L & S Auto and Tire Services

I am writing in response to the grievance that VSP’s Complaint and Appeals team received on 4/26/16 regarding the member listed below:Member name: [redacted]Member ID: [redacted]Research: [redacted]’s benefits have been cancelled and refunded. The April payment for $32.48 was refunded back to the credit...

card on file. That payment had paid for the month of May. Therefore, she is cancelled effective 5/1/16. [redacted] has been sent an email confirming the5/01/2016 cancellation date and that her refund request was approved.Please feel free to contact me at [redacted] if you have any other questions. My office hours are Monday through Friday from 8:30 a.m. to 5:00 p.m., Pacific Time.Sincerely,[redacted]
[redacted]
[redacted]

Response:The three appeals that member [redacted] included in his correspondence with the Revdex.com have been individually reviewed & have been upheld. Claim #[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 exceeded. Claim #[redacted] was assigned appeal #[redacted] & was also upheld because the filed services have already been paid directly to the rendering facility on 9/26/14. A letter for each appeal has been sent directly to the member for his records.Sent on: 10/19/2015 4:58:30 PMSent by: 198.135.203.249

I am writing in response to a grievance that VSP’s Complaint and Appeals team received on December 21, 2016 regarding the member listed below:   ·         Member Name: [redacted] ·         Patient Name: ...

[redacted]  ·         Assigned ID#:  11889630 ·         Research: Our records show [redacted] Individual Plan became effective 12/01/2014 for coverage for her and daughter [redacted].  This policy is a twelve month term plan and premiums are collected one month in advanced around the 15th of each month. ·         The terms and conditions are read to the member when enrolling over the phone.  If it’s an online enrollment, the terms and conditions need to be selected and agreed upon prior to continuing to the next step.  We provide the first 30 days of effective date or renewal date to cancel the plan as long as benefits have not been utilized. If benefits are used then member would be responsible for the full 12 months of premiums. ·         Under our Individual Plans, a child dependent is covered until their 27th date of birth; therefore [redacted] became ineligible on 05/25/2016.        ·         Our records show that for the eligibility period that started on 12/01/2015 through 12/1/2016, dependent [redacted] used her benefit on 12/08/2015 for contacts.  A partial amount of her contact lens allowance was used.  A check was mailed to the member on 12/14/2015 for the reimbursement of these contacts.  Since benefits were utilized, member would then be responsible for the entire 12 months of premium; regardless if dependent aged out of the plan due to the age limit.  ·         Our team that handles cancellation requests was contacted by [redacted] on 11/21/16.  They explained to [redacted] that benefits were utilized so she would still be responsible for the 12 months of premium.  She was offered the option to return the reimbursement payment of [redacted]’s contacts in order to reverse the claim and show that benefits were not utilized for the coverage period and they would consider the cancellation request, but member did not take any action on this offer. ·         Member had been charged for the renewal of the plan in November 2016.  Per her request to cancel the plan, we refunded her the premium of $27.41 back and plan has been termed effective 12/01/2016. At this time there are no further monies due to the member.   Please feel free to contact me at [redacted] if you have any other questions.  My office hours are Monday through Friday 7:30 a.m. to 4:00 p.m., Pacific Time.   Sincerely,   [redacted]

I am rejecting this response because:I want my lens/contacts to match my eye exam 6/1/17. So I have to wait 4 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.

Please see attached letter. Thank you.

VSP stands by their position regarding the initial response to the Revdex.com on 08/17/16. I spoke with Laura at VSP Direct who explained that members must agree to the terms and conditions before enrolling in the plan. These terms and conditions explain that it is a 12 month plan and that cancellation requests are accepted within 30 days of the plans effective or renewal date and benefits cannot have been used. Our records indicate Mr. [redacted] used the plan on 05/03/16 for exam, lens and frame. Mr. [redacted] would be able to cancel the plan effective 05/01/17. [redacted] from VSP Direct was able to get supervisor approval to cancel the plan effective 10/01/16 due to the situation. Cancellations cannot be requested retroactively nor can a refund be provided. On this grievance as well as the initial grievance submitted directly to VSP on 06/20/16 [redacted] has referenced his fiancés account is being charged without permission. VSP is unable to research the concerns regarding the incorrect account being charged without the fiancé’s information. This response is specific to [redacted]’s individual account with VSP only.

I am writing on in response to a grievance your agency has filed on behalf of member [redacted]. I am sorry to hear that [redacted] was disappointed about the automatic renewal process of her vision coverage.   I spoke with [redacted] from our VSP Direct Team who reviewed the member’s request....

She confirmed that [redacted]’s account has now been terminated with VSP Direct effective November 1, 2016 and is the process of being fully terminated in VSP’s main system.  A refund in the amount of $85.00 has already been requested to be mailed to [redacted]. [redacted] had also advised [redacted] of the account termination and refund on February 17, 2017.   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 [redacted] if you have any other questions.  My office hours are Monday through Friday 8:30 a.m. to 5:00 p.m., Pacific Time.   Sincerely,   [redacted] Complaints & Grievance Unit Customer Care Division Case# [redacted]

I am writing in response to a grievance that VSP received from your agency on behalf of member Melody Carter regarding the request to cancel her vision care benefits. Thank you for bringing out member’s concerns to our attention and I am sorry to hear that she wishes to discontinue her coverage...

with VSP. On January 30, 2017, I spoke with [redacted] at the provider’s office who authorized the reversal on the member’s contact lens claim. This reversal was completed in our system within two days. I then contacted our VSP Direct Team on February 1, 2017 to request cancellation of Ms. [redacted] coverage. They were able to cancel the membership immediately on their end and it may take up to 5 business days for this information to reflect in VSP’s main data system. VSP Direct also initiated a refund of $27.08. This refund will be returned to Ms. [redacted] MasterCard account within the next 7-10 business days. There will also be no future billings charged to the member’s credit card. The member’s coverage is now in the process of being completely terminated and a refund is under way. If the member has any questions, she may contact our VSP Direct Team by calling [redacted] (Monday through Friday, 8:00 a.m. - 8:00 p.m. Eastern Time). She may select Option 1 then Option 3 and a representative will gladly assist her. Our sincere apologies to Ms. Carter for any misunderstanding that may have occurred. We appreciate the feedback you've shared as we strive to provide our members with a high level of service. Please feel free to contact me at [redacted] if you have any other questions.  My office hours are Monday through Friday 8:30 a.m. to 5:00 p.m., Pacific Time.   Sincerely,        [redacted] Complaints and Grievance Unit

I am sorry to hear you are unhappy with the frequency of [redacted] vision care plan.  Each employer and VSP client is responsible for establishing the benefits (such as copays, allowances and frequency) for their covered members.  Your plan allows coverage for exam and...

lens services once every 12 months and a new frame once every 24 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. Our records indicate you received an eye exam on 04/13/16.  Additionally you received an eye exam on 06/27/17.  You received glasses on 10/01/16.  You will next be available for lenses on 10/01/17 and a frame on 10/01/18.  You may wish to discuss your concerns with your benefits representative since VSP offers a wide variety of vision care plans. I apologize for any inconvenience you may have experienced.  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.

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 should I receive the check that has been cut a THIRD time.

I just really want him to either give me my money back or fix the suv he sold me.

Please confirm that I have a zero balance due to VSP and that there is no penalty or amount due, nor will I be sent to collections with any amount due because you cancelled my plan via Revdex.com. I am rejecting this response because: I am still receiving correspondence from VSP telling me to call and update my billing information. This is the email I received yesterday:  Member ID: [redacted]Dear [redacted],As a valued VSP® member, we want to inform you we were unable to process your recent payment for your VSP individual vision plan. Your coverage is in jeopardy of being cancelled.Please call us within 5 business days to update your payment information to avoid interruption of service and continue receiving great vision coverage.If payment is not received for any reason, VSP will cancel your coverage effective 30 days from your premium due date.You can reach us directly at [redacted] between 7:00 a.m. to 7:00 p.m. CST, Mondaythrough Friday.We look forward to continuing to provide you with the best care and service available!Sincerely,The VSP Team

Thank you for forwarding [redacted]’s note about the [redacted] frames. We share his frustration but want you to know that he still can purchase [redacted] frames using his out of network benefits. The unfortunate truth is that [redacted] has been suing VSP's affiliates for more than nine years. VSP has...

spent millions of dollars in defending the lawsuits. VSP has proposed ways of resolving the lawsuits through less expensive means such as arbitration or even settlement, but [redacted] has refused to cooperate. Litigation like this just raises our costs without benefiting our members, which is why we worked so hard to resolve it. And it is why we decided the best course is to begin distancing ourselves from [redacted] by deciding that we no longer will provide in-network coverage for frames manufactured and/or distributed by [redacted]. The bottom line is that [redacted] has a propensity for litigation. VSP has been paying substantial amounts of money defending the cases and has been trying for years to find an alternative, less-costly method of resolving the disputes. All the while, VSP has been covering [redacted] frames at in-network rates, contributing to [redacted]'s revenues and profits. Then [redacted] uses its profits to fund its litigation against VSP. As a not-for-profit business, the money spent by VSP in defending these lawsuits is money that could be used towards programs benefitting VSP's member doctors and patients. With over 450 frame brands available on the market, we remain confident that [redacted] will be able to find frames that will meet his satisfaction. However, we wish to emphasize that he can still purchase [redacted] frames, and even use his out-of-network benefits to do so.

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 have received the entire out of pocket total from VSP.Thank you,[redacted]

Response:The member purchased glasses from an Out-Of-Network provider. The glasses were returned and VSP was advised by the Out-Of-Network provider’s billing department on October 9, 2015 and again on October 22, 2015 that a refund check was being mailed to reinstate the member’s benefits. The...

billing department was contacted once again on December 23, 2015 and was advised that the check had not been mailed as previously indicated but that the issue would be escalated to a Supervisor for expedited processing which is typically 5 business days. VSP’s normal policy is to re-open benefits once the reimbursement check is received. Due to the situation we have made a one-time exception to allow the member to use lens and frame benefits prior to the receipt of the reimbursement check from the Out-Of-Network provider. The offer is valid for 60 days and the member’s doctor may contact Customer Service to verify benefits and obtain an authorization. Please be advised that the member filed a separate grievance directly with VSP on November 30, 2015 and a detailed response has been sent to the member as well.[redacted]

I am writing in response to the grievance that VSP’s Complaint and Appeals Team received from the Revdex.com on February 5, 2018 regarding VSP’s policy for minimum prescription requirements for the patient listed below. Primary Member: [redacted] Patient: [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 apologize that this specific information is not contained on our website. However, the information on our website states: “This information doesn't guarantee your eligibility of coverage. Your 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, 2018 about VSP’s policy for minimum prescription requirements. •[redacted] spoke to [redacted] at Dr. [redacted]’s office who verified that [redacted]’s prescription was .25 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 frame. If she chooses any non-covered lens enhancements they will be an out-of-pocket expense. If she selects a frame more than the plan allowance the overage will be discounted by 20% and the balance would [redacted]’s responsibility. These services will affect [redacted]’s future eligibility, meaning she will not be eligible for spectacle lenses until January 1, 2019 and a frame until January 1, 2020. •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 office. I 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 plan. VSP 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 members. I 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 service. Her perspective helps us to evaluate areas for improvement and bring better future service to her. 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 Customer Care Division Case # [redacted]Sent on: 2/7/2018 8:59:20 AM

This is the second time I have reported them, and I'm really angry. They renewed my account without consent and it has FINALLY been closed. Since January 15th I have been promised an $87 refund check and have received nothing. I have called numerous times, and am getting ready to drive myself and my newborn to the location and demand a check.I. Want. My. Money. I want it now, I don't want to play games with these people, I am sick and tired of it. They played on my emotions while I was pregnant, they've given me the run around with a newborn, I'm done. I'm really, really, really angry.

I am rejecting this response because: The statements provided in the response from the business is not accurate. I agree to allowing me to use my benefits within 60 days due to the lack of follow up to me throughout the process and I've paid for benefits I've been unable to utilize. The business failed to mentioned that the grievance I filed with VSP on November 30, 2015 was not the first grievance. My first grievance with VSP was on September 30, 2015. I received a letter request on 10/1/15 advising my grievance was received and someone would follow up with me. I called into VSP as I did not hear from anyone within the 48 -72 hour time-frame and was told again someone would follow up with me. I sent another message to VSP through my VSP account on October 9, 2015. I then called a second time as I had not heard from anyone. I sent a third message on October 20, 2015 and received a letter by email advising my issue would be escalated and someone would follow up with me again. I continued to get the run around. I sent another message on December 2, 2015 and received a response on December 4, 2015 with the same story I was told several times before. After 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 provider. I received a letter from VSP dated December 29, 2015 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.

I am writing in response to a grievance that VSP’s Grievance & Appeal Unit received on April 10, 2018, regarding the member’s vision benefits provided through the State of California. According to our records, the member contacted VSP and spoke with Supervisors in Customer Service on January 30,...

2018 and April 10, 2018. During the call on January 30, 2018, it was confirmed that the member had originally contacted Customer Service on September 21, 2017, and requested to cancel the State of California Premier plan and move to the basic State of California Advantage plan but continued to have premiums taken from his paycheck for the Premier plan. The member was added back to the basic State of California Advantage plan effective January 1, 2018. The member called again on April 10, 2018, regarding the same issue. The Supervisor confirmed with our Client Administrative Services Department that the deductions should stop. VSP is only able to reimburse the member for the difference in premium costs that were taken out of his paycheck. We sincerely apologize for the amount of time it has taken to resolve the member’s issue. Reimbursement checks in the amount of $28.46 were issued on February 9, 2018, March 6, 2018 and April 12, 2018 for the premiums from January through March. No further action is needed from the member. Please accept our sincere apologies for any inconvenience the member may have experienced as a result of this situation.

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 12/01/14.  This plan terminated on 11/30/16.I...

have spoken with [redacted] at VSP Direct who confirmed you contacted them on 11/17/16 regarding the cancellation of your plan and to request a refund.  Due to the bank draft, they must wait at least 8 days before providing your refund of $30.63.  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.