VSP considers co-management to be an integral part of refractive surgery and encourages a co-management relationship between our VSP Laser VisionCare Doctors and Laser VisionCare Facilities. We understand there may be instances when a Laser VisionCare surgeon may determine that it would be in the patient’s best interest to provide preoperative and postoperative care; therefore, VSP allows co-management flexibility.

VSP’s Laser VisionCare Program provides discounted access to facilities and surgeons for most VSP members who wish to pursue laser vision correction services. There are two plans: the standard Laser VisionCare Program (discount only) and the Laser VisionCare Preferred Program (discount with allowance towards procedure).

Laser VisionCare Program (discount only)

Members receive a complimentary screening as well as preoperative and postoperative services through participating VSP Primary EyeCare Providers.

The program includes discounted access to on-label applications of FDA-approved laser refractive procedures. Surgeries that involve implantation of retained medical device(s) (such as refractive lens exchange or corneal inlays) or manipulation of ocular tissue other than what is anticipated during traditional laser vision correction are not included (such as corneal cross-linking or scleral-directed therapies) even if performed in conjunction with an on-label, approved laser vision correction procedure. Likewise, refractive procedures performed in conjunction with a clinical trial are deemed to be experimental and are not part of this program.

Members receive the contracted discount amount. Or, if the laser center is offering a temporary price reduction, VSP members will receive 5% off the advertised price, if it is less than the usual discount price.

After discount, patients should not pay more than the following amounts:

• PRK: $1,500 per eye
• LASIK: $1,800 per eye
• Custom LASIK, Custom PRK or Bladeless LASIK: $2,300 per eye
• All other procedures, including SMILE, patients pay the contracted discount amount or 5% off the advertised price, if lower than the usual discount price

Laser VisionCare Preferred Program

In addition to discounted pricing available through the Laser VisionCare Program, the patient receives an allowance that may be applied to the cost of surgery. The allowance is provided through one of the following two options:

Per eye allowance: This option enables the member to receive an allowance toward the cost of surgery for each eye, once per eye per lifetime.

Total allowance: This option enables the member to receive an allowance toward the cost of surgery regardless if it is on one or both eyes, once per lifetime.

Patient Communication

The Laser VisionCare Program emphasizes the need for a patient to visit a VSP Laser VisionCare doctor to initiate services. If you are not participating in the Laser VisionCare Program and a VSP patient inquiries about receiving services under the program, refer the patient to vsp.com or Member Services. To participate in the Laser VisionCare Program, refer to the Enrollment/Doctor Participation section. 

VSP contracts only with facilities and surgeons who meet our stringent quality standards. Please don’t refer members to facilities that are not in VSP’s network. Members of the LVC Preferred Program often have no benefit for out-of-network services, or a reduced allowance amount available. There is no guaranteed discount on services received from an out-of-network provider.

Determining Eligibility

Select View Plans in the Check Patient Eligibility area on eyefinity.com. If eligible, you will see one of the two plans listed:

• Laser VisionCare Program–Discounted Services Only (nearly all VSP patients are eligible)
• Laser VisionCare Preferred Program
• LASIK: Allowance amount $XXX (per eye or both eyes)
• PRK: Allowance amount $XXX (per eye or both eyes)
•  Custom LASIK, Custom PRK, Contoura, SMILE, or other approved procedures: Allowance amount $XXX (per eye or both eyes)

Complimentary Screening

Evaluate the patient’s viability for surgery. At a minimum, you are required to determine refractive error and briefly discuss laser vision correction. Laser surgery can’t be guaranteed, until a complete preoperative exam has been performed.

Preoperative Exam

If you and the patient agree to proceed, perform a complete preoperative exam to obtain all clinical data required by the facility.

Facility Selection

After completing all preoperative testing, assist the patient in selecting a VSP-contracted facility and surgeon with whom you are affiliated. The facility confirms eligibility and is provided with a tracking number. This number is used for the Laser VisionCare Preferred Program claim submissions or for the collection of encounter data where the patient does not have an allowance.

Surgery

The patient is responsible for paying the facility the discounted surgery fee (less the allowance if covered by the Preferred Program). The surgery is performed at the facility by a VSP Laser VisionCare surgeon. Patient out-of-pocket expenses are not to exceed the stated maximums for PRK, LASIK, Custom PRK, Custom LASIK and Bladeless LASIK.

Postoperative Care

VSP Laser VisionCare patients should return to you for postoperative care as soon as you and the surgeon, along with the patient, agree it is appropriate.

Inform the patient about the importance of regular exams after their surgery. And don’t forget—most VSP Signature Plan^® patients can use their frame benefit for plano sunglasses (off the board or office stocked) after their surgery.

Claim Submission/Encounter Data

The facility is required to submit CMS-1500 form data to VSP electronically.

Compensation

The facility is responsible for paying you and the surgeon.

Billing

Services provided as part of the Laser VisionCare process can’t be billed against the members’ routine benefits.

There is no charge to the patient for complimentary screening and no doctor compensation is offered, even if the patient chooses not to proceed with the surgery after the screening.

Compensation for preoperative and postoperative services is disbursed to you by the facility as part of the global fee. Do not submit a claim to VSP for services.

If the patient receives a preoperative exam and chooses not to proceed with the surgery, or if you determine that the patient is not a viable candidate then:

• If the patient has Preferred Program coverage, coordinate with the facility to submit a claim to VSP for this exam.
• If the patient does not have Preferred Program coverage, you may bill the patient for the exam at 75% of your U&C fee up to $100. There should be no charge to the patient if you would not customarily charge a private patient for this exam.

To participate in VSP’s Laser VisionCare Program, you should:

• Maintain current TPA certification, as applicable for your state.
• Find a participating facility on VSPOnline.
• Contact facility directly to become affiliated. It is the facility’s responsibility to offer laser vision correction training at no cost and to inform VSP of all changes in affiliation.

It is your responsibility to learn the facility’s reimbursement policies, including compensatory fees for preoperative and postoperative services, prior to the affiliation process. All Laser VisionCare compensation is disbursed directly to you by the facility.

Once you become affiliated with a Laser VisionCare facility, the facility will explain their process for coordinating patient care. Like reimbursement, this process will vary from facility to facility.

After you are affiliated with a Laser VisionCare facility, you should contact providernetworkdevelopment@vsp.com to update your profile on vsp.com.