Vision Service Plan

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] 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 rejecting this response because: The business response is incorrect. It is true that I did have coverage from [redacted] more than a year ago, but this was cancelled when I left that employment. I enrolled my wife [redacted], and myself [redacted] through an internet site approximately five months ago. I cancelled the policy approximately three months ago, yet VSP continues to Bill me each month for no services. When I called VSP to question why I was still being billed for non existent services, the spokeswoman suggested I retain an attorney.I simply request VSP stop billing me for services I cancelled.[redacted]

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 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.

VSP 2nd level complaint [redacted]:While Mr. [redacted]' plan is no longer active, his wife as the primary member is where the charge is being applied as her plan is still active.  I contacted [redacted] who manages the enrollment and was advised by Bo that they did receive a phone request on 3/4/15 to cancel the policy.  The member was advised at that time that unfortunately they were not able to cancel the policy as it was outside the 30 day cancellation window as described in the terms and conditions they agreed to when enrolling.  It is a 12 month policy.  Per the member's request the plan will not renew at the end of the year so 12/31/15 will be the end date for the policy.

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]
[redacted]

I am writing in response to a complaint we received from the Revdex.com on 12/09/2014 regarding your premium payment deductions. I am sorry to hear of the confusion regarding your premium payments. I called our Client Administrative Services who handles your enrollment and your monthly premium payments and was provided the following 2014 credit card payment history: On September 15th payment was collected which covered October. On October 15th collected payment for November; however, it failed. This means the payment for November is still owed. On October 21st Client Administrative Services received a call from you updating your payment information and moved your payment collection date to the 24th of each month. On October 24th payment was collected which covered November. On October 24th another payment was collected, in error, which was credited back to your credit card on November 13th. On November 24th payment was collected which covered December. Your account is current and your next payment will be collected on December 24th which will cover January 2015. You mentioned in your comments that your payment date should not be the 24th of each month. To charge this date, please contact the Client Administrative Services at 800-400-4569; option 2. I apologize for any inconvenience you may have experienced. As an organization committed to member satisfaction, we sincerely appreciate your feedback. We are currently in the middle of updating our payment system. 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. [redacted] Customer Care Division; 11043830 VSP Member Services at 800-877-7195

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 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.

After my last argument with VSP, I requested that they cancel my vision plan. They promptly did this and told me I would receive a refund for the payment I made in December, which is when I had my plan canceled. Specifically, it was canceled December 18th. So, knowing that VSP takes full advantage of the 10 business day cycle with which they use to process refunds, I waited. Not counting Christmas Day and New Year's Day, it has been 11 or 12 business days and I have received no refund. Which is exactly what I was expecting from these crooks. So, I would very much like the refund that was promised to me.I would like the refund of my payment of $25.27 as VSP told me that they had sent in a refund for my last payment. I will not accept anything else.

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.

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]

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.

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.

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.

Review: My eye doctor has been contacted and received a decision claiming their recommendations for "medically necessary" are not valid.

Medically necessary contact lenses provide vision improvement in patients with corneal disease or corneal injury. Patients with irregular corneas often see poorly with eyeglasses, but can see quite well with unique contact lenses, which is why the contact lenses in these cases are considered medically necessary, not cosmetic.

VSP has accepted this definition of my eye sight in the past and paid the claim without question. Why has this changed? If this has changed, I should have been notified before I renewed with this VSP vision plan.

What calculations is VSP using to determine that my eye sight correction is not "medically necessary"? How can VSP recreate my vision prescription without an office visit? In the manual I clearly meet the requirements for "medically necessary", (Anisometropia of >3.00D) and have for several years, through VSP and other vision care providers.

My doctor confirmed a good fitting for my medically necessary lenses by ensuring the following:

1) Optimal vision correction

2) Good comfort and wearing time with the lens

3) Ability to wear the lens without compromise to the health of the eye

How could someone who has never looked at my eye determine this to not be true?

I would like printed documentation explaining how this was figured. I also want to know how this is legal. It seems fraudulent to recreate my prescription, based on a calculation developed that favors VSP and not the patient.Desired Settlement: Honor the "medically necessary" prescription.

Review: This company updated their payment equipment, and as patients we were supposed to re-register to continue having our deductible charged, mine is an auto debit. I had decided that I didn't want to renew, so neglected to update my payment info, assuming that it wouldn't renew and that my policy would be cancelled. I then get a few more emails, then one stating that they went ahead an updated my info for me and then charged my deductible. Then I emailed back stating that I didn't want to renew and wanted my policy to lapse, and had sent this email maybe 2 or 3 times. A month later, I get another email stating that I can't cancel until July and will be billed until then. I have put a stop payment on my billing but still feel that the company owes me deductibles since March of 2015 in the total amount of $60.Desired Settlement: I would like a refund of 3 months deductibles and my policy to be cancelled.

Business

Response:

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.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Review: Went for yearly eye exam and submitted claim. Claim was denied. It should have been paid. Claim #[redacted].Desired Settlement: Please re-submit and pay these claims, they are covered under my healthcare plan.

Business

Response:

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

Review: I sent the receipt for eyeglasses to VSP for about $459. which saved VSP hundreds of dollars since the [redacted] Eye Clinic I did not go to that they say is inside their plan wanted over $600. for similar glasses. After saving VSP HUNDREDS of dollars by going to another Optician clinic, VSP only wants to re-imburse me for $170. saying I went outside their plan. I want the full amount of $459. paid or I will write a report on VSP online for everyone who might choose that plan to see how evil they are.

Desired Settlement: DesiredSettlementID: Other (requires explanation)

I wish to be paid the full $459. amount that saved VSP HUNDREDS of dollars from what [redacted] Eye Clinic would charge.

Business

Response:

Initial Business Response

I am writing in response to a grievance that VSP's Complaint and Appeals team received on September 24, 2013 regarding your out-of-network reimbursement.

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.

Due to the circumstances, VSP has made an exception to reimburse you an additional $214.74. A check in that amount will be forthcoming within the next 10 business days. This additional reimbursement is based on the amounts listed on the Member Reimbursement Form and the itemized receipt you submitted with your request for reimbursement. The amounts listed are as follows: Frame $139.99, Coatings $76.00, Lenses $168.75 for a total of $384.74 not $459.00 you reference in the grievance. VSP is not reimbursing your $25.00 copayment of the $5.00 miscellaneous charge.

In the future, please keep in mind [redacted]'s plan through [redacted] Health Care gives you the option to receive services from a VSP doctor's office or a non-VSP provider's office. When you choose to receive services from a non-VSP provider, the reimbursement will be based on a schedule of allowances established under his plan. These allowances may not be sufficient to cover your services in full.

You are currently eligible for a routine eye examination and you will next be eligible for spectacle lenses on August 1, 2014 and a new frame on August 1, 2015.

Final Consumer Response

Yes, thank you very much. The stop payment on the $170. was unblocked.

Final Business Response

We have received the request to dispute the original resolution on 10/18/2013. We are researching this matter and will follow up on Monday 10/21/2013.

Review: I cancelled a policy with vision service plan 3 months ago. They continue to debit my bank account for 14.95 each month, stating that I signed a one year contract.I did not sign a one year contract.Desired Settlement: Stop debiting my bank account. Cancel the policy like a normal reputable company would.

Business

Response:

I am writing in response to complaint VSP's Complaint and Appeals Team received on May 14, 2015 from your office on behalf of the member listed above.Our records show that [redacted] was reporting to VSP that Mr. [redacted]' vision policy was termed as of November 30, 2014 and his [redacted]-Basic policy was termed as of January 1, 2015. The collections of policy premiums for these two policies are collected by [redacted]. Mr. [redacted] will need to contact [redacted] if these are the policies he is questioning the deductions of premium payments. I am unable to locate any other vision policies with Mr. [redacted] as the policy holder or listed as a dependent under someone else's policy.If Mr. [redacted] has any written communicate regarding a policy that we are administering and would like to provide a copy, I would be more than happy to further assist him.Please feel free to contact me at [redacted] if you have any other questions. My office hours are Monday through Friday from 6:00 to 2:30 p.m., Pacific Time.

Business

Response:

I am writing in response to complaint VSP's Complaint and Appeals Team received on May 14, 2015 from your office on behalf of the member listed above.Our records show that [redacted] was reporting to VSP that Mr. [redacted]' vision policy was termed as of November 30, 2014 and his [redacted]-Basic policy was termed as of January 1, 2015. The collections of policy premiums for these two policies are collected by [redacted]. Mr. [redacted] will need to contact [redacted] if these are the policies he is questioning the deductions of premium payments. I am unable to locate any other vision policies with Mr. [redacted] as the policy holder or listed as a dependent under someone else's policy.If Mr. [redacted] has any written communicate regarding a policy that we are administering and would like to provide a copy, I would be more than happy to further assist him.Please feel free to contact me at [redacted] if you have any other questions. My office hours are Monday through Friday from 6:00 to 2:30 p.m., Pacific Time.

Consumer

Response:

I am rejecting this response because: The business response is incorrect. It is true that I did have coverage from [redacted] more than a year ago, but this was cancelled when I left that employment. I enrolled my wife [redacted], and myself [redacted] through an internet site approximately five months ago. I cancelled the policy approximately three months ago, yet VSP continues to Bill me each month for no services. When I called VSP to question why I was still being billed for non existent services, the spokeswoman suggested I retain an attorney.I simply request VSP stop billing me for services I cancelled.[redacted]

Consumer

Response:

I am rejecting this response because: The business response is incorrect. It is true that I did have coverage from [redacted] more than a year ago, but this was cancelled when I left that employment. I enrolled my wife [redacted], and myself [redacted] through an internet site approximately five months ago. I cancelled the policy approximately three months ago, yet VSP continues to Bill me each month for no services. When I called VSP to question why I was still being billed for non existent services, the spokeswoman suggested I retain an attorney.I simply request VSP stop billing me for services I cancelled.[redacted]

Business

Response:

VSP 2nd level complaint [redacted]:While Mr. [redacted]' plan is no longer active, his wife as the primary member is where the charge is being applied as her plan is still active. I contacted [redacted] who manages the enrollment and was advised by Bo that they did receive a phone request on 3/4/15 to cancel the policy. The member was advised at that time that unfortunately they were not able to cancel the policy as it was outside the 30 day cancellation window as described in the terms and conditions they agreed to when enrolling. It is a 12 month policy. Per the member's request the plan will not renew at the end of the year so 12/31/15 will be the end date for the policy.

Business

Response:

VSP 2nd level complaint [redacted]:While Mr. [redacted]' plan is no longer active, his wife as the primary member is where the charge is being applied as her plan is still active. I contacted [redacted] who manages the enrollment and was advised by Bo that they did receive a phone request on 3/4/15 to cancel the policy. The member was advised at that time that unfortunately they were not able to cancel the policy as it was outside the 30 day cancellation window as described in the terms and conditions they agreed to when enrolling. It is a 12 month policy. Per the member's request the plan will not renew at the end of the year so 12/31/15 will be the end date for the policy.

Consumer

Response:

I am rejecting this response because: My wife and I had not verbally or physically signed an agreement with vision service plan that would include a clause that "a policy has to cancelled within a 30 day limit". I would ask that this company produce any documents that I or my wife agreed to in regards to such a scam like agreement. Billing for cancelled services is a fraudulent act, and we will next file a complaint with Washington State Attorney Generals office if we are unable to resolve it at this level.[redacted]

Consumer

Response:

I am rejecting this response because: My wife and I had not verbally or physically signed an agreement with vision service plan that would include a clause that "a policy has to cancelled within a 30 day limit". I would ask that this company produce any documents that I or my wife agreed to in regards to such a scam like agreement. Billing for cancelled services is a fraudulent act, and we will next file a complaint with Washington State Attorney Generals office if we are unable to resolve it at this level.[redacted]

Business

Response:

I am writing in response to your additional inquiry regarding [redacted]’s VSP plan. VSP has made an exception and [redacted]'s plan has been cancelled. A refund in the amount of $101.08 is currently processing. This represents seven payments at $14.44 a month. Since the refund is for payments older than 120 days the refund will be issued via check. Typically this process takes 30-45 days to complete but we have expedited it for you. A refund in the amount above will be mailed directly to on June 24, 2015. Please allow for 10 business days to receive this refund. I apologize for any inconvenience you experienced. [redacted]Complaints and Appeals

Business

Response:

I am writing in response to your additional inquiry regarding [redacted]’s VSP plan. VSP has made an exception and [redacted]'s plan has been cancelled. A refund in the amount of $101.08 is currently processing. This represents seven payments at $14.44 a month. Since the refund is for payments older than 120 days the refund will be issued via check. Typically this process takes 30-45 days to complete but we have expedited it for you. A refund in the amount above will be mailed directly to on June 24, 2015. Please allow for 10 business days to receive this refund. I apologize for any inconvenience you experienced. [redacted]Complaints and Appeals

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.