L & S Auto and Tire Services

Please see attached grievance response for member *** ***: I am writing in response to a grievance that VSP's Complaint and Appeals Team received on March 20, regarding the patient listed below:Member Name: *** ***Revdex.com ID: ***Response: Our records confirm that
member received exam and contact lens services on January 12, at *** ***A payment in the amount of $has been sent to the member on March 9, Upon further research of the claim, I am pleased to inform you that we are paying MsStuive an additional reimbursement of $to honor her in network coverageThis payment has been sent on March 23, to the member's address on filePlease allow mailing time from Sacramento, California. I sincerely apologize for any inconvenience Ms*** has experiencedAt VSP, we pride ourselves in providing world class customer serviceIn situations where this has not occurred we take it very seriouslyI have documented the member's concerns and will ensure that coaching is provided to the appropriate department. Please feel free to contact me at *** *** if you have any other questionsMy office hours are Monday through Friday from 5:a.mto 1:p.m., Pacific Time. Sincerely *** ***Complaint & Grievance Unit

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 *** *** *** effective 12/01/This plan terminated on 11/30/16. I have spoken with *** it VSP Direct who confirmed that the refund request $was posted on November 30, 2016. He apologized and explained that depending on the member’s financial institution, refunds can typically take up to ten business days. Their records indicate that the refund processor received confirmation from the bank that the funds were received on December 6, 2016. The member may contact their bank if there are further questions. 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 attentionThis enables us to evaluate areas for improvement and bring better future service to youTell us why here

* Member Name: *** *** * Assigned ID: *** * Response: I am sorry to hear that you are not satisfied with your vision plan through your employer. VSP offers a wide variety of vision care plans to our clients. If you are unhappy with the level of coverage contained in your employer's vision care plan you may wish to discuss your concerns with your benefits representativeVSP is making a one-time exception to allow you to receive lens and a frame up to the limits of your plan. You will be responsible for any copayments, non-covered lens enhancements and frame overage. This offer is valid for days from the date of this response. Please let the VSP doctor’s office know that they will need to contact VSP directly to obtain authorizationPlease note that in the future VSP will not be able to provide another exception. You will be required to work within the parameters of your plan. Tell us why here

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 am writing in response to a grievance that VSP's Complaint and Appeals Unit received on October 5, regarding *** ***.I apologize for any inconvenience Ms*** experienced regarding her vision care servicesI would also like to apologize for the customer service experience she
encounteredAt VSP, we pride ourselves in providing world class customer serviceIn situations where this has not occurred we take it very seriouslyI have documented her concerns and will ensure that coaching is provided.Our members are not required to file a claim form when services are received from a VSP network provider's officeThe office applies the member's insurance coverage in order to maximize the benefits of the plan and then the office files a claim with VSP directlyTherefore, when VSP received a claim form from a member it is paid in accordance with the out of network reimbursement scheduleI have reviewed Ms***'s claim and requested a check be issued for the requested difference in the amount of $Please allow ten business days for processing.Since it is our primary goal to provide a high level of service to our membersWe sincerely appreciate it when situations such as there are brought to our attentionThis enables us to evaluate areas for improvement and bring better future service.Please feel free to contact me at *** *** if you have additional questionsMy office hours are Monday through Friday 7:a.mto 3:p.m.Pacific Tiem.Sincerely,*** ***Complaint & Grievance Unit

I am rejecting this response because: I have been calling for months advising They are debiting the wrong account(each time they state they do not handle billing and they would send the request up) and I called several times advising of my marriage and VSP was not proactive in cancellingNow my spouse whom was my fiancé at the time is rejecting and disputing the premiums illegally taken from VSP and I'm disputing the term dateWhen enrolling through ** *** I was advise the same eligibility rules apply so I called and canceled as advised by ** *** this is unacceptable and needs to be reviewed again

The claims for both *** *** and *** ** have been processed and payment for $per claim will be sent to the member withing - business days

I am writing in response to a grievance your agency filed on the behalf of member *** ***Please accept my apology for any misunderstanding regarding her daughter *** $total copayment for her VSP benefits Her plan under
*** Agency provides an out of network exam, lens and frame allowance when a patient receives services with non-VSP providers after a $total copaymentThese services are available once everymonths based on a service year frequencyPlease note that the total $copayment for the exam, lenses, and frame is applied to the first claim that is received by VSP Our records reflect that we received *** lenses and frame claim on January 8, We process and paid the claim on January 13, Since this was the first claim we received, the $total copayment was applied to the lenses and framesThen on January 11, VSP received her exam claim from Carolina Vision Group. *** was referred to the Carolina Vision Group for the $refundAny refunds for copayments and out of pocket expenses are considered a a private transaction between the member and doctor’s office Also, after some research, I was not able to find her February 19, online inquiryDue to the misunderstanding, I will send the member a $check for *** copayment to the address we have on filePlease allow business days for processing and mailing time from Sacramento, California I apologize for any inconvenience the member may have experienced. As an organization committed to member satisfaction, we thank you for bringing the member’s concerns to our attention. Please feel free to contact me at *** *** if you have any other questions. My office hours are Monday through Friday 6:a.mto 2:p.m., Pacific Time.Sincerely, *** *** Complaints & Grievance Unit Customer Care Division Case# ***

Per Ebony at VSP Direct the plan was cancelled effective 3/1/15 as an exception and Kira was refunded $42.75 on 5/28/15. The plan premiums are charged a month ahead so the refund was for the March and April premiums. No additional payments were taken and the plan is inactive.

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: * 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 + 0.50 diopters does not improve visual acuity. I 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 benefits. The member's employer selected a plan designed to help with typical eye care expenses. If 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] expectations. We take all member concerns very seriously and have documented the members concerns. As an organization committed to member satisfaction, we sincerely appreciate the feedback. We 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 questions. My office hours are Monday through Friday 7:00 a.m. to 3:30 p.m., Pacific Time.Sincerely,[redacted]Complaints & Appeals UnitCase: [redacted]

I am writing in response to a grievance that VSP’s Complaint and Appeals team received on January 24, 2018, regarding the claim for [redacted] under the primary member [redacted].The members plan through [redacted] provides coverage for exam, lens and frame once every 12...

months based on a service year. As an alternative, a patient may obtain elective contact lenses instead of lens and frame, but not both services in the same eligibility period. Please note that each employer and VSP client is responsible for establishing the benefits (such as copays, allowances and frequency) for their covered members. According to our records, we received an out-of-network claim on October 14, 2016, for Austin [redacted] for contact lenses purchased on date of service August 3, 2016.  This claim set the eligibility period from August 1, 2016 – August 1, 2017. A reimbursement check for $105.00 (maximum out-of-network allowance for elective contact lenses) was issued to the member on October 19, 2016. The reimbursement the member received is in accordance with the non-VSP provider fee schedule established under the member’s plan. This schedule is applied when a patient chooses to seek services from a non-VSP provider. There is no assurance that the schedule will be sufficient to pay for the services in full.  Based on this claim, the member’s next eligibility date for material services was August 1, 2017.   On November 24, 2017, we received an out-of-network claim for Austin [redacted] for contact lenses purchased from Walgreens on date of service November 11, 2017. A reimbursement check for $97.58 was issued to the member on December 1, 2017.  We received an additional out-of-network claim on January 6, 2018, for contact lenses purchased on date of service April 6, 2017. We were unable to process reimbursement or adjust the eligibility date back to April 1, 2017, as the patient was not eligible for additional reimbursement on the date of service.   We sincerely apologize for any inconvenience the member may have experienced as a result of this situation.

Our records show that the member has coverage under the VSP Individual Plan with an original effective date of May 1, 2016. Per the Terms & Conditions of the plan, cancellation requests are accepted within 30 days of the plan effective or renewal date and benefits must be unused....

According to our records, the member used the benefits for exam and materials on date of service May 3, 2016. I spoke with [redacted] from the VSP Direct Team that handles all billing and payment inquiries. She informed me that due to the situation a request for an exception was submitted by a Supervisor (Rose) to cancel the coverage effective October 1, 2016. Please note that cancellations cannot be requested retroactively. Should the request be accepted premiums will no longer be withdrawn and the member will receive email confirmation. The member may contact the VSP Direct Team for more information at [redacted] option 1 then option 3.

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 did request cancellation in February but they did not cancel and continued to charge me.  They are thieves and only canceled my policy because I filed a complaint to Revdex.com.  I would like everyone to know they are not trustworthy so please make sure my compliant stays active in Revdex.com.

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 writing in response to your complaint VSP received on June 30, 2015 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, 2014 paid correctly.  The $70.00 frame and $35.00 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, 2014 and an exam on September 23, 2014 at Natomas Optometry, a VSP plan participating doctor. These claims were paid to the doctor. Your 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, 2014 paid correctly.   The spectacle lens service was denied as you were not eligible for this service until January 1, 2015. The $70.00 frame reimbursement you received is in accordance with the non-VSP provider fee schedule established under your employer’s plan. You 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, 2014 paid correctly.  The $70.00 frame and $35.00 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 copay. Your frame is covered up to $200.00.
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, 5:00 a.m. to 8:00 p.m., Saturday 7:00 a.m. to 8:00 p.m., and Sunday 7:00 a.m. to 7:00 p.m. Pacific Time. Our Customer Service Representatives will be happy to access the information regarding your request.

I am writing in response to the grievance that VSP received on December 20, 2017 from the Revdex.com regarding the information you received about your VSP Individual plan through Healthy Vision Association. VSP has made an exception to cancel your plan effective October 1, 2017. This is...

the date that your plan through the [redacted] went into effect. The cancellation is currently processing and can take up to 10 business days to complete. As requested, attached is a copy of the terms and conditions of your plan. I apologize if you did not receive this information previously. According to our records out-of-pocket expense letters were sent to you on December 20, 2017. I have attached copies of those letters for the following family members: [redacted] and yourself. These letters are for the claims from 2017. I apologize for any inconvenience you may have experienced. As an organization committed to member satisfaction, we sincerely appreciate your feedback. We 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 future. If 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 Friday5:00 a.m. to 8:00 p.m., Saturday7:00 a.m. to 8:00 p.m. and Sunday7:00 a.m. to 7:00 p.m., Pacific Time). You may also visit our Website at vsp.com for additional information regarding your vision benefits. [redacted]. Ext. [redacted] Customer Care Division Ref: Case # [redacted]

I accept this response as long as they are not going to send my account to collections after they cancelled it.  
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 am writing in response to the grievance your agency submitted on behalf of member [redacted] with regards to the reimbursement of her premium payments. As [redacted] indicated previously, [redacted]’s account was canceled with VSP Direct effective November 1, 2016. VSP Direct advised us that an $85.00 refund was requested and would be mailed directly to [redacted]. I was sorry to hear that she has not received this reimbursement check. I contacted VSP Direct and spoke with [redacted] who let me know that the $85.00 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 $17.00 but they also voided the $85.00 check out. A new check in the amount of $68.00 was requested and will be mailed out today. The $17.00 and $68.00 equal $85.00 which is the refund amount she was promised. This check is being mailed from Frisco, Texas so [redacted] will need to allow at least 10 days mailing time. If at that time she has not received the check she may wish to contact VSP Direct. They can be reached at [redacted]. I apologize for any inconvenience [redacted] has experienced as a result of this situation. Please feel free to contact me at [redacted] if you have any other questions. My office hours are Monday through Friday from 6:00 a.m. to 2:30 p.m., Pacific Time. Sincerely, [redacted]Complaint & Grievance Unit

I am writing in response to the grievance that VSP's Complainant and Appeals Unite received on May 31, 2016 regarding [redacted]. Please accept my apology for your second request for response. However our records do not reflect receipt of the original request of May 7, 2016 referenced in your letter. I apologize for any inconvenience Ms. [redacted] experienced attempting to cancel her plan outside of the provisions of the first 30 days of the contract. I would also like to apologize for the rudeness she experienced when she spoke with one of our representatives. At VSP, we pride ourselves in providing world class customer service. In situations where this has not occurred we take it very seriously. I have documented her concerns and will ensure that coaching is provided.According to our records, VSP received a telephone call on May 7, 2016 from Ms. [redacted]; however no written request for cancellation of the account was never received. On May 31, 2016, I contacted [redacted] in our billing department who was able to make an exception and cancel the policy effective June 1, 2016. In an effort to resolve the situation satisfactorily the account will be terminated and can be confirmed by referencing the following cancellation ID #[redacted]. Since it is our primary goal to provide a high level of service to our members, we sincerely appreciate it when situations such as these are brought to our attention. This enables us to evaluate areas for improvement and bring better future service. Please feel free to contact me at [redacted] ext [redacted] if you have any other questions. My office hours are Monday-Friday 7:00am to 3:30pm Pacific Time. Sincerely, [redacted]Complaints & Grievance Unit Customer Care Division Case #[redacted]

I am writing in response to a grievance that VSP's Complaint and Appeals Unit received on May 23, 2016 regarding [redacted].I apologize for the frustration Mr.[redacted] has experienced with the length of time VSP has taken to research and resolve his concerns. We strive to resolve complaints as quickly as...

possible. By submitting a formal complaint through our online grievance form VSP has 30 days to resolve a complaint. Prior to completing the form online we disclose this information and advised that our Customer Service Department may be reaches for immediate assistance.According to our records, we received an online grievance on 05/08/2016 and it was acknowledged via email on 05/11/2016. On 05/24/2016 we expedited the complaint and contacted [redacted]. The doctor's office was apologetic for Mr. [redacted]'s dissatisfaction and stated the glasses are now ready to be dispensed. In an effort to resolve the situation satisfactorily they are prepared to refund all out of pocket expenses for the glasses. Experiences such as these are not typical with a VSP doctor and in acknowledgement of this the doctor's office also voluntarily reinstated Mr. [redacted]'s benefits due to the delay and this situation. On 05/24/2016 a resolution letter was sent to Mr. [redacted] from [redacted]. advising him of the resolution to his complaint.Since it is our primary goal to provide a high level of service to our members, we sincerely appreciate it when situations such as these are brought to our attention. This enables us to evaluate areas for improvement and bring better future serivice.Please feel free to contact me at [redacted] if you have any other questions. My office hours are Monday through Friday 7:00 a.m to 3:30 p.m..Pacific Time.Sincerely,[redacted]Complaints & Grievance UnitCustomer Care Division