Photo credit: Getty Images. Dr. Miller says you have to be proactive and strategic to offset the impact of low insurance reimbursements slicing into your profitability.
Overcoming the challenge of low insurance reimbursements
By Pamela Miller, OD, FAAO, JD, FNAP
July 16, 2025
If you own an optometric practice, you’ve seen it: reimbursements from insurance providers seem perpetually stagnant, even as your overhead rises.
When I looked at my own bottom line, it became clear—practice survival meant getting strategic about contracts, patient flow and income diversity.
Should You Keep Every Insurance Plan?
Many of us started out accepting as many insurance plans as possible just to get patients in the door. But these one-sided contracts too often work in the insurer’s favor, not yours. Take the time to analyze which panels are worth your effort. If payments haven’t increased in years and paperwork continues to pile up, sometimes the best business move is to say no.
If you want to exit a contract, make sure you do it right—give written notice and keep communication formal. Post accepted insurances on your website and always ask about coverage when scheduling new patients.
Click HERE to view four videos on exiting insurance panels
The Risk of Going Cash Only
Some ODs dream of ditching insurance entirely and going cash-only. In reality, the success of this model depends on your practice’s niche, your community and your tolerance for risk. You might consider not accepting credit cards to avoid fees—though this can deter some patients. And remember: billing and collection will require more effort by you and your staff.
Boosting Revenue: See More, Not Just New
One way I offset low reimbursements is by increasing patient return rates and follow-ups, and maximizing the number of patients seen per day. This usually requires tighter staff scheduling and utilization—using scribes or delegating everything allowed by law to auxiliary staff. When each appointment and every staff member’s minute counts, time management becomes your lifeline.
Find Your Niche and Market It
Specialty services like low vision, contact lenses, children’s vision or geriatric care can help you attract cash-paying patients. If you’re in an economically healthy area, social media marketing can amplify your reach—but this only works if you or a staff member is skilled and active online.
Also, be choosy about which frames and products you carry. Some insurance panels dictate what you must stock and where you must send lab work; greater freedom to make decisions about your optical inventory and lab work may bring costs but also more control and potential for add-on sales.
Other Articles to Explore
Understand Your Contracts—No Surprises
Insurance companies aren’t your partners—they’re contractors, and most contracts are “take it or leave it.” Be sure you know the specifics about prohibited up-charges, reimbursement on lens options and requirements for both vision and medical services. Often, you can’t “give away” services or products to make patients happy because contracts forbid it.
It’s also important to remember that contracts often change—sometimes with minimal notice—so always read updates and know your opt-out process.
Don’t Put All Your Eggs in One Basket
Relying on a single big payer? You’re at their mercy. Diversification is a must. Some ODs negotiate directly with local employers or school districts. For others, offering more medical eye care—often reimbursed at higher rates—can supplement low-paying vision plans.
Know State-Specific Rules and Stay Legal
Thinking about expanding into new services? Know what’s legal in your state before investing in technology or marketing. Telemedicine, for example, is regulated closely by optometry boards—which may differ from medical boards.
Watch Your Costs Like a Hawk
Low reimbursements squeeze margins, so “chair cost” analysis is more important than ever. If you own your building, explore whether it’s still the best financial move, or consider relocating if lease costs are high. Small changes add up, and every dollar matters.
The Bottom Line: Treat Your Practice Like a Business
At the end of the day, owning a practice means making business decisions—sometimes tough ones. Know your worth, run the numbers before making changes and never accept less than your practice deserves out of habit or fear. The love of your profession should not come at the cost of your financial health.
Pamela Miller, OD, FAAO, JD, FNAP, has a solo optometric practice in San Bernadino, Calif. She holds a law degree and a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivision.com
