New NC law prohibits limited fees on non-covered services, materials

August 1, 2014

North Carolina Governor Pat McCrory recently signed into law a bill that prohibits insurers and health benefit plans from limiting the fee an optometrist can charge patients on services or materials, unless those services or materials are covered by reimbursement under the plan or insurer contract.

Raleigh, NC-North Carolina Governor Pat McCrory recently signed into law a bill that prohibits insurers and health benefit plans from limiting the fee an optometrist can charge patients on services or materials, unless those services or materials are covered by reimbursement under the plan or insurer contract.

“We thought that it was extremely important to take a stand and take back some degree of control on some of the things going on in our practices,” says Charles Sikes, OD, president of North Carolina State Optometric Society (NCSOS). “A lot of people are struggling more and more to get things to work well financially in their practices, but insurers want to dictate how we can compete on services and materials that they don’t even cover. We felt that was out of bounds.”

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According to Dr. Sikes, NCSOS was heavily involved in the nearly two-year process of passing the law.

The law states, “No agreement between an insurer or an entity that writes vision insurance and an optometrist for the provision of vision services on a preferred or in-network basis to plan members or insurance subscribers in connection with coverage under a stand-alone vision plan, a medical plan, or health insurance policy may require that an optometrist provide services or materials at a fee limited or set by the plan or insurer unless the services or materials are reimbursed as covered services under the contract.”

The new law is effective Oct. 1, 2014, and will affect contracts entered into, amended, or renewed on or after that date.

“I’m very proud of our membership and the NCSOS. Had it not been for a very tight, dedicated group of leaders and optometrists who answered when they were called on to contact their representatives about the bill,” says Dr. Sikes.ODT