FAQ: How Do I Calculate Whether to Collect the Copay vs. 85% of U&C?

Answer: 

Making the most of the reimbursement, incentive, and support programs available through your vision plan partnerships can boost revenue and support long-term growth. Understanding copays and Usual and Customary (U&C) fees helps ensure accurate billing and appropriate reimbursement.

VSP^® Contact Lens Exam Copay with Materials Allowance: Patients who request a contact lens exam pay a contact lens exam copay or 85% of your U&C fees, whichever is less. There is no copay for contact lens materials, which are covered under a separate allowance.

• Example 1: Patient has a $60 contact lens exam copay, and your U&C fee is $60. Since 85% of your U&C fee ($51) is less than the $60 copay, you would only charge $51 (85% of U&C). 
• Example 2: Patient has a $60 contact lens exam copay, and your U&C fee is $80. Since 85% of your U&C fee ($68) is greater than the $60 copay, you would collect the $60 copay from the patient, and VSP would pay the remaining $8. 

In both examples, you receive 85% of your U&C fee for the contact lens exam. 

Learn More:

• Read Dr. Seth Geiger's insights on uncovering hidden revenue opportunities through your vision plan partnerships. 
• Build confidence in your own billing processes—register for the Billing Best Practices curriculum on UUniversity™—including a new Visually Necessary Contact Lenses course. 

Stay tuned to At a Glance to see more of your frequently asked questions—and the answers!