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ODs’ top 4 gripes about vision care plans


Vision care plans (VCP) can be difficult to figure out because each provider tends to have its own set of rules. In an attempt to bring clarity to the VCP landscape, I have put together a five-part series of blogs.


The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

Vision care plans (VCP) can be difficult to figure out because each provider tends to have its own set of rules.

In an attempt to bring clarity to the VCP landscape, I have put together a five-part series of blogs.

Part one outlines the complaints ODs have with VCPs. These blogs are not intended to bash VCPs-nor to paint a rosy picture of unicorns for providers.

After more than 20 years in practice plus time spent with colleagues at meetings, I had a pretty good idea of what ODs dislike about VCPs. To gain more insight, I crowdsourced on social media.

Previously from Dr. Spear: The benefits of cleaning out your practice

I posted on two optometry Facebook groups, ODs on Facebook and ODs on Practice Management and Insurance, asking for complaints about VCPs in preparation for a SECO lecture.

Next week I am doing a lecture at SECO called, "What's my beef with vision plans."
Tell me your beefs so I can include them!

I was overwhelmed with comments, likes, and private messages.

Here are three comments showing ODs have a sense of humor:

• “Did they give you an eight-hour block?”

• “Your course should be very popular. (Wonder if any antacid companies would want to sponsor your talk and hand out samples).”

• “I'm sure a few alcohol manufacturers would make great sponsors too.”

After reviewing the comments, I divided them into four topic buckets. Here are the top four complaints ODs have with VCPs.

Related: Does your practice have a culture of can’t?


1. Does it have to be this difficult?

Many people commented on how difficult VCPs have made the entire vision coverage process. ODs were quick to point out that they think VCPs are nothing more than a discount for goods and services.

Overall, the sense is that ODs invest too much staff time with VCP coverage before, during, and after the exam.

Here are some comments:

• “The fact that you need a PhD in ‘EOB [explanation of benefits] Understanding’ to know what you get paid.”

• “Too time consuming for optical staff to explain to patients.”

• “They never mail ID cards, so patients don't know what they have.”

• “Lack of universal reimbursement across all plans within a VCP.”

• “600-page VCP manual.”

Related: 6 steps to survive a ransomware attack

2. Reimbursements

I don’t think it’s surprising that a major gripe is reimbursements. What surprised me in conversations and correspondence with many ODs was reimbursements was not the top complaint.

Many ODs recognize that VCPs bring patients into the office and help provide access to patients. Most might accept the reduced payments if the other problems were mitigated.

Problems such as:

• Patients knowing their plans

• The VCP reimbursement process streamlined

• Representatives available with consistent, accurate information

• Clear distinction made between medical coverage and VCPs

• Payment systems that are easy to understand

If these other problems were addressed, then the trade-off in reimbursement might be easier to accept.

Reimbursement is the complaint that has many ODs feeling frustrated and disenfranchised.

Comments include:

• “Low exam fees, terrible pay for frames and lenses.”

• “In many years no increase in reimbursement (in fact a decrease) despite the cost of business going up-making profitability increasingly difficult.”

• “Getting paid less for an exam than I did in 1984 when I started practice.”

• “More and more documentation, less reimbursement.”

• “Horrible exam reimbursement.”

Related: 4 steps to opening a practice cold


3. Competing with ODs for retail sales, patients

ODs are feeling the pressure as VCPs move toward a model that not only cuts reimbursement but competes with ODs for patients, goods, and services.

Recent vertical integrations, combined with increasing overt online presence and direct marketing to patients, was a common complaint. ODs expressed frustration that materials profit has to the potential to be diverted after they have already taken reduced fees for service.

• “Their newest ploy to drive patients to purchase their glasses or contact lenses online and use their benefits from the website the insurance company owns.”

• “Two [VCPs] that I know of are actively emailing patients about using their benefits online as soon as the exam authorization is pulled. We've resorted to waiting to pull those until patients are in office.”

• “Promoting their own online contact lens sales when they are already giving me extremely low reimbursements.”

• “Vertical integration means they push patients to their physical entities vs. private practice ODs.”

Related: 10 tips to surviving an insurance audit

4. Misleading and incorrect information

Of all the categories, this one has the most responses and raw emotion. The general tone of the responses, and conversations with my colleagues, is that VCPs mislead patients about what is covered and what is not covered.

A great amount of this confusion and discontent centers around patients with a known medical diagnosis who expect medical care from the VCP.

• “Too many patients come in with medical complaints and think they are covered. Many times the caring doc feels compelled to take care of people so he takes care of the patient. Thus, insurance companies get away with not paying for medical care.”

• “Patients with medical complaints think these plans should cover the visit. When the patients call the VCP, customer service always respond that the plan will cover the exam. These plans have created a huge issue when we try to explain this. Also, these plans are simply discount plans!”

• “One of the plans says it covers diabetic exams and to pay an extra $5 or $10 for the diabetic exam.”

There you have the top four categories of complaints. I know the list is not inclusive, and I expect to have a lot of feedback. I will also tell you that within the comments and complaints are some very real misunderstandings and opportunities for practices to minimize these challenges.

Our offices accepted every VCP and were able to build a successful and thriving business by understanding the insurances, developing processes, and providing high-quality customer service. In my next four blogs, I will share ideas on how ODs can view these problems as opportunities to grow their practices.

Got a gripe I didn’t address? Have a comment? Email me at chspear@gmail.com or contact me via distinctivestrategies.com.

Dr. Carl Spear’s lecture “What’s My Beef with Vision Plans?” was heard at SECO 2017 in Atlanta and was a part of SECO’s “What’s My Beef” series of lectures.

Read more from Dr. Spear here

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