L & S Auto and Tire Services

I am writing in response to the grievance that VSP’s Complaint and Appeals Team received from the Revdex.com on February 5, regarding VSP’s policy for minimum prescription requirements for the patient listed belowPrimary Member: [redacted] Patient: [redacted] Response: •The VSP Board of Directors, which consists of optometrists and ophthalmologists, has determined that a prescription less than + diopters does not improve visual acuityI apologize that this specific information is not contained on our websiteHowever, the information on our website states: “This information doesn't guarantee your eligibility of coverageYour VSP provider will contact VSP to check your eligibility.” •Our records indicate that [redacted] spoke to [redacted] in our Customer Service Department on February 5, about VSP’s policy for minimum prescription requirements• [redacted] spoke to [redacted] at Dr [redacted] ’s office who verified that [redacted] ’s prescription was for both eyes•Due to the circumstances, VSP is going to make a one-time exception to allow [redacted] to receive non-prescription lenses and a frameIf she chooses any non-covered lens enhancements they will be an out-of-pocket expenseIf she selects a frame more than the plan allowance the overage will be discounted by 20% and the balance would ***’s responsibilityThese services will affect [redacted] ’s future eligibility, meaning she will not be eligible for spectacle lenses until January 1, and a frame until January 1, •I left a detailed message at Dr [redacted] ’s office to advise them of the exception that VSP was making to approve non-prescription lenses and a frame for [redacted] I faxed authorization number [redacted] directly to the officeI requested that the office contact me should they have questions regarding this authorization [redacted] may wish to contact the office to schedule an appointment for [redacted] to order her glasses•Going forward [redacted] and her eligible dependents will be required to work within the parameters of her planVSP will be unable to make any additional exceptions to the plan•Regarding VSP not supplying an identification card, typically patients only utilize their vision benefit once per year, unlike a medical plan; therefore, it has not proven to be cost effective to provide identification cards to our membersI apologize for any inconvenience [redacted] has experienced because of this situation•In closing, we want you to know we value [redacted] choosing VSP as her vision provider and we appreciate the feedback she has shared as we strive to provide members with a high level of serviceHer perspective helps us to evaluate areas for improvement and bring better future service to herPlease feel free to contact me at [redacted] if you have any other questionsMy office hours are Monday through Friday from 6:a.mto 2:p.m., Pacific TimeSincerely, [redacted] Complaint & Grievance Unit Customer Care Division Case # [redacted] Sent on: 2/7/8:59:AM

Per Ebony at VSP Direct the plan was cancelled effective 3/1/as an exception and Kira was refunded $on 5/28/The plan premiums are charged a month ahead so the refund was for the March and April premiumsNo additional payments were taken and the plan is inactive

Response:The three appeals that member [redacted] included in his correspondence with the Revdex.com have been individually reviewed & have been upheldClaim # [redacted] was assigned appeal # [redacted] & # [redacted] was assigned appeal # [redacted] ; both of these claim denials were upheld because the allowable timeframe in which to file an appeal has been exceededClaim # [redacted] was assigned appeal # [redacted] & was also upheld because the filed services have already been paid directly to the rendering facility on 9/26/A letter for each appeal has been sent directly to the member for his records.Sent on: 10/19/4:58:PMSent by:

I am writing in response to the grievance that VSP received on December 20, from the Revdex.com regarding the information you received about your VSP Individual plan through Healthy Vision AssociationVSP has made an exception to cancel your plan effective October 1, This is the date that your plan through the [redacted] went into effectThe cancellation is currently processing and can take up to business days to completeAs requested, attached is a copy of the terms and conditions of your planI apologize if you did not receive this information previouslyAccording to our records out-of-pocket expense letters were sent to you on December 20, I have attached copies of those letters for the following family members: [redacted] and yourselfThese letters are for the claims from I apologize for any inconvenience you may have experiencedAs an organization committed to member satisfaction, we sincerely appreciate your feedbackWe are always grateful when our members identify areas that need improvement so we can address the issue and provide better service to you in the futureIf you have any questions regarding VSP's resolution or would like further information regarding your benefits, please contact VSP Member Services at [redacted] or TDD: [redacted] (Monday through Friday5:a.mto 8:p.m., Saturday7:a.mto 8:p.mand Sunday7:a.mto 7:p.m., Pacific Time)You may also visit our Website at vsp.com for additional information regarding your vision benefits [redacted] *Ext*** Customer Care Division Ref: Case # [redacted]

I am writing in response to your complaint VSP received on June 30, forwarded from the Revdex.com regarding your claim reimbursements Your employer has provided different benefits and coverage levels based on services received at VSP Plan Participating doctor or at a non- VSP plan participating doctor This allows their members to have access to vision insurance regardless of where they live Your plan provides service frequency for exam, one set of spectacle lenses and a frame once every calendar year The out of network claim you filed for the spectacle lens and frame services [redacted] received at Ideal Vision Center, a non-plan participating doctor on November 24, paid correctly The $frame and $spectacle lens reimbursement you received is in accordance with the non-VSP plan participating provider fee schedule established under your employer’s plan: You received the maximum payout Our records show you received both services; spectacle lens on January 27, and an exam on September 23, at Natomas Optometry, a VSP plan participating doctorThese claims were paid to the doctorYour out of pocket cost were the copays and non-covered lens enhancement purchased at a cost savings The claim you filed for lens and frame services received at Ideal Vision Center, a non-VSP plan participating doctor on November 24, paid correctly The spectacle lens service was denied as you were not eligible for this service until January 1, The $frame reimbursement you received is in accordance with the non-VSP provider fee schedule established under your employer’s planYou received the maximum payout The out of network claim you filed for the spectacle lens and frame services [redacted] received at Ideal Vision Center, a non-VSP plan participating doctor on November 24, paid correctly The $frame and $spectacle reimbursement you received is in accordance with the non-VSP plan participating provider fee schedule established under your employer’s plan You received the maximum payout If you choose to received eligible services from a VSP Plan participating doctor your single vision or lined multifocal lenses are coved after the copayYour frame is covered up to $ I apologize for any policy coverage confusion provided by your employer and any inconvenience you may have experienced If you have any questions regarding your benefits or claim payments you may also contact our Customer Service Department at (800) 877-7195, Monday through Friday, 5:a.mto 8:p.m., Saturday 7:a.mto 8:p.m., and Sunday 7:a.mto 7:p.mPacific TimeOur Customer Service Representatives will be happy to access the information regarding your request

I am writing in response to the grievance your agency submitted on behalf of member [redacted] with regards to the reimbursement of her premium paymentsAs [redacted] indicated previously, [redacted] ’s account was canceled with VSP Direct effective November 1, VSP Direct advised us that an $refund was requested and would be mailed directly to [redacted] I was sorry to hear that she has not received this reimbursement checkI contacted VSP Direct and spoke with [redacted] who let me know that the $check was issued in February; however, [redacted] disputed the monthly premium payments with [redacted] ***The case number for this dispute is [redacted] This dispute was sent to VSP Direct and they immediately refunded the monthly premium payment amount of $but they also voided the $check outA new check in the amount of $was requested and will be mailed out todayThe $and $equal $which is the refund amount she was promisedThis check is being mailed from Frisco, Texas so [redacted] will need to allow at least days mailing timeIf at that time she has not received the check she may wish to contact VSP DirectThey can be reached at [redacted] I apologize for any inconvenience [redacted] has experienced as a result of this situationPlease feel free to contact me at [redacted] if you have any other questionsMy office hours are Monday through Friday from 6:a.mto 2:p.m., Pacific TimeSincerely, [redacted] Complaint & Grievance Unit

I am rejecting this response because: The statements provided in the response from the business is not accurateI agree to allowing me to use my benefits within days due to the lack of follow up to me throughout the process and I've paid for benefits I've been unable to utilizeThe business failed to mentioned that the grievance I filed with VSP on November 30, was not the first grievanceMy first grievance with VSP was on September 30, I received a letter request on 10/1/advising my grievance was received and someone would follow up with meI called into VSP as I did not hear from anyone within the -hour time-frame and was told again someone would follow up with meI sent another message to VSP through my VSP account on October 9, I then called a second time as I had not heard from anyoneI sent a third message on October 20, and received a letter by email advising my issue would be escalated and someone would follow up with me againI continued to get the run aroundI sent another message on December 2, and received a response on December 4, with the same story I was told several times beforeAfter getting no where with contacting Target Optical and filing complaints with Target as well as VSP, I then contacted Revdex.com as no consumer should ever have to keep getting the run around from a eye care provider regarding benefits they paid for, regardless if I went to an out of network providerI received a letter from VSP dated December 29, with the information above in their response, but I did not get an exam or contact lens that they mentioned in the letter as my exam is done through my health insurance provider

We are sorry to learn that you were disappointed with the length of time it is taking to receive the refund from your Individual plan through VSP Direct.Our records indicate you had member only coverage through [redacted] effective 12/01/ This plan terminated on 11/30/16.I have spoken with [redacted] at VSP Direct who confirmed you contacted them on 11/17/regarding the cancellation of your plan and to request a refund Due to the bank draft, they must wait at least days before providing your refund of $ She is deeply apologetic for any inconvenience this has caused you [redacted] did confirm with me that your refund will go through on 12/01/16.Since it is our primary goal to provide a high level of service to our members, we sincerely appreciate it when our members bring situations such as yours to our attention This enables us to evaluate areas for improvement and bring better future service to you

RevDex.com: I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me. They have fulfilled their promise. Thank you for your help expediting this. Their customer service department made it quite difficult for me to resolve myself.

I am rejecting this response because:I want my lens/contacts to match my eye exam 6/1/So I have to wait month from my exam to order my new prescription every year? Can I purchase now and submit the claim in 10/1/17? If not the headaches are killing me since I am wearing the incorrect prescription

I am writing in response to a grievance that VSP's Complaint and Appeals Unit received on April 20, 2017, regarding the member listed below: [redacted] Member Name: [redacted] Assigned ID: [redacted] Response:The VSP Board of Directors , which consists of optometrists and ophthalmologists, has determined that a prescription less than + diopters does not improve visual acuityI was able to verify the patient's prescription with our VSP provider and confirmed the prescription was .25; therefore based on the plan's provisions, the glasses would not be covered at this time.VSP offers many different plans that offer valuable benefitsThe member's employer selected a plan designed to help with typical eye care expensesIf there are further questions regarding the benefits of the plan, we suggest the member contact their benefits representative.I apologize the plan did not meet Ms [redacted] expectationsWe take all member concerns very seriously and have documented the members concernsAs an organization committed to member satisfaction, we sincerely appreciate the feedbackWe are always grateful when our members identify areas that need improvement so we can address the issue and provide better future service.Please feel free to contact me at [redacted] if you have additional questionsMy office hours are Monday through Friday 7:a.mto 3:p.m., Pacific Time.Sincerely, [redacted] Complaints & Appeals UnitCase: [redacted]

I am rejecting this response because: I was told that *** said the refund would go in by 12/well it is now 12/and no refund stillExcuses and lies!!!I believe this is their way of punishing people for cancelingNext step Attorney General !!!

Business Response to a ComplaintComplaint ID#: ***Company Name: Vision Service PlanCompany Contact: *** ***Company Phone: ***Company Email: ***Person Who Sent the Complaint: *** ***Staff Member: *** ***Response:Our records indicate the member is
currently active under Vision Service Plan with an original plan effective date listed as November 1, Per *** *from VSP Direct Team that handles all billing inquiries, all payment information was removed from the member’s account and a cancellation letter was sent to the memberPer the member’s request the plan will be cancelled effective June 1, 2016.Sent on: 5/19/4:46:PMSent by: ***

This is in response to a Revdex.com complaint that VSP received on 07/22/The complaint information we received did not include complete member information to locate our member's vision plan to do the required researchPer Revdex.com agent's instructions, I called the member directly to the daytime phone
number that was provided and left a voicemail message on 07/22/& 07/25/with VSP's direct number to our Complaint's DepartmentAs of today 7/28/2015, member has not responded to our calls to continue with the researchWe were in need of the primary member's date of birth and member ID# or last four of ssn#

I am writing in response to Ms*** rejected reply dated 01/01/I was sorry to learn that Ms*** was unhappy with VSP's response letter dated 12/30/2016.I apologize for the confusion with the dependents eligibility period and the cancellation requestAs indicated in the 12/30/letter, the offer was made to Ms*** to permit her to return the $reimbursement for consideration to cancel the policy for the dependant and to date there is no record that VSP has received the $from the member.I have approved reimbursement to the member for $This amount covers the dependent's policy premiums of $for the policy year minus the $payment VSP made for contactsPlease allow ten business days for processing.Please feel free to contact me at *** *** if you have additional questionsMy office hours are Monday through Friday 7:a.mto 3:p.mPacific Time.Sincerely,*** ***Complaints & Grievance UnitCase:

I am rejecting this response because: they have not paid the claim that was sent to them in a timely fashion and at the time of claim, the contract between us was validErrors of a third party should not void our contract

Dear Revdex.com,I am writing in response to a grievance that VSP's Complaint and Appeals team received on May 18, and to the additional letter received on June 1, regarding the member listed below:Member Name: *** ***Member ID#: ***Revdex.com Complaint ID: 11435284Research:Our records
show the member had coverage under the VSP Individual Plan from November 1, to June 1, I contacted VSP Direct as they handle all billing and payment inquiries and spoke with *** (Supervisor) who provided me with the following information:* The member contacted them directly on May 11, to ask that the automatic withdrawals be stopped and that they bill her directly.* As direct billing was not an option, they instead removed all payment information from her account and agreed to cancel her plan effective June 1, 2016.* Per the member's request, a cancellation letter was sent to the email on file.Please note that VSP's original response was submitted via the Revdex.com online complaint system on May 19, 2016.Please feel free to contact me at (916) 858-7853 if you have any other questionsMy office hours are Monday through Friday 7:a.m to 4:00., Pacific Time.Sincerely,*** ***Complaint & Grievance UnitCustomer Care Division

Please see attached grievance response for member *** ***

January 29, Re: *** *** Case: *** I am writing in response to a complaint VSP received on your behalf from the Revdex.com on 01/25/regarding your experience with VSPI have spoken with *** in our Customer Service Department who informed me that multiple emails were
sent to you as well as multiple phone calls regarding the resolution of your complaintI apologize if you did not receive these emails or phone callsThe resolution documented on your account and in an email sent to you states that your VSP Individual Plan does reimburse $for progressive lenses and $for the frame for glasses that are purchased out of network*** *** is considered out of network under your planIn addition we will reimburse the copays for your materials, $25.00, Anti-reflective coating, $and Polycarbonate, $These were the copays that were offered during our discussion on 11/04/Additional reimbursement was not offeredWe care about your experience; therefore, an additional agreement was made to reimburse you $Our records indicate a check in the amount of $was mailed to you on 12/30/A check in the amount of $was mailed to you on 12/23/Our records show this check was returnedVSP was able to reissue it to an update address on 01/13/A check in the amount of $was mailed to you on 12/26/Again our records indicate this check was returned and VSP was able to reissue this check to you on 01/13/Additionally, a check in the amount of $was mailed to you on 12/31/This check was also returned and a check was reissued to you on 01/20/Your total reimbursement for the glasses you purchased at *** *** was $which is the amount on the receipts submitted to VSP on 12/06/Since it is our primary goal to provide a high level of service to our members, we sincerely appreciate it when our members bring situations such as yours to our attentionThank you for giving us the opportunity to resolve your complaint

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me
I especially want to thank Revdex.com, this is a system that makes our business world a better one.Sincerely yours, *** **