The Battle We Won...Did You Know We Fought it?

10:21 PM

You don't need me to tell you that health care is changing.  In optometry, it sometimes feels like health care is changing every single day.  As insurers try to cut their own costs, many new policies are being explored in how insurances reimburse practices for services and goods.  Here's an example of a recently proposed plan by Superior Vision that was supposed to go into effect May 1st:


Currently Superior Vision gives member an X dollar amount benefit towards the purchase of "covered" contact lenses.  The patient can use their X amount benefit towards purchasing contact lenses through any in-network doctor's office.  Beginning May 1st Superior Vision had planned to change this policy so that patients that had their plan would only be able to order their contact lenses through Superior Vision's personal web portal.  In essence, the doctor or office would not order or supply the contact lenses.  Superior Vision would provide the lenses, and collect the profit on the lenses for themselves.  They would pay the doctor's office $5 to process and handle the data collection for them.  The patient would lose all ability to price shop, and be forced to use only the web portal for their purchase.

As a doctor, of course this is immediately offensive.  The insurance company would now control sales of contact lenses entirely, forcing small business owner (otherwise known as private practice) optometrists to lose a previous revenue source.

But to a patient, what did Superior Vision's proposed contact lens plan mean to you?  Superior was not discounting contact lens prices, and some contact lenses were found to be more expensive through Superior's portal than they were at the current independent doctor's office.  Yes, for some lenses you were going to have to pay more for your lenses by purchasing from Superior directly! Additionally, by having the insurance company control how you use your benefits entirely, you would have no ability to shop around or price match with other offers, either at an office or on other websites.  You would have to use their service only, and accept their price, no matter how non-competitive.  Obviously a major disadvantage for the patients as well!

Luckily, this shockingly bad plan that compromised doctors and patients both was thwarted at the last minute.  When they got hit with a letter detailing the change from Superior in late March, private practice doctors immediately started voicing their concerns, and many threatened to stop doing business with ABB (the contact lens supplier that Superior Vision was going to use to fill their orders).  Within a very short time, ABB ended their partnership with Superior Vision due to the risk of losing so many private practice accounts, and without a contact lens vendor, Superior was forced to withdraw their new policy plan.  But did most of us know we fought this battle and won?  It is scary to me that so little press was given to this proposal and its subsequent demise.  Optometrists (and people with vision insurance!) please stay vigilant!  We can't ban together to collude about pricing, but we can each personally take a stand and refuse to let our career and our patients suffer from insurance monopolies.  Please post here, email me, contact your congressman, do whatever you can to fight for patient and optometrist rights, because all of our voices are needed right now.  We are so close to losing major battles for pricing fairness to both doctors doing the work and patients trying to use the benefits they paid for, so please don't let your voice go unheard. 

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