Are vision plans killing your practice?

In everyday practice most all of us have encounters with patients with benefits from Vision Care Plans (VCP). Here is an opportunity for you as an individual optometrist to communicate with the Vision Care Plans your individual views, both pros and cons, in a professional manner, in order to maintain highly effective patient care.

Reason for the Project

1. Vision plans are making it increasingly difficult to provide quality care.

2. To improve quality of VCP: e.g. knowledgeable customer service representatives, ease of administration of the plan, adequate reimbursement so that quality examination and materials can be maintained at the highest level.

3. To slow the downward spiral of fees and services, which is occurring in the present system, where the employer groups are driving the market in conjunction with the plan with little if any input from the profession or real care in the quality for the end product. Ask the VCP to consider having optometrists at the table to assist in the crafting of the plan with the employer group so as to assist in insuring quality in services and materials results.

4. To slow watered down forms of VCP emerging where the patient ends up paying the lion’s share of the costs of the services and materials with little or no payment from the plan to the doctor.

5. Please do not assume that others will make the effort. You must communicate the your views in regards to the plan directly.

6. VCP do not like to have unhappy doctors! Vision plans can and do change the terms of their contracts based on communication from OD's. Consider Eyemed: last year, their provider manual stated: "You must honor the member's request to bill the vision plan if that's what they want to do..." This year, this has been replaced with "Should an EyeMed member insist that a vision plan claim be submitted and the presenting problem, in your professional judgment, would indicate the need for another service and/or procedure, you may elect to refuse to provide the comprehensive eye examination under the vision plan." This was in no small part due to OD's being informed, engaged, and voicing their concerns!

Plan Structure

Pull out all your contracts with the various plans you are participating in.

Read through each one noting the pros and cons of each plan, relating to your office.

Call, write or e-mail the professional affairs department of each plan, communicating the pros and cons relating your office asking the representative to pass along the input to the leadership of the plan. [Attached is a listing of some of the more common VCPs, however, others are likely present in various areas of the country and should be looked over with communication to them as well.]

Communicate to the VCP that you as an individual optometrist praise them for the good parts of their plan, but request a response and change to the parts of the plan which is not satisfactory for your office. Advise them that you will be calling back for their response, be sure to please place that return call or e-mail.

This is an ongoing project which means that you as an individual optometrist, as you come across in daily practice an issue with a VCP, please communicate it directly with the VCP as soon as possible after it occurs. This ongoing communication will educate the VCP as to what it takes on your end for the plan to work most effectively for your patients. It should as well guide them in any future changes they desire to make especially unilaterally to their plans.

Let’s all participate as individual optometrists in this important communication project.

This is a TOS sponsored project and membership is encouraged, but not necessary to participate in this project with us. TOS will also communicate with VCP on behalf of its members, when necessary and appropriate to do so. Please refer to TOS' positive correspondence with Spectera below.