Under most TBT Plans, vision care benefits are provided through the Vision Service Plan (VSP) network. For details about your Plan’s vision care coverage, see the Summary of Coverage for your TBT plan.
You may choose any licensed eye care professional, but the paid benefit amounts will be greater when you use a VSP provider. You and your covered dependents don’t have to use the same eye care professional. Each of you may choose a different eye care professional for covered benefits at any time.
How to Use the VSP Network
Step 1. Before making an appointment, make sure you understand your Plan benefits. Check your Summary of Coverage for details about your vision care coverage. If you’re not sure which TBT Plan is yours or have questions, contact the TBT Plan Administration Office.
Step 2. Find a VSP provider by visiting their website at www.vsp.com or calling the VSP network at (800) 877-7195. Once you find the VSP provider located closest to your home or workplace, make your appointment. Be sure to identify yourself as a TBT VSP patient in advance.
Step 3. The provider will contact VSP before your visit to receive advance authorization to provide your covered services. If you are not currently eligible for vision care benefits, the VSP provider notifies you of this, usually before your visit.
Step 4. At the visit, the VSP provider will ask the patient to sign a benefit form and provides a copy for your records. VSP providers agree to accept this signed form as full payment for covered expenses. (You may need to pay for any non-covered expenses.) Then, the eye care professional receives payment from VSP. You do not need to file claims. VSP pays its providers directly for covered services, materials or supplies covered under your TBT plan.
How to File Claims (if you choose not to use a VSP Provider)
Follow these steps if you receive services from a non-VSP provider:
Step 1. When you use a non-VSP eye care professional, you must pay the full amount charged for your services, materials or supplies and send the itemized bill to Vision Service Plan, P.O. Box 997100, Sacramento, CA 95899 (within six months of the date of service).
Step 2. VSP processes your claim and sends the reimbursed amounts directly to you. Reimbursed amounts cannot be made payable to the eye care professional. VSP only reimburses you for covered services and materials—and only at the specific non-VSP rates listed in your Summary of Coverage—if you file within the six-month deadline. You are not reimbursed for non-covered items.
You may be charged the standard fee for these services and you will also have to pay the eye care professional directly at the time of your visit and send back the claim form for reimbursement at the non-VSP rates.