Profitably dropping a major vision plan.
By Michael N. Kleamenakis, OD
Jan. 31, 2024
Reimbursements from managed care vision plans have lagged for years behind what an independent practice needs to stoke profitability.
It may seem that if you drop a heavily used vision plan that your practice will lose patients, and, ultimately, end up worse off than before. However, our practice’s experience was different. We experienced rich rewards after dropping a major vision plan.
Do We Take a Chance & Drop the Plan?
The scary part of the decision was that more than 15 percent of our patients were on this plan.
The main reason to drop the plan was low pay, poor lab work, claims “approved,” then denied after the product was dispensed (specifically contacts). Even when shown written proof of approval, the company operating this plan would frequently just say, “Oh, well, we’re not paying!”
The reason to keep the plan was that so many established patients were on the plan and significant medical eyecare was driven into the practice by it.
What Tipped the Decision for Us
1) The office is very busy and booked out more than six weeks.
2) We could keep the medical side of the plan. And we did.
3) We could refer optical (for those who would not accept a discount) to our boutique office across town that does not do much medical or have time to perform extra exams.
4) Not much competition nearby.
Implementing the Decision
We informed each patient before their exam that we no longer accept their vision plan, but could still see them as cash-pay patients or use their medical plan for an exam, if applicable. We always pre-approve insurance before the patient arrives, so there were never any surprises at check-out.
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Results of Our Decision
The results paid off! We no longer have to deal with a poorly operated vision plan.
In addition, we picked up more cash pay, about 20 percent, have more control over our optical work, and how we deliver those services to patients, and are able to deliver more medical exam and treatment work.
We are able to see more patients who have better plans or prefer to pay in cash. Both our gross and net income are way up with the same number of exams performed.
We think we made a good move.