Managed Care

Vision Insurance: Work With the Plans That Are Profitable

By April L. Jasper, OD, FAAO


Working with insurance plans that are profitable for the practiceis a key to practice survival. Carefully analyze plans–and stop working with plans that cost you money.


UNDERSTAND INSURANCE CONTRACTS. Keep copies of insurance contracts easily accessible to review as needed so staff understands requirements of each.

ACCEPT PROFITABLE PLANS.Say no if you cannot cover your chair costs with the reimbursement offered, and you are already busy.

TRAIN STAFF ABOUT INSURANCE. Have reps come in for staff meetings to explain how staff can help patients to optimize their specific benefits.

At my practice, we take the time to educate ourselves–and our patients–about insurance, so patients will be able to use their benefits more easily and our practice will be able to continue profitably growing. Here is how we work with insurance companies to keep our patients satisfied and our practice thriving.

Take Time to Learn Details of Plans

It can be very difficult to provide the best products for patients, and still make a profit, if the details of insurance plans are not fully understood. The details are different for every plan, and sometimes different for plans offered by the same insurance company. Patients seldom fully understand their benefits and many times are expecting more than what the insurance covers. To provide outstanding customer service we must continue to become more knowledgeable about the plans we participate in.

We take the time to explain these details to patients telling them, for instance: “The great news is your insurance provides an X$ contribution toward your purchase today.”

Fully Understand Insurance Contracts

We keep a copy of the old and new contracts of every plan available (yes, on paper) so that we can look information up as needed, as well as use if ever audited. Every time a new contract is provided we read it carefully to understand what our requirements are and also where we have opportunity for our patients, as well as our practice. Best patient care and following the contracts’ rules for medical necessity must always be paramount. We let patients know: “Here’s what your insurance contribution is toward your purchase today…”

Discontinue Insurance Plans That Cost You Money

We take several insurance plans, but certainly not all plans. There are some plans that are not profitable and only serve to make the entire office miserable due to the intense paperwork required for the low reimbursement and lack of understanding of benefits by the majority of members. By no means should you take insurance plans just for the sake of taking them.

I remember reading one of Dr. Ben Carson’s (prominent neurosurgeon from Johns Hopkins, now retired) books where he said he was considering retirement because he could no longer cover the expenses of the hospital at the current reimbursement offered by the insurance plans, and then he decided to re-negotiate the hospital’s reimbursement with those plans. Always think of your relationship with the insurance companies as a business relationship. They make you an offer and you evaluate it intelligently and then counteroffer. If they say no to your counter, then you decide if you are going to take their offer. If you cannot cover your chair costs with the reimbursement offered, and you are busy enough without them, then say no.

Accept Insurance for Contact Lenses

Contact lenses offer a great opportunity for the patient and practice. Evaluate contact lens coverage for each plan based on the patient’s diagnosis and type of lens required. The biggest mistake I see with contacts is a doctor deciding that the reimbursement offered by the insurance is too low, so they balance bill the patient or tell them it is not covered and is a cash pay item. If the contract allows this practice, then all is well. However, many contracts specifically prohibit this, so once again, know the details of the contracts. No one wants to be eliminated from an insurance panel because of misconduct.

Utilize lenses that are best for the patient and understand how to apply benefits accordingly. Specialty contact lenses provide wonderful results for patients and are typically reimbursed at a higher rate by insurance plans, as well.

Train Staff About Insurance

Understanding insurance plans comes with a huge learning curve for boththe doctor and staff. Continue to review different case scenarios at training events with your team so that they will continue to improve. VSP is very good about sending quality reps to the office to help train staff. Many of the lens manufacturers like Essilor can also help with training in this area. You can never have too much training. Remember, the only thing you can be sure of is that the rules are changing constantly, so read, read and re-read the faxes and e-mails insurance companies send you.

Related ROB Articles

Select Your Managed Care Plans to Ensure Profitability

Insurance Credentialing: Enable More Patients to Use Vision Benefits

Enhance Vision Benefit Communication with Patients to Increase Revenues

April Jasper, OD, FAAO, is the owner of Advanced Eyecare Specialists in West Palm Beach, Fla. To reach her:

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