Curbing Out of Network: Good for Members and VSP Network Doctors

I coach a Little League baseball team and am an avid baseball fan. In the game of baseball, most teams, at any age, invest time, effort, and money in developing their players. This is done so that the team can be successful and so the players will stay with the team and produce a return on that investment.

Similarly, VSP wants to keep its 88 million members with its “team” of in-network providers because that’s where they receive the best overall value for their benefits. Yet, VSP determined through a recent claims analysis that among members who had visited an out-of-network provider, roughly two-thirds did so without realizing it. And of that group, 60 percent said they would have gone to an in-network provider had they known.

Think about it. In baseball terms, this would be the equivalent of the Yankees developing a network of players but having some of them report for Spring Training with the Red Sox, not even realizing they had switched teams.

Determined to reverse the trend, VSP launched a strategy to bring VSP members back in-network by making some operational changes and marketing differently. The results were astounding. Out-of-network claims dropped to their lowest percentage in three years. VSP’s out-of-network strategy was a “home run” for members and for doctors on the network.

VSP used a number of “plays” to direct patients to in-network practices. It started with VSP Vision Care Customer Service limiting who could obtain member eligibility and benefit information. In the past, the company would supply that information not only to the member, but also to a provider calling on the patient’s behalf whether they were in- or out-of-network.

Now, members visiting an out-of-network provider must call Customer Service directly to obtain coverage information. This allows VSP to educate members on how they can maximize their benefits by staying in-network and helps members make informed decisions about their choice of provider. No more Yankees players showing up in Red Sox uniforms!

VSP also continues to develop new exclusive Premier Program member offers that create even more reasons for members to stay in network. Launched late last year, a new promotion encourages members to visit a Premier Program location and receive a rebate of up to $100 when they purchase a Marchon or Altair frame and Unity digital lenses. No action is needed on the part of the practice until a VSP patient brings the rebate form to their appointment—then the practice just confirms the frame and lenses were ordered, signs the form, and the patient is ready to go! 

As I see it, VSP is serious about directing patients with VSP coverage to in-network practices, specifically those participating in the Premier Program. As a practicing optometrist and a baseball coach, I’m excited to see VSP putting time, effort, and money into keeping the players on the VSP team.