Some practices opt out of insurance entirely, while others reframe the conversation
Judging by the number of comments on a recent post in the ODs on Facebook group, many eye doctors feel that optometry is undervalued. Patients often expect their vision plan to cover everything, while doctors’ reimbursements are typically quite low. Coverage and transparency may be confusing or obscure. Meanwhile, retailers are targeting consumers directly with competing offers.
“The problem is, and always has been, the retail market bombarding the general public with discount ads everywhere you turn … free eye exam with glasses purchase, $99 glasses with second pair free…”
“I am fed up with giving away my time, my talents, and my services for ridiculously low fees dictated by our bloodsucking vision plans.”
“Vertical integration means [vision plans] push patients to their physical entities vs. private practice ODs.”
What can eye care professionals (ECPs) do to make working with vision plans better for their practices and their patients? Do they have other options?
Reframe how you talk about vision plans with patients
As of March 2020, more than 50 percent of the U.S. adult population—approximately 130 million people—had some type of vision insurance or managed vision care coverage, according to the 2020 Vision Council VisionWatch U.S. Consumer Study. This percentage has remained relatively flat over the last five years.
VSP is the largest vision-benefit provider with nearly 90 million members, reported David Lazarus, business columnist for the LA Times, followed by EyeMed, which has 46 million members. Patients covered by one of these vision plans can account for more than 75 percent of customers at many independent eye care practices, Lazarus found.
‘The reality is that vision plans … are primarily discount programs intended at least in part to promote sales of eyewear affiliated with each company.’ – David Lazarus, LA Times
The problem is that patients tend to think of vision plans as being like any other health insurance, but they’re not. “The reality is that vision plans … are primarily discount programs intended at least in part to promote sales of eyewear affiliated with each company,” wrote Lazarus.
Patients are likely unaware of eye doctors’ reimbursement rates. As another person commented on ODs on Facebook, “Patients don’t really know what we get from insurance companies. Many think we get 200-300 dollars for an eye exam, ‘so why is the doctor trying to charge me for more?’ If patients knew how little we get from insurance, many would be appalled.”
How to opt out of vision plans
Some eye care practices have responded by opting out of vision plans entirely. At East Main Vision Clinic in Washington state, 45 percent of their more than 8,000 patients were covered by managed care plans. The practice felt that managed care was forcing them to write off a lot of potential revenue, as well as affecting their ability to provide excellent customer service. So after many months of planning, East Main Vision Clinic stopped accepting vision plans.
Some ECPs choose to stop dealing with vision plans altogether, while others may drop the one plan they feel isn’t worth it. Whatever you decide, vision plans typically require you to notify them in writing and wait a set period—often up to 90 days—in order to be officially out of the network. Check with your participating vision plans to understand the process. You will also need to notify patients that you are no longer accepting their insurance, such as through an email blast.
Callout: One practice that stopped accepting vision plans lost some patients, but gained the capacity to take on new, self-paying patients.
Inevitably, East Main Vision Clinic still lost some patients. However, the practice was able to withstand this loss because they were able to collect more revenue per patient—upfront—and they gained the capacity to accept new patients. They also found that many of the patients who left for in-network providers came back when they realized they missed their old ECP and were willing to pay a little extra for better care.
Changing the script with insured patients
If you don’t want to drop vision plans entirely, consider changing the dialogue you and your staff have with participating patients, said Brandon Blaker, OD. “Let’s say a patient has a $150 frame allowance.” Instead of saying, “These are the frames your insurance covers” and showing them only $150 frames, or showing them $180 frames and saying, “These aren’t covered,” you change your message to, “Your plan contributes $150 to the cost of these frames. You only have to pay $30.”
‘Just because [frames] aren’t free, doesn’t mean [patients] aren’t getting an incredible benefit for the product.’ – Brandon Blaker, OD
“Just because it’s not free doesn’t mean they’re not getting an incredible benefit for the product,” said Blaker. Even generating an extra $10 or $30 per patient adds to your revenue. The key is to train staff to change the conversation and emphasize to patients what their vision plan is paying towards their desired frames, rather than only what’s fully covered.