COB: Why using VSP’s industry-best program will benefit patients and your practice

AOA Focus is highlighting VSP’s approach to coordination of benefits (COB) because it stands apart from other plans specifically in the ease of the process, including maximizing benefits and electronic secondary claim submission.

With that in mind, we asked VSP Vision’s Board Chair, Matt Wickham, O.D., a series of questions to further understand COB and what makes VSP’s approach so unique.

Dr. Wickham, can you tell us a little about yourself?

First, let me say, I appreciate the opportunity to talk about coordination of benefits. We view COB as a great way for doctors and patients to solidify their relationship. A bit about me: I am originally from Warrensburg, Missouri, and have degrees from Missouri State University and an Advanced Graduate School Certificate from Creighton University-Werner School of Law. I received my doctorate and graduated with honors from the University of Missouri-St. Louis College of Optometry in 1993. I have been a member of the VSP Board of Directors since 2017 and board chair since 2024.

What is coordination of benefits (COB)?

COB is more than a question of who’s paying—or who pays first—it’s about maximizing patients’ benefits by saving them time and money. The Centers for Medicare & Medicaid Services (CMS) defines COB as applying any time a beneficiary is covered by more than one plan, permitting Medicare, in this instance, to coordinate with other plans or payers to reduce administrative burdens and enable patients to obtain payment of the maximum benefit allowed. COB claims are those sent to secondary payers with claims adjudication information included from a prior or primary payer obligated to pay first. 

Why is COB important?

The goal of COB between medical and vision plans is to allow members to utilize a paid-for benefit when they have a medical eye condition. Without COB, that would mean a medical eye care patient would end up with higher out-of-pocket expenses and unused benefits. VSP supports this with COB between major medical and VSP routine plans and the VSP supplemental medical plan, Essential Medical Eye Care. Members can coordinate eligible services between their major medical plan and their VSP routine exam and/or Essential Medical Eye Care, including medical exams, refractions and additional medical services.

How does VSP’s COB process benefit doctors?

VSP has a COB benefit on many, but not all, plans that can be utilized toward both routine (e.g., refraction) and medical services when not paid in full by the medical plan. VSP has worked to develop a system that allows doctors to easily coordinate benefits through our electronic claims systems. Unlike some other plans, no paper claims need to be submitted. As a health-focused company, VSP’s goal is to improve the ease of COB claim administration to simplify and better support medical eye care services. This helps doctors better serve their patients, keeping them in their chair for all their eye care needs and supporting retention.

How does COB benefit patients?

COB saves patients money and multiple visits. If eligible, COB allows patients to utilize their routine benefit allowance toward uncovered portions of the medical eye exam and refraction. VSP members with both routine benefits and Essential Medical Eye Care coverage can maximize both plans, helping to cover any overages from their primary medical coverage and encouraging patients to stay with their optometrist for all their routine and medical needs.