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Eye doctors ask states to protect them from vision plan price pressure BenefitsPRO
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Optometrists say they need protection against big, remorseless vision benefit plans to save patients' access to fast, flexible, high-quality vision care services.
The vision plans say optometrists are trying to limit price competition in ways that will push up the cost of vision benefit plans and hurt consumers' ability to pay for eyeglasses and contact lenses.
The National Council of Insurance Legislators is preparing to bring both sides together July 17 in Boston, at an in-person meeting of NCOIL's Health Insurance & Long Term Care Issues Committee.
The preliminary list of speakers includes a representative from the American Optometric Association, a representative from the National Association of Vision Care Plans, and Randi Chapman, the managing director for state affairs at the Blue Cross Blue Shield Association, according to a meeting document packet.
The speakers will be discussing a draft NCOIL model act, "Ensuring Access to Eye Care Services and Materials for Patients Through Transparent and Fair Business Practices by Vision Benefit Plans." The model was introduced by Kentucky state Rep. Deanna Gordon, a Republican who has worked as an audiologist and who has founded and owned a hearing clinic. Provisions in the model would affect everything from how a vision plan pays eye care providers to which labs and suppliers a patient's eye care provider could use.
JP Wieske, a representative for the vision care plans' association, said at an in-person NCOIL committee meeting in April, in Louisville, Kentucky, that the provider pay section would let a provider charge patients a rate that's higher than the plan's rate, block a plan from applying a standard "usual and customary" rate schedule, and require a vision care plan to hide the lower-cost providers in their provider networks from consumers in at least some situations.
"That is not a pro-consumer bill," Wieske said, according to draft minutes included in the meeting packet.
Dr. David Parker, a representative from the Mississippi Optometric Association, said the model provisions would keep big, national companies from crushing local independent providers, centralizing distribution facilities, and, ultimately, making care slower, more expensive and less convenient.
Requiring vision benefit plans to provide fair reimbursement will protect provider independence and ensure that the doctor is in charge of clinical decisions, Parker said.
What it means: NCOIL discussions about the vision care model could be a rehearsal for how state lawmakers, and members of Congress, will talk about a wide range of health care competition proposals in the coming months.
Some Republicans and Democrats in the House seem to be eager to impose new rules on both health insurers and on hospital-controlled health care systems.
Benefit plans are also involved in similar types of battles with medical doctors, dentists and other types of health care providers at the state level.
Vision plans in Texas, for example, are squaring off with optometrists over an effort by state officials in Texas to keep the plans from steering patients toward the lowest-cost vision care providers.
NCOIL model details: Wieske said at the NCOIL committee meeting in April that one provision in the model appears to require the charge for an item or service to be the provider's cost, along with some profit for the provider, according to the draft meeting minutes.
"So, we're looking at something that creates a provider price floor across the market, which will lead to significantly less provider price competition," Wieske said. "It requires, in fact, that every single provider has to be accepted inside a network at their rate.... This means that consumer costs are going to go up."
Parker, the representative from the Mississippi Optometric Association, said the model provisions would keep big, national companies from crushing local independent providers, centralizing distribution facilities, and, ultimately, making care slower, more expensive and less convenient.
Today, he said, typical plans let optometrists provide eyeglasses for patients with an urgent need for eyeglasses on the spot.
"Some of the new plans that I've seen pop up this year will not allow us to do in-office finishing at all," Parker said. "And it's not a term that something in our practice has agreed to. It's just been something that's been added on by vision plans. The problem is that we can't opt out of new imposed terms, because to opt out would jeopardize our ability to remain with the parent plan, which covers a number of the patients in the office. I don't see that as negotiation. I see that more as a coercive type of tactic."
Continue reading...
Eye doctors ask states to protect them from vision plan price pressure
What You Need To Know
- Local optometrist say they need protection against rigid, low-quality corporate giants.
- The plans say a proposed NCOIL model would set a de facto price floor.
- An NCOIL committee is preparing to talk more about the model July 17 in Boston.
Optometrists say they need protection against big, remorseless vision benefit plans to save patients' access to fast, flexible, high-quality vision care services.
The vision plans say optometrists are trying to limit price competition in ways that will push up the cost of vision benefit plans and hurt consumers' ability to pay for eyeglasses and contact lenses.
The National Council of Insurance Legislators is preparing to bring both sides together July 17 in Boston, at an in-person meeting of NCOIL's Health Insurance & Long Term Care Issues Committee.
The preliminary list of speakers includes a representative from the American Optometric Association, a representative from the National Association of Vision Care Plans, and Randi Chapman, the managing director for state affairs at the Blue Cross Blue Shield Association, according to a meeting document packet.
The speakers will be discussing a draft NCOIL model act, "Ensuring Access to Eye Care Services and Materials for Patients Through Transparent and Fair Business Practices by Vision Benefit Plans." The model was introduced by Kentucky state Rep. Deanna Gordon, a Republican who has worked as an audiologist and who has founded and owned a hearing clinic. Provisions in the model would affect everything from how a vision plan pays eye care providers to which labs and suppliers a patient's eye care provider could use.
JP Wieske, a representative for the vision care plans' association, said at an in-person NCOIL committee meeting in April, in Louisville, Kentucky, that the provider pay section would let a provider charge patients a rate that's higher than the plan's rate, block a plan from applying a standard "usual and customary" rate schedule, and require a vision care plan to hide the lower-cost providers in their provider networks from consumers in at least some situations.
"That is not a pro-consumer bill," Wieske said, according to draft minutes included in the meeting packet.
Dr. David Parker, a representative from the Mississippi Optometric Association, said the model provisions would keep big, national companies from crushing local independent providers, centralizing distribution facilities, and, ultimately, making care slower, more expensive and less convenient.
Requiring vision benefit plans to provide fair reimbursement will protect provider independence and ensure that the doctor is in charge of clinical decisions, Parker said.
What it means: NCOIL discussions about the vision care model could be a rehearsal for how state lawmakers, and members of Congress, will talk about a wide range of health care competition proposals in the coming months.
Some Republicans and Democrats in the House seem to be eager to impose new rules on both health insurers and on hospital-controlled health care systems.
Benefit plans are also involved in similar types of battles with medical doctors, dentists and other types of health care providers at the state level.
Vision plans in Texas, for example, are squaring off with optometrists over an effort by state officials in Texas to keep the plans from steering patients toward the lowest-cost vision care providers.
NCOIL model details: Wieske said at the NCOIL committee meeting in April that one provision in the model appears to require the charge for an item or service to be the provider's cost, along with some profit for the provider, according to the draft meeting minutes.
"So, we're looking at something that creates a provider price floor across the market, which will lead to significantly less provider price competition," Wieske said. "It requires, in fact, that every single provider has to be accepted inside a network at their rate.... This means that consumer costs are going to go up."
Parker, the representative from the Mississippi Optometric Association, said the model provisions would keep big, national companies from crushing local independent providers, centralizing distribution facilities, and, ultimately, making care slower, more expensive and less convenient.
Today, he said, typical plans let optometrists provide eyeglasses for patients with an urgent need for eyeglasses on the spot.
"Some of the new plans that I've seen pop up this year will not allow us to do in-office finishing at all," Parker said. "And it's not a term that something in our practice has agreed to. It's just been something that's been added on by vision plans. The problem is that we can't opt out of new imposed terms, because to opt out would jeopardize our ability to remain with the parent plan, which covers a number of the patients in the office. I don't see that as negotiation. I see that more as a coercive type of tactic."
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