How VSP Out-of-Network Vision Benefits Work

What VSP out-of-network benefits are

VSP (Vision Service Plan) out-of-network benefits are the coverage you receive when you see an eye doctor who does not have a contract with VSP. Instead of going to a VSP network provider — who has agreed to charge set prices — you pay the eye doctor's full fee upfront, then submit a claim to VSP for reimbursement.

The amount VSP reimburses you depends on your specific plan. Some plans reimburse a fixed dollar amount (for example, $50 toward an exam or $150 toward glasses). Others reimburse a percentage of what you paid. The difference between what VSP pays back and what you actually spent comes out of your pocket.

Out-of-network care is useful if your preferred doctor is not in the VSP network, or if you live in an area with few VSP providers. It gives you more choice, but it typically costs you more money than using an in-network provider would.

Key Takeaways

Out-of-network providers do not have a contract with VSP, so you pay their full fee and request reimbursement afterward.
VSP reimburses a set amount or percentage based on your plan, and you pay the difference between the reimbursement and the actual bill.
Your VSP member card or online account shows your out-of-network benefit amounts for exams, glasses, and contact lenses.
You will need to submit a claim with an itemized receipt from the eye doctor to receive reimbursement.
Out-of-network reimbursement is usually lower than what you would pay at an in-network provider, so compare costs before you schedule.

How out-of-network reimbursement amounts are set

VSP plans typically list separate benefit amounts for in-network and out-of-network care. An in-network provider might cover your exam at no cost to you, while an out-of-network exam might reimburse you $50. For glasses, you might get a $150 allowance at an in-network provider but only $75 out-of-network.

The reimbursement is based on what VSP considers a reasonable charge for that service in your area — not on what the doctor actually charged you. If an out-of-network eye doctor charges $200 for an exam but VSP's reimbursement limit is $50, you receive $50 and owe the remaining $150.

Your VSP member card or the VSP website shows your exact out-of-network benefit amounts. Log into your account or call the customer service number on your card to see what your plan covers before you schedule an appointment.

When out-of-network care makes sense

Out-of-network care is worth considering if your preferred eye doctor is not in the VSP network, or if you live in a rural area where VSP providers are scarce. Some people also choose out-of-network providers because they trust a specific doctor or want a particular style of glasses that an in-network provider does not stock.

Before you commit to an out-of-network visit, call the eye doctor's office and ask their full fees for an exam, glasses, and contact lenses (if you use them). Then check your VSP benefits to see how much you will be reimbursed. Subtract the reimbursement from the doctor's fee to find out what you will actually pay out of pocket. Compare that to what an in-network provider would charge you — often nothing for the exam and a small copay for glasses.

If the out-of-network cost is significantly higher, it may be worth traveling to an in-network provider or asking your preferred doctor to join the VSP network.

How to submit a claim for out-of-network reimbursement

After your appointment, ask the eye doctor's office for an itemized receipt that shows the exam fee, the cost of any glasses or contacts, and the date of service. The receipt should also list the doctor's name, license number, and office address.

You can submit your claim to VSP online through your member account, by mail, or by phone. Most plans allow you to upload a photo of the receipt through the VSP website or app, which is the fastest method. If you mail the claim, send the original itemized receipt (not a credit card statement) to the address listed on your VSP member card or website.

VSP typically processes out-of-network claims within two to four weeks. You will receive a check or direct deposit for the reimbursement amount, minus any copays or deductibles that explore to your plan. Keep a copy of your receipt and claim confirmation for your records.

Out-of-network versus in-network costs

In-network providers have agreed to charge VSP's set fees, so your out-of-pocket cost is predictable and usually low. An in-network exam might be free, and in-network glasses might have a $25 copay. You know the cost before you walk in.

Out-of-network providers set their own prices, which can be much higher. You pay the full bill upfront, then wait for reimbursement. If the doctor's fee exceeds VSP's reimbursement limit, you absorb the extra cost. Over time, choosing in-network providers saves most people money.

That said, if an out-of-network provider is the only option in your area, or if you have a strong reason to see a specific doctor, the extra cost may be worth it to you. Just budget for the difference and plan ahead so you are not surprised by the bill.

What happens if your plan has no out-of-network benefits

Some VSP plans do not offer out-of-network coverage at all. If your plan is one of these, VSP will not reimburse you for care from a provider outside the network. You would pay the eye doctor's full fee with no reimbursement.

Check your plan documents or call VSP customer service to confirm whether your plan includes out-of-network benefits. If it does not, you have two options: find an in-network provider, or pay out of pocket and receive no reimbursement. Some people choose to pay out of pocket for a specific provider they trust, understanding they will not recover any of the cost.

Frequently Asked Questions

Do I have to pay the eye doctor upfront for out-of-network care?

Yes. Out-of-network providers do not bill VSP directly, so you pay the full fee at the time of your visit. You then submit the receipt to VSP and receive reimbursement later. Plan to have the money available before your appointment.

How long does it take to get reimbursed?

Most out-of-network claims are processed within two to four weeks. The timeline depends on how quickly you submit your claim and whether VSP needs any additional information from you or the eye doctor's office.

What if the eye doctor's fee is higher than my VSP reimbursement?

You are responsible for the difference. If the doctor charges $200 for an exam and VSP reimburses $50, you pay $150 out of pocket. This is why it is important to ask the doctor's fees and check your VSP benefits before your appointment.

Can I use out-of-network benefits for contact lenses?

It depends on your plan. Some VSP plans cover contact lenses out-of-network, while others do not. Check your member card or log into your VSP account to see whether contact lens coverage is included in your out-of-network benefits.

What if I lose my receipt?

Contact the eye doctor's office and ask them to send you a duplicate itemized receipt. VSP will need an official receipt from the provider to process your claim. A credit card statement alone is not enough.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.