VSP Choice Access® Plan
The VSP Choice Access Plan is a savings plan with regional pricing on exams, lenses, and certain lens enhancements (listed below) that provides a savings to eligible patients when they see a VSP Choice Network Doctor. Benefits may be used an unlimited number of times during the patient's enrollment in the VSP Choice Access Plan.
The plan is not available in Montana, Vermont, Washington, Guam, Puerto Rico, and the U.S. Virgin Islands.
Eligibility
- Verify eligibility through eyefinity.com or call VSP at 800.615.1883.
- You can view the Patient’s Record Report for plan information including savings information and regional pricing.
Important!
There are no authorizations or claims to file—just bill the patient directly after applying the appropriate fees.
Exam Coverage
Provide the level of exam needed to determine your patient’s visual health status. Use professional judgment when evaluating prescriptions from another doctor. You may request an additional exam at 80% of U&C.
- Savings only applies to services and procedures included in a WellVision Exam®. It doesn’t apply to additional diagnoses and treatment.
- Deduct 20% from your U&C fees for a WellVision Exam and then compare the fee to the pricing for your region--charge the patient the lower of the two.
Materials Coverage
Eligible patients get the following discounts on glasses, sunglasses, and lens enhancements for prescription and non-prescription lenses:
Lens
- Charge 80% of U&C fees for base lenses up to the regional member fee.
Lens Enhancements
- Polycarbonate: Charge 80% of U&C fees or $40, whichever is less.
- Standard Anti-Reflective Coating (Code QM Only): Charge 80% of U&C fees or $45, whichever is less.
- All other Anti-Reflective Coatings (refer to the Product Index): Charge 80% of U&C fees.
- Standard Scratch Coating (Factory Applied Only): Charge 80% of U&C fees or $15, whichever is less.
- UV Coating: Charge 80% of U&C fees or $15, whichever is less.
- Standard Progressive (Code KA): Charge 80% of U&C fees or $55, whichever is less (only the amount over the base lens – flat top 28).
- Premium and Custom Progressive (Code FA, JA, NA, OA): Charge 80% of the additional U&C cost for the progressive (only the amount over the base lens—flat top 28).
- Higher Powers: Charge 80% of the additional U&C cost for high powers lenses.
- All Other Lens Enhancements & Features: Charge 80% of U&C fees.
Premium Progressive Lenses
For progressives, subtract the U&C FT28 bifocal cost from the progressive U&C fee, and then deduct 20% off that amount.
You can use this example to help determine what to bill a patient for a progressive lens. In this example, the practice is located in Arkansas (or Region 4).
Bifocal Base Lens |
|
---|---|
Bifocal (Flat Top 28) U&C |
$100 |
Deduct 20%($20) |
-$20 |
80% of U&C Bifocal Lens |
$80 |
Regional bifocal price (Region 4 = $60)* |
$60 |
Patient Bifocal Price |
$60 |
Progressive Add-On |
|
Premium Progressive U&C |
$220 |
Minus Bifocal U&C (Use Flat-Top 28) |
-$100 |
Premium Progressive Add-On Price |
$120 |
Deduct 20%($24) |
-$24 |
Patient Progressive Add-On Price |
$96 |
TOTAL Patient Cost |
|
Patient bifocal price |
$60 |
Total Patient out-of-pocket for bifocal and progressive |
$156 |
*Important!
Please refer to the Lenses section above to determine the appropriate bifocal price for your region based on your office location.
Frame
- Charge 75% of U&C.
- Savings don’t apply if the frame manufacturer prohibits discounts.
Contact Lenses
- Charge 85% of U&C fees for contact lens services (fitting and evaluation) for prescription lenses only.
- Charge 100% of your U&C fees for contact lens materials, solutions, or cleaning products.
Lab
Lab work is handled privately. You may supply lenses through any lab, including in-office labs.
VSP Laser VisionCareSM Program
Refer to the Laser VisionCare section of the VSP Manual for information.
Claims/Billing & Reimbursement
Important!
There are no claims to file.
Apply the corresponding savings to your U&C fees, with the not-to-exceed maximums. Collect the appropriate fees from the patient. Handle the transaction as a private payment arrangement.
Regional Pricing
The applicable regional prices are listed on the Patient Record Report and are also included below for your reference.
Charge patients 80% of your U&C fees or price for your region—whichever is lower.
State |
County(s) |
Region |
Exam |
Single Vision |
Bifocal (Flat Top 28) |
Trifocal (7x28) |
---|---|---|---|---|---|---|
AK |
All |
1 |
$90 |
$50 |
$70 |
$90 |
AL |
All |
4 |
$75 |
$40 |
$60 |
$75 |
AR |
All |
4 |
$75 |
$40 |
$60 |
$75 |
AZ |
All |
3 |
$80 |
$45 |
$65 |
$85 |
CA |
Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano |
1 |
$90 |
$50 |
$70 |
$90 |
All other counties |
2 |
$90 |
$45 |
$65 |
$85 |
|
CO |
All |
3 |
$80 |
$45 |
$65 |
$85 |
CT |
All |
1 |
$90 |
$50 |
$70 |
$90 |
DC |
All |
1 |
$90 |
$50 |
$70 |
$90 |
DE |
All |
2 |
$90 |
$45 |
$65 |
$85 |
FL |
All |
2 |
$90 |
$45 |
$65 |
$85 |
GA |
All |
3 |
$80 |
$45 |
$65 |
$85 |
HI |
All |
1 |
$90 |
$50 |
$70 |
$90 |
IA |
All |
4 |
$75 |
$40 |
$60 |
$75 |
ID |
All |
4 |
$75 |
$40 |
$60 |
$75 |
IL |
All |
2 |
$90 |
$45 |
$65 |
$85 |
IN |
All |
4 |
$75 |
$40 |
$60 |
$75 |
KS |
All |
4 |
$75 |
$40 |
$60 |
$75 |
KY |
All |
4 |
$75 |
$40 |
$60 |
$75 |
LA |
All |
3 |
$80 |
$45 |
$65 |
$85 |
MA |
All |
1 |
$90 |
$50 |
$70 |
$90 |
ME |
All |
3 |
$80 |
$45 |
$65 |
$85 |
MD |
All |
2 |
$90 |
$45 |
$65 |
$85 |
MI |
All |
2 |
$90 |
$45 |
$65 |
$85 |
MN |
All |
3 |
$80 |
$45 |
$65 |
$85 |
MO |
All |
4 |
$75 |
$40 |
$60 |
$75 |
MS |
All |
4 |
$75 |
$40 |
$60 |
$75 |
MT |
All |
Plan not sold or accepted in state. Do not provide discounts to patients from participating states. Refer them to a doctor in a participating state. |
||||
NE |
All |
4 |
$75 |
$40 |
$60 |
$75 |
NC |
All |
4 |
$75 |
$40 |
$60 |
$75 |
ND |
All |
4 |
$75 |
$40 |
$60 |
$75 |
NH |
All |
2 |
$90 |
$45 |
$65 |
$85 |
NJ |
All |
1 |
$90 |
$50 |
$70 |
$90 |
NM |
All |
3 |
$80 |
$45 |
$65 |
$85 |
NV |
All |
2 |
$90 |
$45 |
$65 |
$85 |
NY |
Bronx, Kings, Nassau, New York, Richmond, Rockland, Suffolk Queens, Westchester |
1 |
$90 |
$50 |
$70 |
$90 |
All other counties |
3 |
$80 |
$45 |
$65 |
$85 |
|
OH |
All |
3 |
$80 |
$45 |
$65 |
$85 |
OK |
All |
4 |
$75 |
$40 |
$60 |
$75 |
OR |
All |
3 |
$80 |
$45 |
$65 |
$85 |
PA |
All |
2 |
$90 |
$45 |
$65 |
$85 |
PR (Puerto Rico) |
All |
Plan not sold or accepted in state. Do not provide discounts to patients from participating states. Refer them to a doctor in a participating state. |
||||
RI |
All |
2 |
$90 |
$45 |
$65 |
$85 |
SC |
All |
4 |
$75 |
$40 |
$60 |
$75 |
SD |
All |
4 |
$75 |
$40 |
$60 |
$75 |
TN |
All |
4 |
$75 |
$40 |
$60 |
$75 |
TX |
All |
3 |
$80 |
$45 |
$65 |
$85 |
UT |
All |
3 |
$80 |
$45 |
$65 |
$85 |
VA |
All |
3 |
$80 |
$45 |
$65 |
$85 |
VT |
All |
Plan not sold or accepted in state. Do not provide discounts to patients from participating states. Refer them to a doctor in a participating state. |
||||
WA |
All |
Plan not sold or accepted in state. Do not provide discounts to patients from participating states. Refer them to a doctor in a participating state. |
||||
WI |
All |
4 |
$75 |
$40 |
$60 |
$75 |
WV |
All |
4 |
$75 |
$40 |
$60 |
$75 |
WY |
All |
4 |
$75 |
$40 |
$60 |
$75 |