The TSO Operations Committee met in August to address the following items:
Committee members are excited about the conference and wants to encourage TSO doctors to attend. Ann Deen will also contact doctors to encourage participation in this important conference.
Humana Vision Care Plan (VCP)
VCP has recently completed an analysis of the TSO provider fee schedule and have determined a fee adjustment to the current materials reimbursement is necessary. The materials rate decrease started August 15, 2013.
At this time the committee recommends that TSO continue their partnership with VCP and will review again in 2014. Please direct your questions to Ann Deen at firstname.lastname@example.org.
Spectera Essential Healthcare Benefits Program (EHB)
Effective January 1, 2014, medical plans must offer a comprehensive package to individuals and small employer groups (2-50 employees) that include the services of “10 Essential Health Benefits.” Among the 10 elements is pediatric dental and vision care. Spectera is not offering dental and vision coverage to adults enrolled in EHB plans in 2014, only offer coverage to pediatric to age 19. The EHB plans will be available both inside and outside the healthcare exchanges. Spectera estimates 700,000 to 1,000,000 individuals will enroll in EHB during 2014.
There are no dollar limits or allowances in the EHB plans. Since there is no allowance, frames and materials will be reimbursed as stated in the TSO/Spectera current fee schedule. Spectera is covering scratch and poly in full and members are responsible for usual and customary on any other lens options they may want.
EHB Contact Lens Program
The EHB CL formulary will be shorter than the commercial formulary and include some child-specific lenses. The EHB CL program will be a 12-month supply, based on the type of lens prescribed (bi-weekly, or monthly).
Feel free to contact any member of the Operations Committee members or Ann Deen concerning the items listed above.
|Office #||Name||Phone Number||Fax Number||E-mail Address|
|#888||Dr. Robert Graceyemail@example.com|
|#1024||Dr. Amit Shah||281-431-1000||Amits32@yahoo.com|
|#1002||Dr. Doug Jackman (Chairman)||firstname.lastname@example.org|