Elective Contact Lens Copayment Exception Clients
Eligibility
This information applies only to clients with Elective Contact Lens (ECL) copay exceptions if the following comment is indicated on the authorization within the contact lens section. These clients require subtracting the copay from the total charged, rather than the allowance.
For complete ECL information, refer to “Contact Lens Plans” in the Plans & Coverages section.
Comment code D385: Copay applies to ECL. Subtract copay from total of discounted fitting and evaluation and U&C material charge. Apply your patient’s allowance to the remaining balance. Refer to “VSP” Manuals on VSPOnline, ECL Copay Exception Clients page in the Client Details section.
Examples
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Remaining balance is less than Contact Lens Allowance |
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1. Determine the total of your fitting & evaluation and U&C material charge. |
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Your U&C fee for contact lens materials: |
$50 |
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Add 85% of your U&C fee for fitting and evaluation: |
+$30 |
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Total: |
$80 |
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2. Subtract the copay from this total to determine the remaining balance. |
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Patient’s copay: |
-$20 |
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Remaining balance: |
$60 |
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3. Subtract the contact lens allowance from this total. |
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Contact lens allowance (e.g., $105) |
-$60 |
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Remaining balance to charge to patient: |
$0 |
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Remaining balance is more than Contact Lens Allowance |
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1. Determine the total of your fitting & evaluation and U&C material charge. |
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Your U&C fee for contact lens materials: |
+$95 |
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Add 85% of your U&C fee for fitting and evaluation: |
+$50 |
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Total: |
$145 |
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2. Subtract the copay from this total to determine the remaining balance. |
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Patient’s copay: |
-$20 |
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Remaining balance: |
$125 |
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3. Subtract the contact lens allowance from this total. |
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Contact lens allowance (e.g., $105) |
-$105 |
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Remaining balance: |
$20 |
Note:
Our online Savings Statement won’t automatically calculate copays for these scenarios.