Managed Care

Smoke, Mirrors and Vision Plans: Time for Vision Plan Standardization Forms?

By Ally Stoeger, OD

We have reached a tipping point. It often takes longer to explain what vision plans do and don’t cover than it does to actually perform eye exams.

It is time for simplification–through standardization.

Discussing vision plan information with patients–and making sure they are getting correct information–requires knowledge of vision care, differentials of medical eye treatment considerations, understanding different types of contact lenses, being able to “predict” what type of contact lens fitting might be necessary, the nuances of frame pricing and understanding the differences between about 100 different types of spectacle lenses and lens treatments. The only people who can properly answer these types of questions are either doctors or highly trained staff, and these are typically your most highly paid assistants.

Put someone who is inexperienced or not very sharp on this, and you alienate patients. But how can we afford to pay a highly skilled assistant for 20 minutes of time? The low reimbursements barely cover exam time and time needed in the optical. Throwing in an extra 20 minutes to explain the plan can put the entire visit into the financial loss category.

Vision plan administrators who develop the plan benefit minutiae do not encounter the fury of a patient who believes they have been given the wrong information because, no matter how you explain it, they think that anything that complicated is out to cheat them. Or the patient may in fact have been given the wrong information because all but the most highly trained employees can barely figure out these authorization forms. Even highly trained staff members are frustrated by frequent plan variations and exceptions.

This problem is stressing out optometry practice employees and creating a substantial revenue loss for practice owners because so much time is wasted explaining vision plan information to our patients. Employee stress adds to staff turnover and the subsequent expense of hiring and training new staff members. And patients despise the smoke and mirrors impression they have of convoluted formulas.

We need vision plan standardization forms similar to that of every mortgage company having to present interest percentages the same way.

It would be a worthy goal for our optometric organizations and optometric leaders to initiate the process of requiring vision plans to standardize their benefits information.

Do you feel that complicated vision plan formulas create problems in your practice? How are you helping patients wade through their options while also streamlining the process for your staff?

Ally Stoeger, OD, was a founding and managing partner of a multi-doctor practice and has recently opened a new practice in Gainesville, Va. Contact:

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