On January 1, 2026, we will be out-of-network with VSP

We understand this change may come with questions. We have compiled this FAQ to help provide answers. If your question or concern is not addressed here, we are more than happy to speak with you about your specific issue.

We will still be in-network with Medicare, Blue Cross Blue Shield/Blue Care Network, Priority Health, and UnitedHealth commercial and Medicare advantage plans, Healthsmart, and ASR insurances. We will maintain the ability to submit your annual eye exams and follow up visits to your medical insurance if there is any medical condition with the potential to affect vision, such as diabetes, cataracts, dry eye, among others.

Why are you going out-of-network with VSP?

The short answer is that we cannot afford to continue to be in-network and provide the level of care that we wish to provide.

VSP has not increased their provider reimbursement in over 25 years. For the sake of transparency, here is exactly what we bill to VSP for an established patient comprehensive exam and what VSP reimburses us.

  • Comprehensive exam + refraction fees billed to VSP=$185

  • The patient may have a copay of $5-$15 that we collect at the time of their exam

  • VSP reimbursement= $43-53

  • Our total reimbursement= $58/exam

    • In other words, we have to write off $127 for every established comprehensive exam we see.

In order to be able to pay our staff, to pay for our costs of goods, to pay for improvements in the office and in our office technology, it is just not possible anymore for us to write-off more than 60% of our exam fees for every single VSP exam we perform.

Then why are any offices in-network with VSP?

Many offices, like this one, began accepting VSP decades ago when reimbursement levels made good financial sense. As inflation increased and reimbursement remained stagnant, these offices continued to accept VSP as a means to get more patients in the door. That is where VSP still excels - they have a large pool of members who look for in-network eyecare.

If you have ever been to a corporate or chain eye clinic or optical and felt like just a number or felt like you were on a conveyor belt getting sped through your exam, that is the setting where being in-network with VSP is still viable. Their focus is on quantity to make up for the low exam reimbursements.

Our focus is quality. We cannot, and do not want to, see 4 patients an hour. Therefore, we have to make this change to be able to continue providing high quality care in the exam room and in the optical.

Is money the only reason you are making this change?

No, it is not. We’re glad you asked. Most people with VSP refer to it as “vision insurance” or “eye insurance”. In reality it is not insurance. It is a vision benefit discount plan. This is misleading for VSP subscribers and often leads to confusion after some exams.

VSP’s exam benefit covers a routine comprehensive vision exam. This includes checking vision, your glasses prescription, and examining your eye health. It does not include any evaluation, discussion, or treatment of eye abnormalities or disease that has the potential to cause eye abnormalities. Here are some examples:

  • An annual diabetic eye exam is not covered under VSP because we are looking for potential eye damage caused by diabetes

  • An exam for a patient with chronic dry eye disease that is causing vision changes or eye discomfort is not covered under VSP because we need to discuss and treat an eye condition actively causing symptoms

  • An exam for a patient with cataracts that are starting to blur their vision is not covered under VSP because the vision changes are related to more than just a change in their glasses prescription

Some VSP plans do have additional coverage called Essential Medical that covers some medical eye exams. However, according to VSP’s provider manual, we are required to submit these exams to a patient’s medical insurance first. In other words, even in these cases VSP is acting only as a supplemental plan and does not eliminate a patient’s deductible or co-insurance costs.

By dropping VSP, we will be able to perform the same thorough exam, have the same discussions, and provide the same education and treatment for all patients, regardless of exam type.

Can I still be a patient even if I keep my VSP?

Yes, you can be. Some VSP plans do allow for out-of-network reimbursement. In this case, we would collect your payment for your exam, glasses, and/or contacts at the time of you visit and provide you with an itemized receipt and out-of-network form. You can submit that form and receipt for direct reimbursement from VSP.

Alternatively, explore our options for our KFE Direct Care plans. These are our in-house vision and exam plans with monthly or annual payment options. Compare what your monthly payments are for VSP and what they would be with one of our plans.

What is the cost of an exam with an out-of-network vision plan or without a KFE Direct Care plan?

For a new patient, the cost of a comprehensive exam with dilation is $220. If you opt for ultra-widefield retina photos instead of dilation, the cost is $259.

For an established patient, the cost of a comprehensive exam with dilation is $185. If you opt for ultra-widefield retina photos instead of dilation, the cost is $214.

If you are a contact lens wearer, an additional $75-$135 would be added to any of the totals above for annual evaluations or new fittings when applicable.