patient along the process at my locations.  If any of my docs do it differently, they are working for the wrong guy.  We have a dispensary in every location and it's expected that we do all we can to keep patients with us for materials.




> In today's LI paper NEWSDAY, it was announced in a story that Marchon (VSP):
> 1. Will be hiring approximately 53 people.
> 2. Opening an "ophthalmologic" clinic here (in the US, probably near their home office on LI)
> B


53 people sounds like a lab.....but what do I know.....

----------


## B101875

I have worked for a couple of OD's that have taken VSP.  The labs are ok the turn around time is ok and the pts are better than most.  Infact it seems that these are the pts that are paying a little extra to pay for a frame.  you just have to make sure that  none of your frames are listed below $150 on your board.

----------


## Dr. Bill Stacy

> It is a good program.  We've been doing in office work for years and I'm glad I can move into it with my VSP Patients where it makes sense.   It's good for them and the market overall too.  It's a way for them to pinch the other competitve labs even when they don't get the lab work thus forcing everyone to become more efficient.  It also puts pressure on Essilor and the others that are in total control of the materials space.  For us, they leverage their buying power to get good pricing and yes, I can earn $10-$32 more (my average) per fit than before.  I already have the staff and business model, so now it really adds up to making sense.
> 
> 
> 
> Yep, everyone is out to push it to the consumer and client level aren't they?  It often appears EyeMed may pay you more, but keep in mind they don't pay your lab bill Like VSP Does, so that money may be yours to do spend as you wish, but lab bills need to be paid with it too. 
> 
> 
> 
> I disagree in terms of your not having control.  Sell in the lane and handoff those patients to your staff in the dispensary.   Like or not, we're in a business where retail is a huge portion of our money source.  Perhaps it's just me, but I always assume the sale and move the patient along the process at my locations.  If any of my docs do it differently, they are working for the wrong guy.  We have a dispensary in every location and it's expected that we do all we can to keep patients with us for materials.
> ...


Apparently a typical spellchecker mistake, "ophthalmologic lab" instead of "ophalmic lab".

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## Dr. Bill Stacy

oops, even I can make mistakes:  ophthalmic lab   

I seem to have stopped even noticing the squiggly underlines....

----------


## bigeyejim

> Yep, everyone is out to push it to the consumer and client level aren't they?  It often appears EyeMed may pay you more, but keep in mind they don't pay your lab bill Like VSP Does, so that money may be yours to do spend as you wish, but lab bills need to be paid with it too.


I did a quick calculation, and since I can't put actual dollars on here, I'll summarise. 

I don't believe that VSP fully "pays the lab bill," as you can ask anyone who owns a contract lab and they will tell you differently.  We basically split the difference.  VSP charges providers and the labs for the lenses, as a "chargeback."  Sure, it might not be as much as what we would normally pay for lenses, but they do not fully pay for the lab.  

If we all check our VSP Options Chart, it will have the Patient Fee, the Service fee, and the difference is the Charge Back.  That's our charge for COGS.  

The bigger question is which plan do you make more money on?  Even if you had a 20% off plan (Eyemed), I feel you could make just as much money off that plan than VSP, even considering your COGS.  Maybe more depending on what lenses you are using.  I calculated what I would make off a private pay progressive patient (love alliteration) versus a VSP patient, and just for lenses VSP was at 75%, meaning a 25% "discount."  That included the Chargeback from VSP. 

FWIW..

The original question was would you go back to vision plans, and I say again that if you are already happy without it, don't go back.  

 :Smile:

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## Dr. Bill Stacy

The main difference between eyemed and vsp is that eyemed reimburses less than vsp for most covered items, but allows you to charge anything for non-covered options.  vsp dictates how much you can charge for most non-covered options.  Do NOT use vsp's patient option fee schedules to guide your UCR rates.  Always claim your UCR even when you have to accept a lower fee on covered individuals.  Here's an example of best AR coating on common plans:

Avance' coating:  Usual and Customary        VSP signature Patient Pays:      EyeMed Intel Employee Pays

                               60                                      60                                        48                           
                               80                                      75                                        64
                              100                                      75                                        80
                              150                                      75                                       120

If your UCR is EVER lower than the top reimbursements of any plans, you might need a lesson in how not to shoot yourself in the foot.

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## Dr. Bill Stacy

oops again, dollar amount formatting didn't line up with headings. oh well, you get the idea.

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## bigeyejim

> If your UCR is EVER lower than the top reimbursements of any plans, you might need a lesson in how not to shoot yourself in the foot.


Yessiree!  

I bet both plans come out pretty close.  I would tend to think (and I am not a provider of EyeMed) that if your UC charges are high enough, without pricing yourself out of the market, that the 20% off plans would be better. 

Meh.

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## jcamp

We are kicking Davis to the curb right now. Next up Spectera, after that...

----------


## racethe1320

> I did a quick calculation, and since I can't put actual dollars on here, I'll summarise. 
> 
> I don't believe that VSP fully "pays the lab bill," as you can ask anyone who owns a contract lab and they will tell you differently.  We basically split the difference.  VSP charges providers and the labs for the lenses, as a "chargeback."  Sure, it might not be as much as what we would normally pay for lenses, but they do not fully pay for the lab.  
> 
> If we all check our VSP Options Chart, it will have the Patient Fee, the Service fee, and the difference is the Charge Back.  That's our charge for COGS.  
> 
> The bigger question is which plan do you make more money on?  Even if you had a 20% off plan (Eyemed), I feel you could make just as much money off that plan than VSP, even considering your COGS.  Maybe more depending on what lenses you are using.  I calculated what I would make off a private pay progressive patient (love alliteration) versus a VSP patient, and just for lenses VSP was at 75%, meaning a 25% "discount."  That included the Chargeback from VSP. 
> 
> FWIW..
> ...


Actually *VSP does pay your lab bill in full on a VSP Jobs*.  You don't split anything.  You're confusing a chargeback in using the term split.   However on a VSP job, as a VSP approved doctor you should *never* be receiving a bill directly from a contract or VSP Wholy owned lab for any additional amounts on VSP Patients.   If you do then the lab is double-dipping on you and let's just say that's a HUGE issue, but I can't see anyone doing that even by accident let alone purposely. 

When you see a VSP Patient, you're reimbursed through VSP for your exam, refraction and all dispensing fees for services provided to that patient.  Chargebacks are VSP's withdrawl of money from your EOP (money that you collected from a patient for upselling them from CR39 to say 1.67 or upselling them transitions, etc....) that withdrawl of money aka chargeback is what is then used to pay the contract lab for that upgrade as they incur that cost by providing the material to you.  Does that make sense? 

  EyeMed is different, they pay you the money on your EOP and then YOU are then resposible for paying your lab.   Don't confuse things with EyeMed pays you more and then think VSP _takes_ money from you.....it's the other way around, VSP Pays you more and then in turn even pays your lab for you.  EyeMed says,_ "here doctor Jim, take $xxx and go get the job done and pay the lab you in turn use"  _ A contract lab in turn has to go collect from all thousands of their doctors each month....that sucks...it's way better for them to get paid directly from VSP regularly without having to do anythign.

So for example, if you have a VSP Patient order transitions, they pay out of pocket $76, you order transitions through the lab, VSP reimburses you $76 then takes a chargeback out because VSP paid the contract lab on your behalf for that transitions _they_ provide you.  You then keep the $25 difference.  Do you follow that?   The contract lab is made wholeon their $51 COG's through VSP, thus why VSP is seen as the largest customer of every lens company as they pay all 250+ VSP approved lab's bills for the lenses supplied to VSP Patients.   Essilor, Hoya and others love it because they have 1 huge customer that pays very timely.  Contract labs and doctors too get paid twice per month, thus they love it.  

It's the same on a frame...VSP pays you the wholesale amount of the frame up to a certain amount depending on the plan and you get a dispensing fee.  If you want to earn more than just the dispensing fee, that's fine, go SELL!!!.   Then you collect and keep the difference of the patients allowance and what you're frame costs them and keep both that additional amount and the dispensing fee.    Thus when my people see VSP Patients, we start them with the higher end costing frames and congratulate them on being able to apply their frame benefit towards them.  I've seen office complain about it but it's because they take the patient to frames that are fully covered by their benefit.  Dumb and poor business.

It's the same the same with AR and any uncovered option.  So if I sell an upgrade, even an uncovered option, we collect the money from the patient and the chargeback is simply VSP taking the money back to cover the check they wrote to pay the lab for said options COGS.  I just had a patient yesterday order Crizal Saphire.  VSP Covers $xxx dollars for thier plan, however, I collected that amount plus the difference for saphire.  When I get my EOP, it will show a chargeback because VSP is paying the Essilor lab in Dallas that provides Saphire their COGS's.   Make sense still?

I hope that clarifies things, but in the end, if you're taking VSP Patients and are an approved panel doctor, *VSP does pay your lab bill in full on VSP Patients*.  They even cover shipping both ways.    EyeMed does not provide this service to you or any contract lab. Go figure....  So just remember that when calculating the two against one another.

----------


## racethe1320

> The main difference between eyemed and vsp is that eyemed reimburses less than vsp for most covered items, but allows you to charge anything for non-covered options.  vsp dictates how much you can charge for most non-covered options.


Ding, ding, we have someone who understands it all.  Thank you.   So now the OP should understand how to make money on both plans and also see why for the patient, VSP Does provide a better value.   Managed care isn't here to be the money tree for doctors.  Their  customers are business and their employees.   We are simply PROVIDERS  who willingly accept contracted fees to provide services to said clients and  their employees.  No one is forcing any of us who accept managed care to  do that.   It's the same with contract labs.   They don't have to provide services for VSP for set pricing.  They too would much rather bill all of us their U&C fees less a discount (since they are a wholesale lab) vs taking what VSP or managed care companies provide.  However, they are paid timely by said managed care companies and paid quite well so the model for them is very profitable.  It still amazes me that they bi tch so much though.

As a doctor if you don't like VSP Dictating max. charges, then don't take VSP.  That's a choice you as a provider to their clients employees you make.  Lot here, including DRK don't like hearing that, but YES, they are VSP clients first, your patients second.   You can't look at it as if VSP is taking your clients.  That's like saying without Iran and Iraq, all that oil over there would costs less or be ours.   Without dry weather my grass would grow.  The realiity is this is 2012, not 1968 and managed care is a reality.  If you don't like it, then go live off private pay. Many do.

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## AustinEyewear

> Actually *VSP does pay your lab bill in full on a VSP Jobs*.  You don't split anything.  You're confusing a chargeback in using the term split.


I actually loathe this.  Makes it too difficult to run accounts receivable.  The only advantage I have been able to find for the OD is that VSP has the ability to control lense prices for you.  But in reality, your collecting money for VSP and then they take it away from you in the form of a chargeback. This can be looked at from two perspectives. One, pt just sees you "rolling in the bucks", little do they know VSP is going to turn around and take the money from you.  Two, its actually a good thing should your pt ever switch to a private payer.  Then they are used to paying something for the lenses.  To get the best of both worlds, I would prefer to just collect the money, and pay the lab bill, and be in total control my accounts receivables.  Running thru all of VSP's financial "over engineered" payment system is enough to make even Einstiens head spin.

----------


## racethe1320

> I actually loathe this.  Makes it too difficult to run accounts receivable.  The only advantage I have been able to find for the OD is that VSP has the ability to control lense prices for you.


VSP controls lab prices as it relates to VSP work overall as they has contracted _discounted_ prices that ECP's benefit from as their program allows you to use _any_ VSP approved lab and the costs for your work remains the same.  They also help insure low prices from the lens makers too since they are the sole customer vs. if all thier contract labs were to try and buy from the lens makers.  So in the end, by doing so, it saves the ECP & contracted labs time money.




> But in reality, your collecting money for VSP and then they take it away from you in the form of a chargeback. This can be looked at from two perspectives. One, pt just sees you "rolling in the bucks", little do they know VSP is going to turn around and take the money from you.


You see it as collecting money _for_ VSP, but then you could also look at it as VSP is paying a bill _for_ you too.  Think about the benefit that is for their contract labs.  It's huge. Especially in terms of their managing recievables.   From a patients standpoint, I don't don't agree with your point.  The patient is always going to think you're rolling in it as you're the doctor.  However, they aren't so dumb as to think you don't have a COG's associated with the products you sell.   

Can we ditch the VSP is taking money already? VSP isn't _taking_ anything as that would imply you're entitled to the chargeback.  You're not, those moneies are to cover COG's they are paying on your behalf thus are moneies you would be paying out anyway.  Again, it's all the same to the patient.  In fact an educated patient would see that for what it is, a means of reducing costs.




> Two, its actually a good thing should your pt ever switch to a private payer.  Then they are used to paying something for the lenses.  To get the best of both worlds, I would prefer to just collect the money, and pay the lab bill, and be in total control my accounts receivables.


Sure you would, but then who would insure you're paying your contracted lab in a timely fashion? How about the 28,000 other panel providers?   Under the current system contracted labs performing VSP work are happier than can be as there's never any VSP related work at any VSP Practices that has an outstanding balance.  By insuring your bills are paid in full, VSP is also reducing the likelihood that one of their clients/covered lives is working with a practice that's on credit hold.  The beauty is that even if you slack off on paying your private pay work, your lab will likely just reject private jobs as they know you're good for the money on VSP Jobs beause they are paid by VSP.   It's a great system actually.




> Running thru all of VSP's financial "over engineered" payment system is enough to make even Einstiens head spin.


Maybe for some but the intent is to insure timely payments and reduced costs.  So for all those that say VSP doesn't care....they have much better system for looking out for their ECP's, Contracted labs and patients than EyeMed does.

----------


## AustinEyewear

> Can we ditch the VSP is taking money already? VSP isn't _taking_ anything as that would imply you're entitled to the chargeback.  You're not, those moneies are to cover COG's they are paying on your behalf thus are moneies you would be paying out anyway.  Again, it's all the same to the patient.  In fact an educated patient would see that for what it is, a means of reducing costs.


Sorry poor choice of words (taking) on my part.  This all goes back to their overengineered system.  I would rather just charge the pt for the upcharge, and not deal with the so called chargebacks.  What is a chargeback anyway?  I've studied business, and don't ever recall that term.  Pretty sure its something VSP invented. Or the credit card industry.  Anyway, I think you see my point.  They are a PIA.




> The patient is always going to think you're rolling in it as you're the doctor.


LOL.  Probably true of any business owner....



> Sure you would, but then who would insure you're paying your contracted lab in a timely fashion? How about the 28,000 other panel providers?


True, I'm sure it works great for them.  It doesn't work great for me though.  We don't slack on paying our bills.  It is part of our company DNA.




> Running thru all of VSP's financial "over engineered" payment system is enough to make even Einstiens head spin.                      
> 
> 
> Maybe for some but the intent is to insure timely payments and  reduced costs.  So for all those that say VSP doesn't care....they have  much better system for looking out for their ECP's, Contracted labs and  patients than EyeMed does.


My goal is to be able to reconcile a statement down to the penny within a reasonable amount of time.  About the same time it takes to reconcile a bank statement.  If I can't meet that goal, then something is wrong.  VSP reimbursement systems does not allow me to meet that goal.  If there is anyone out there that has figured out a way to do this, please PM me.  I will be willing to pay for the software that allows me to do this.

----------


## racethe1320

> Sorry poor choice of words (taking) on my part.  This all goes back to their overengineered system.  I would rather just charge the pt for the upcharge, and not deal with the so called chargebacks.  What is a chargeback anyway?  I've studied business, and don't ever recall that term.  Pretty sure its something VSP invented. Or the credit card industry.  Anyway, I think you see my point.  They are a PIA.


What you call an overengineering of the systm is simply a practice that insures payments on invoices.  You're right, it's not done to protect you, it's done to protect the patient so that if a practice doesn't pay a lab for their services, the patient visiting said practice doesn't incur an inconvenience because the office is on credit hold and possibly unable to deliver services and materials.  Again, that patient is the first and foremost concern to any managed care company.   The patient and their employer are their customer.  You can fault that type of assurance.

By that same account, such a system insurs the contract labs are made whole are made and is insurance to the contracted labs that they are promptly which goes to insure they too perform for you.

In the end, it may be a little more work for you, but your accounts payables in turn have less to manage as well.  Doctors are among the worst business people out there and that's not something we need to debate.





> True, I'm sure it works great for them.  It doesn't work great for me though.  We don't slack on paying our bills.  It is part of our company DNA.


Perhaps, but when you have a network as vast as VSP, there have to be assurances that everyone does the same.  Honor systems and company DNA like yours isn't the standard.  Again, no need for a debate there.  I personally agree with their system as it does work.




> My goal is to be able to reconcile a statement down to the penny within a reasonable amount of time.  About the same time it takes to reconcile a bank statement.  If I can't meet that goal, then something is wrong.  VSP reimbursement systems does not allow me to meet that goal.  If there is anyone out there that has figured out a way to do this, please PM me.  I will be willing to pay for the software that allows me to do this.


The challenges you have face every medical office, not just those with VSP. Thus the entire reason third party medical billing companies exist.  Our world is by far easier than medical doctors function within.   Those challenges exist because of managed care, but then cars are complicated systems that I no longer work on myself either.  Things were much simplier when there were no EPA smog regulation items and engines were a lot more simply overall.  Change or die as they say.    Insurance isn't here to benefit us first, it's for the patient.  You all scoff at me, but again, show me a managed care company that supports and helps us, the patients and contract labs more than them, please show me where and how.  I've been doing this for years and watch the evolution and seen the good bad and ugly.

----------


## AustinEyewear

> What you call an overengineering of the systm is simply a practice that insures payments on invoices.  You're right, it's not done to protect you, it's done to protect the patient so that if a practice doesn't pay a lab for their services, the patient visiting said practice doesn't incur an inconvenience because the office is on credit hold and possibly unable to deliver services and materials.  Again, that patient is the first and foremost concern to any managed care company.   The patient and their employer are their customer.  You can fault that type of assurance.
> 
> By that same account, such a system insurs the contract labs are made whole are made and is insurance to the contracted labs that they are promptly which goes to insure they too perform for you.


For the record, not scoffing.  Actually have learned quite a bit from you.  Although I'm not convinced they deserve any great award for their humanitarian efforts to serve the OD. The OD is just a tool for them to do what you mention, serve their customers.  You may be right... that they are the best there is, or at least as I'll put it, they may just be the best of the worst.  My biggest complaint with VSP is their billing methodology.  I'm sure I could come one with a better one that works better for the OD and would work just as good for them.  

One thing that has been on my mind lately concerning them, is their ability to pay more is certain lenses are used.  I've been wondering how legal (for lack of better word) this is.  Its sort of akin to a MD pushing a certain Rx because they can get paid better. Any thoughts on this?

----------


## sharpstick777

When looking at whether managed care is good or bad, you have to look at patient acquisition costs.  If you are advertising, and divide the cost that by the number of patients you see it gives you some idea what it costs to acquire each patient.  Even theortically.   With managed care, not just VSP, you are through discounts PAYING the insurance company to bring you patients, just like advertising.    

The way to do the math is too look at your average net revenue per patient now, compared with VSP patients.  If the difference is less than your advertising cost, then its probably better to go managed care.  If you can attract patients for less than the difference, then don't. 

If you are seeing more patients at less margin, it will also detract from the service level you provide to your existing patient base.  If service drops, you could be in a cylce where you loose high margin patients to see more low margin patients, and have to cut costs (and service) again.  Now you NEED those low margin patients.  It can be a death cycle as once again, you have to cut costs to service low margin patients.

If your practice is doing well without managed care, by all means, let the low margin patients go to your competition.  Managed care could ruin what you worked hard to build.

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## Dr. Bill Stacy

Good move. Never did take Spectera due to low reimbursements.  Took Davis for a couple of years before I had a revolt in my office to get rid of the "tower of doom".  (Davis vision specializes in discontinued/over-run frames, kind of like costco).

Actually  I kind of liked the fact that davis covered lots of lens options by making you use their lab.  Pretty good for the patient anyway.    

Another thing my people made me do was drop Medi-Cal (medicaid) and healthy families (a vsp program).  Oh and yeah, I dropped eyemed's ATT plan until enough of us did to make them change it.  What was it,  $5 for an exam or something really stupid like that.  

My people have limits.

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## racethe1320

> One thing that has been on my mind lately concerning them, is their ability to pay more is certain lenses are used.  I've been wondering how legal (for lack of better word) this is.  Its sort of akin to a MD pushing a certain Rx because they can get paid better. Any thoughts on this?


As the managed care co., they can decide what lenses fit into their desired categories or even what is covered.  Their program participation is up to their discretion.  Just because a new lens comes out doesn't mean it will be covered nor does the manufacturer have a say in what category it would fit.  That's VSP's call.   It's a good call too as it keeps the manufacturers honest in many ways.

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## racethe1320

> When looking at whether managed care is good or bad, you have to look at patient acquisition costs.  If you are advertising, and divide the cost that by the number of patients you see it gives you some idea what it costs to acquire each patient.  Even theortically.   With managed care, not just VSP, you are through discounts PAYING the insurance company to bring you patients, just like advertising.


In theory yes, but with advertising the audience is far less "captive" or likely to select you.  VSP also carries a very recognizable brand and has much greater reach overall. So while yes, you could break anything down on a per patient cost advertising vs managed care isn't quite an equal comparison.   




> The way to do the math is too look at your average net revenue per patient now, compared with VSP patients.  If the difference is less than your advertising cost, then its probably better to go managed care.  If you can attract patients for less than the difference, then don't.


I agree.  If the portion of the patient pie you have is profitable from a time/dollar standpoint that's great.  However, key then becomes how you expand that pie.  I started with 1 then 2 locations in a growing suburban area as did hundreds of other docs.   My time was easily maxed out.  However, the key then become how to run the business so that I don't have to put in the hours, but rather put others in place to run the offices and see the patients and keep them busy.  Of course hiring more staff costs more, but VSP Brought me way more dollars than the costs involved and the time I had to put in was but that of a fraction of what was needed for my first two locations. (just do a basic labor management study of payable hours against revenue earned per day and subtract all operating expenses.)

 Now I have a number of locations and am bringing in way more than without managed care as to advertise for all of them and get the targeted draw that VSP alone brings me would be outrageous.  It becomes a business mgt game is all.  Lawyers have their local bar association that drives them clients, repair centers partner with warranty companies, warranty companies partner with manufacturers, restaurants pay their associations, etc.  What we are facing is nothing new or unique and is actually a proven system that all can benefit from when managed correctly.




> If you are seeing more patients at less margin, it will also detract from the service level you provide to your existing patient base.  If service drops, you could be in a cylce where you loose high margin patients to see more low margin patients, and have to cut costs (and service) again.  Now you NEED those low margin patients.  It can be a death cycle as once again, you have to cut costs to service low margin patients.


That is true if you don't expand the resources needed to effectively maintain both.  I sense we're talking about two different things, you and the OP are assuming stay small and I'm thinking much bigger, grow the initial practice and expand into more locations.  Use managed care for what it does best, fills your chairs.  Profitability is only problem if you're losing the good patients and can't manage more overall.  Again, I challenge you all to stop looking at what you think managed does to you and start thinking about how you can better expound on what it does for you.   I'm sorry a single location pulling down $1M at a margin of XX% is great but having 3-4 doing a mix of work at 3-4 that revenue even less a -20-30% puts way more profit in your bank accounts.




> If your practice is doing well without managed care, by all means, let the low margin patients go to your competition.  Managed care could ruin what you worked hard to build.


The above needs augmented to say that it will ruin it if you are not sharp in the financials of running a business.  Otherwise, it will only increase it dramatically.  Some choose to learn how to maximize the systems in place, others tend to rant about them.  I know which one pays me more.

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## Dr. Bill Stacy

I don't think that accepting plans decreases your quality, unless of course you let it.  In fact, like golf, to be any good you have to have talent AND practice a lot.  If you don't do many exams or fit many glasses, your quality may go down, just like if you don't get out on the links enough. I've always felt that anyone who takes an hour to do an exam is just fiddling around and probably will get less than stellar results.  Of course taking less than 10 minutes and being worked to death doesn't work well either.

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## racethe1320

> I don't think that accepting plans decreases your quality, unless of course you let it.  In fact, like golf, to be any good you have to have talent AND practice a lot.  If you don't do many exams or fit many glasses, your quality may go down, just like if you don't get out on the links enough. I've always felt that anyone who takes an hour to do an exam is just fiddling around and probably will get less than stellar results.  Of course taking less than 10 minutes and being worked to death doesn't work well either.


I agree.  I think it's a small-office mentality to think taking on more is going to yield lesser quality or lower profits.  Manage your people/resources and business overall general and I think you can do more _with_ more and even _raise_ the quality a bit.

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## Dr. Bill Stacy

Or maybe a whole lot, as in being able to buy some nice diagnostic equipment that you can't afford at 5 patients a day...

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## sharpstick777

> I don't think that accepting plans decreases your quality, unless of course you let it.  In fact, like golf, to be any good you have to have talent AND practice a lot.  If you don't do many exams or fit many glasses, your quality may go down, just like if you don't get out on the links enough. I've always felt that anyone who takes an hour to do an exam is just fiddling around and probably will get less than stellar results.  Of course taking less than 10 minutes and being worked to death doesn't work well either.


After consulting in many practices, I would disagree . The difference is not wether you take managed care, or not, but whether managed care provides the bulk of your practice income.  If 50% or more of your patients are managed care it will effect service levels, even with VSP.

You will see this more visably in practices that are 80% one low paying insurance company, Davis or Spectara especially (less damange from Eyemed or VSP).  At very high VSP practices I see higher turnover among staff and fewer licensed Opticians which also lowers service.  The walls are painted, the faces smiling, but capture rate can often be below 40% with poor average sales (in contrast some practices have 90% capture rates).

I can walk into a practice and in 1 minute tell whether they are primarily managed care, or a heathly balance.  

I just did a study of Yelp reviews on the West Coast here and consistantly the highest scoring practices had a lower percentage of their business from managed care.  In fact, I help practices move away from their dependance on managed care quite a bit.  In every case they work less, and make more money. 

Not every practice that has great net revenue turns that into great service though.

Can you take managed care and maintain great service?  Yes, but its a lot more work when you are only netting $226 per patient, vs. $334 per patient without.  If you are willing to take managed care, you are willing to take less money.  If your rent is really low you may be able to pull it off, but at some point that less money will pinch... where is up to you.  Its just simple math.

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## Dr. Bill Stacy

I don't really get it.  What is this "capture rate"?  And what the heck is the 226 vs. 334 supposed to mean?  I could envision doing a lot more work for the 334 than for the 226 if the 334 required a major "sales" effort while the 226 required a more standardized approach to patient care with much less time spent on selling stuff.  Whatever the case, neither tells me much about the quality of care.  In eye care and lots of things, more money doesn't always equate to higher quality.   

As for the prejudicial practice comments in your post, I wonder if you've really seen many successful insurance oriented practices.  Maybe the only ones seeking your help are the ones who need your help?

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## racethe1320

> After consulting in many practices, I would disagree . The difference is not wether you take managed care, or not, but whether managed care provides the bulk of your practice income.  If 50% or more of your patients are managed care it will effect service levels, even with VSP.


So when consulting with your practices that are 50% or more managed care, what factors of their business are impacting the quality of service?





> You will see this more visably in practices that are 80% one low paying insurance company, Davis or Spectara especially (less damange from Eyemed or VSP).  At very high VSP practices I see higher turnover among staff and fewer licensed Opticians which also lowers service.  The walls are painted, the faces smiling, but capture rate can often be below 40% with poor average sales (in contrast some practices have 90% capture rates).


So again, in your experience, what factors make Davis or Spectara service providers worse than VSP or EyeMed?
You also see a higher turnover at VSP Volume practices.  What did they attribute that turnover to?
Did you validate your capture rates with the managed care companies that processed the claim?   With _your_ "connections" at VSP that's a pretty easy stat to find out.  I'd even be willing to bet nationwide you're quite low on that 40% figure.




> I can walk into a practice and in 1 minute tell whether they are primarily managed care, or a heathly balance.


So what is it that your keen eye looks for when walking into a practice that in one minutes allows this?




> I just did a study of Yelp reviews on the West Coast here and consistently the highest scoring practices had a lower percentage of their business from managed care.  In fact, I help practices move away from their dependance on managed care quite a bit.  In every case they work less, and make more money.


So do you honestly feel your single statement here provides validity to the claim you're making?  Did you contact every practice and cross reference all of their records?  Please, tell me it was in state of WA.  I'd be happy to do some tapping of _my_ contacts at VSP.




> Can you take managed care and maintain great service?  Yes, but its a lot more work when you are only netting $226 per patient, vs. $334 per patient without.  If you are willing to take managed care, you are willing to take less money.  If your rent is really low you may be able to pull it off, but at some point that less money will pinch... where is up to you.  Its just simple math.


So you're saying that by managed care driven practices have to be in the low rent districts or they somehow happen to just "pull it off" and scrape by eh?  That's a LOL moment for me.  Yeah, I never see a VSP Driven practice with spectacular offices. Insert the biggest laughing rolling eye face you can here.  Please, list for me what you believe are the top 5 VSP Practices in your city, Seattle right?  You're connected, you're a consultant, should be easy for you.  




> I don't really get it.  What is this "capture rate"?  And what the heck is the 226 vs. 334 supposed to mean?  I could envision doing a lot more work for the 334 than for the 226 if the 334 required a major "sales" effort while the 226 required a more standardized approach to patient care with much less time spent on selling stuff.  Whatever the case, neither tells me much about the quality of care.  In eye care and lots of things, more money doesn't always equate to higher quality.


Bill, you're spot on in terms of your comments.   These points need a lot more validation.  Believe me, it can be done.




> As for the prejudicial practice comments in your post, I wonder if you've really seen many successful insurance oriented practices.  Maybe the only ones seeking your help are the ones who need your help?


I'm with you.  Doubtful.   The stats on VSP Practices are readily available.  In fact as a consultant he can either work directly with VSP or ask for the doctor to share his/her practice report.  New ones are about due to be mailed.

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## sharpstick777

> I don't really get it.  What is this "capture rate"?  And what the heck is the 226 vs. 334 supposed to mean?  I could envision doing a lot more work for the 334 than for the 226 if the 334 required a major "sales" effort while the 226 required a more standardized approach to patient care with much less time spent on selling stuff.  Whatever the case, neither tells me much about the quality of care.  In eye care and lots of things, more money doesn't always equate to higher quality.   
> 
> As for the prejudicial practice comments in your post, I wonder if you've really seen many successful insurance oriented practices.  Maybe the only ones seeking your help are the ones who need your help?



One of the things I love about this industry is that there are so many ways to be successful. 

The capture rate refers to the ration between the number of refractive exams vs. the number of pairs of eyewear you sell (I count 1 yrs contacts as eyewear).  Medical exams are excluded.  The industry average is about 41%.  There are offices that reach 90% consistantly, but it requires a tremendous level of service.  Patient Capture is in my opinion the best indicator of your Practice's over all health.  Every office should know their capture, and track it every month.  That way you can measure and benchmark your business.   With higher capture rates, you are generating more revenue without adding one patient to your exam schedule.

Managed care plans at practice I just analyzed net an avg about $226 per pat. after expenses inc. exam and eyewear.  VSP came in at $243, But PPO's (Blue Cross,  Uniform ect) netted $334 per patient, and cash patients were higher still.  In none of these cases did the more profitable insurances require more work in general.  The only difference was the reimbursements.  Its not prejudice, its just math.  The average purchase among insurances was about the same, it varied only slightly.  

You can be successful with managed care, but its a lot more work.  It requires a more careful and deliberate strategy, very controlled spending, there are other posts on here describing some of those "tricks" for each carrier.  For example, with Eyemed you don't have to offer the 20% frame discount on many premium lines, carry a few of those lines and you can increase your per patient revenue by $40 in a flash.  That's an easy $120 per week, times 52... and that is an extra $6240 per year without lifting a finger.  

The Premim PPO's in this area (Regence BC, Premera, Uniform etc) pay about $115 more than Managed Care plans per patient, and the gap can be even wider.  Regence can pay on some plans $400 per patient, per year, no discounts required.  VSP Signature for example averages about $245 net to the practice, per patient, and that is much better than some, some pull in about $170.  If you perform only 2 exams per hour, that gap becomes enormous... about $300 difference per hour .   That is an additional $120,000 per year for your practice, with out any additional outlay, expense, or effort. 

So in effect, you could be paying at the extreme, an extra $120K per year for the patients VSP sends you over a premium insurance plan in unrealized potential revenue. In reality that could work out to be about $80K depending on the mix of insurances you take and your patient load.  Again, for doing the exact same work you do now.

If your schedule is empty, take every insurance you can.  But when your schedule is full, it makes sense to cull those plans that pay your practice less doesn't it?

Every owner should know their practices patient capture rate, and what revenue they generate from each insurance they take.  When I do audits, I even break down the different VSP plans.  Its a crucial to making sound decisions.  

Even if you decide to take, keep, and love managed care, you should know the numbers of what its doing, both good (bringing in more patients) vs the bad (earning less per patient) to your bottom line.    Its only basic sound business principles.

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## anthonyf1509

I did just want to mention, since I couldnt find any previous posts about the benefit of some plans, like an EyeMed premium plan. 
With exam, frame, and lens can reimburse over $650 plus any overage patient pays and that's SV! Not to mention it'll show all eligible members so Moms' glasses equals dad daughter and son too. They won't leave without them. And now they love us even more. 
There aren't a lot of plans like this , but our office is 5 minutes from the area hospital and all the employees who signed up for vision have it. 
We did 65 pairs last year on that 1 plan. Word of mouth at work will double that number this year.

VSP we are only preferred out-of-network only, but that's great too, in that it's still write off free and sends a little more numbers our way.

Of course there are successful practices with and without managed care. How you measure success can differ too. It's important to know the numbers, but not so precisely if you aren't using outside labs and also doing covered only items.
Net per patient is what it is, as long as its a good bottom line.

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## sharpstick777

> So in one breath you're telling VSP to pay you more, yet you willingly accept less through their competor?   
> 
> ...*I needed to find ways to up my income per patient on managed care VSP jobs.  I have found that and I can also apply the same benefits to my private pay jobs.
> 
> The market is changing and we have to change the way we dispense too if we want to stay profitable*.


So in one breath you are saying that Managed Care is wonderful, and in the other, you are saying that you need to find ways to make it more profitable?  I am confused.

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## racethe1320

> So in one breath you are saying that Managed Care is wonderful, and in the other, you are saying that you need to find ways to make it more profitable?  I am confused.


My comment about needing to find ways to up my per patient selling price comes from the fact that I don't ever stop doing that.  If you're not continually looking to increase ASP or improve profitability, you're complacent and that's now how I run my offices.   Same goes for my second comment which refers to all offices not just mine or that of managed care based practices.    

The fact that you continually imply that managed care based practices struggle is what inspired me to word my statement that way.  The reason being it is true that there is a percentage of practices, irregardless of whether they accept managed care or not, that struggle.  Heck, many post of such sufferings here on Optiboard.  Thus they and everyone have to evolve their dispensing practices to maintain the level of profitability that their business plan targets.

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## racethe1320

> Every owner should know their practices patient capture rate, and what revenue they generate from each insurance they take.  When I do audits, I even break down the different VSP plans.  Its a crucial to making sound decisions.


You must work with some pretty inept businessmen as if they are a VSP based practice, they already have a more than detailed look at the breakdown or audit as you call it, of their VSP plans and business.  It not only covers their practice but they can see where they stand in relation to other offices around them and nationwide.  They just need to know how to review the reports.  VSP will be happy to consult with them via phone or in person too.  All they have to do is have a clue. Sounds like the ones you visit don't.

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## racethe1320

> The capture rate refers to the ration between the number of refractive exams vs. the number of pairs of eyewear you sell (I count 1 yrs contacts as eyewear).  Medical exams are excluded.  The industry average is about 41%.  There are offices that reach 90% consistantly, but it requires a tremendous level of service.


Regarding managed care based practices, I'll leave it at this, your capture rates don't come close to matching.  You're way low, especially since you say the numbers you provide include contact lens dispenses.   Now if you're stating that includes all managed care _and non managed care based practice_s, then your numbers show actually prove managed care _increases_ capture rates.

If anyone has question, direct them to your managed care provider rep.  They will easily be able to show you where your practice stands vs those in your area or even nationwide.  I can assure you capture rates including contacts from the major managed care plans are much much higher than 41%.

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## sharpstick777

> Regarding managed care based practices, I'll leave it at this, your capture rates don't come close to matching.  You're way low, especially since you say the numbers you provide include contact lens dispenses.   Now if you're stating that includes all managed care _and non managed care based practice_s, then your numbers show actually prove managed care _increases_ capture rates.
> 
> If anyone has question, direct them to your managed care provider rep.  They will easily be able to show you where your practice stands vs those in your area or even nationwide.  I can assure you capture rates including contacts from the major managed care plans are much much higher than 41%.


41% is the industry average for Optometrists from Jobson Research 2009, I have worked in practices where it was actually 20%.  Yes, VSP provides great tools for VSP patients, but no other insurance Co does.  I do appreciate that very much, its a great tool but unless a practice is 100% VSP it doesn't help past the VSP patients.

Race, what is your issue?  You sound more like a lawyer than an OD.  Why do you argue so much?  Going back through all your posts you have made contributions in only 2 instances that didn't involve VSP?   And in both cases your information was unusually vague.  Are you this way to your staff?   Can you contribute in any other area besides VSP?  

I never said managed care is bad.  I have not mentioned VSP once.  All I have said is that if you are heavy in managed care you have to "manage" managed care in your practice.   You have said the same thing yourself really, in your efforts to maximize your returns.

I am in a lot of practices, and meet a lot of ODs.  Many of them are very business savy, many of them are not.  Nothing against them, OD schools spend about 2 weeks discussing business.  Its not everyone's passion.  I just give them the tools so they can make their own business decisions better.  They are less stressed as a result, and even if they dont change thier practices, they feel better knowing the consequences of their decisions.  I put them on more solid ground.  Do you really prefer that ODs work in the dark (Ok they often do,but that is just a joke).

VSP does give good tools, but I have never seen another company do that.  All I do is give Drs the ability to do the same analysis for other insurance plans.  There are other insurance plans.

Do you take Spectera?  Eyemed?  Medicare?  Davis?  Molina?  NBN?  If you don't, you have already made a cost/benefit decision based on reimbursements vs. your cost basis and your practice goals.  If you do take them, every OD/Manager should at least make the decision based on solid information for your practice and your patients.  All I do is give individual ODs the tools to make those decisions themselves, as there is wide variations between practices and areas, and even neighborhoods.  No judgements either way.

Really dude, are you really arguing with me on that?  Or do you just hate me?

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## racethe1320

> 41% is the industry average for Optometrists from Jobson Research 2009, I have worked in practices where it was actually 20%.  Yes, VSP provides great tools for VSP patients, but no other insurance Co does.  I do appreciate that very much, its a great tool but unless a practice is 100% VSP it doesn't help past the VSP patients.


Sounds like the 2009 data is a bit dated don't you think?   Have you not seen quite a bit of change since the recession hit full swing in late 08-09?  I have.




> Race, what is your issue?  You sound more like a lawyer than an OD.  Why do you argue so much?  Going back through all your posts you have made contributions in only 2 instances that didn't involve VSP?   And in both cases your information was unusually vague.  Are you this way to your staff?   Can you contribute in any other area besides VSP?


I have no issue.   You're not far off on the lawyer bit either.  I have a fairly diverse background.   I think I've summarized my place here before, but in short, If I come of as argumentative it's because right away after joining I noticed quite a number of members following those that bashed VSP and managed care.  Those members bashing them provided little if any insight on the validity of the comments and when directly asked, provided little if any answers to my legitimate questions.  It was almost as if there were a handful of bullies with little willingness to participate in actual conversations driving the mix of posts about managed care.  Quite frankly, I'm not here to nod my head in agreement with everything said, especially if I believe it's incorrect.  That makes for way too boring of a place to kill some time.   Not my style either.

If my information is vague, then please ask for clarification. I'll gladly share details within reason and within my comfort.    I think overall though on the subjects I've been a part of, I've been pretty clear without sharing too much that would make anything said be personal.  In terms of my contributions, I've contributed to other threads.  However, becoming a master poster here is not my goal either.   Everyone here seems to have a specific areas they like to discuss.  Mine is managed care.   If you're looking for me to discuss the latest lens technology or patient issues, don't hold your breath. I may place a comment on those here and there, but I'm not trying to be a jack of all sub-forums.




> I never said managed care is bad.  I have not mentioned VSP once.  All I have said is that if you are heavy in managed care you have to "manage" managed care in your practice.


You have in the past been less than positive in terms of views on VSP and managed care.  Considering VSP is the larger of the providers too, many of your nuetral appearing statements by nature do apply to them unless you clarify otherwise.     You have in this thread made some statements however, that are slanting to the negative on managed care and thus VSP and I felt the need to clarify a few things.     Saying you have to manage any aspect of a business, including that of a managed care program is business mgt. 101. 




> I am in a lot of practices, and meet a lot of ODs.  Many of them are very business savy, many of them are not.  Nothing against them, OD schools spend about 2 weeks discussing business.  Its not everyone's passion.  I just give them the tools so they can make their own business decisions better.


Then you and I do have many things in common, but your spin is that their less than steller businesss accumen is brought upon them by managed care.  That's the way I read your comments anyway, and that's not necessarily true.   Especially given their choice to accept those programs and make the most of them or not make the most of them is their choice.




> VSP does give good tools, but I have never seen another company do that.  All I do is give Drs the ability to do the same analysis for other insurance plans.  There are other insurance plans.


That's a fair point so long as you differentiate the various plans to maintain clarity.  Otherwise, your comments are rather broad and incorrect.




> Do you take Spectera?  Eyemed?  Medicare?  Davis?  Molina?  NBN?  If you don't, you have already made a cost/benefit decision based on reimbursements vs. your cost basis and your practice goals.


I take VSP only.  Over the years and early on as managed care became more prevalent I did experiment with the others, but I have no interest in supporting EyeMed or anything Lux based and the all the rest in my area make up such a small percentage, I see no benefit in the volume they would bring me.  My decision wasn't so much based on their reimbursements it was based on my beliefs and aliment between what their company is built on vs mine.




> Really dude, are you really arguing with me on that?  Or do you just hate me?


I don't know you and even if I did it's not likely I'd use the word hate or even dislike to describe my feelings.   No I do not have a bone to pick with you as an individual on the board.  I enjoy a good debate and as noted, am here to provide a more than clear understanding of VSP where and when it comes up.  I don't see that as wrong do you?  I've not yet seen anyone else take that position, so one would think bringing a little diversity to the board as a value wouldn't you?  Opinions on VSP either in support or dislike are fine, but with the nature of the board, also open for discussion right?    Then with that said, I hope I've clarified with you my position on the matter.

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