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ODs top 4 gripes about vision care plans: Part 2-Does it have to be this difficult?


In an attempt to bring clarity to the landscape around vision plans, I have put together this five-part blog series. In Part 1, I outlined four big topic areas where optometrists seem to have the most complaints with vison plans.

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

In an attempt to bring clarity to the landscape around vision plans, I have put together this five-part blog series.

 In Part 1, I outlined four big topic areas where optometrists seem to have the most complaints with vison plans. 

Previously from Dr. Spear: ODs’ top 4 gripes about vision care plans-Part 1

To recap, the four big gripes are:

1.     Does it have to be this difficult?

2.     Reimbursements

3.     Competing with me for retail sales and patients

4.     Misleading information and misinformation

In Part 2 of this five-part blog series, let’s take a closer look at Gripe Number One.

Does it have to be this difficult?

Comments to my question on Facebook about optometrists’ big gripes with vision plans were numerous. 

Here are specific comments that optometrists had about the difficulty in dealing with vision plans.

• “The Fact u need a PhD in “EOB Understanding” to know what you get paid”

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

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

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

• “600-page VSP manual”

These are legitimate complaints. However, what I am going to say about them may upset some of you, and that is OK.  

You as a provider have a very simple decision to make: Do I accept the plans or not? 

Related: The benefits of cleaning out your practice

Deciding to take a plan

Only you can make this decision. For most practices, I think it is a good business decision to accept vision plans. Send your dissenting opinions and hate mail to chspear@gmail.com.

The top five insurers cover ± 164 million lives. (See table below.)

When we add in other smaller plans around the country, this number will exceed 200 million people with some type of vision care coverage.  


Given that there are 320 million people in the United States, this means that more than 60 percent of potential patients have some form of vision care coverage.

Sourced from each vision plan providers website and with the information supplied by vision plan providers, per Carl H. Spear, OD, MBA, FAAO

Unfortunately, many optometrists accept vision plans, then do not learn the rules of those plans. Over the last two years, I have lectured to over 3,000 optometrists about vision plans and how to be successful with them in their practices.

Related: 10 tips to surviving an insurance audit

During these lectures, I ask the following questions:

• How many of you take vision plans? As you can imagine, usually 95 percent or more are taking vision plans. As I tease the question out, it is also not uncommon for a practice revenue to be 70 percent, 80 percent,  or even more dependent on vision plans. Then I ask question Number Two.

• Have you read your vision plan manual and your vision plan contract? What do you think the answer is? Have you read your vision plan manual and contract? The general response is fewer than 5 percent of ODs have actually read the rules.

Time to make you mad again: The problem may not be the vision plans. The problem may be you.

You make a logical business decision to accept vision plans because they bring patients in the door. Then, the majority of the revenues of your practice/business come from vision plans, and you have not read the rule book. That is like flying an airplane without instructions. Yes, it would be difficult.

I am not trying to paint a happy picture where you read the contract and manual and suddenly everything is great. I am saying that we as optometrists tend to make very emotional decisions. This is one instance in which we make the right business decision on facts but then fail to take the next step of taking advantage of the decision.  

I have always believed in taking vision plans to get patients in the door. I am the first to agree that vision plans are simply a negotiated discount for goods and services. They are not really insurance but rather a prepaid, often employer-provided, subscription for discounts at participating providers. 

In other words, in a world without vison plans I would have to market to get patients into the practice. I accept the decrease in reimbursement, and in my mind I allocate that to marketing costs. This would be especially true if I am charging a higher fee than a market competitor advertising a free eye exam, two pairs of glasses, and a puppy for $79.

Related: 5 steps to creating a budget

In working with practices, I have found that I can increase practice profitability significantly by knowing the rules, performing a strategic pricing analysis, selecting the right mix of products, and implementing protocols for handling medical and vision insurance. You can do the same thing just by reading the rules and treating your practice like a business.

A lot of frustration comes from the fact that vision insurance companies treat their business like a business and make decisions accordingly. Optometrists tend to be more emotional-after making the decision to take insurance plans, ODs tend to not follow through with a business strategy. It is time for us to treat our practices like businesses in order to remain profitable.

In Part 3 of this series, I will tackle reimbursements. A big part of increasing reimbursements is knowing the rules. Start reading the contracts and manuals and be ready to be more profitable.

I look forward to your questions and comments. Reach me at chspear@gmail.com or http://www.distinctivestrategies.com.

Read more from Dr. Spear here

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