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This opinion piece is a response to The Divide series conversation on vision plans
By Bethany Fishbein, OD
August 21, 2026
The decision of whether or not to take vision plans is multi-faceted, and like most business decisions, there is not a right or wrong answer that applies to every single practice.
I frequently get asked for my opinion on the “business side” of this decision. I’ll meet doctors just starting out who envision a practice free from vision plans, established doctors who happily accept multiple plans and those who are wondering about the economic and social implications of dropping one or more.
VISION FOR THE BUSINESS
In their contributions to The Divide series, Karishma Arora, OD, and Samantha Hamblet, OD, each talked about the vision they had for their practices—and on the surface, they landed in opposite places. Dr. Arora’s commitment to access to care, shaped by her own family’s experience with vision insurance, led her to participate broadly. Dr. Hamblet’s insistence on clinical and product freedom led her to leave plans behind almost entirely.
But if you read closely, they actually did very similar work to end up in the places they each did. Neither one just picked a side and hoped it would work out. Dr. Arora built a model using vision plans as the access point, then converts patient encounters into medical billing, specialty treatments and self-pay services that support her margins. Dr. Hamblet built a model around leaving plans. She reworked her lab relationships, her pricing and her cost structure before she dropped even one. Each doctor engineered her business to match her personal choice around vision plans, rather than making an isolated decision about insurance and expecting the business to create itself.
IF YOU BUILD IT, WILL THEY COME?
For a practice to be successful, it needs to have patients. For a new office or a practice in a growth phase, the owner needs to consider how patients will find the practice—a very important piece that owners sometimes skip when thinking about their practices in purely philosophical and wishful terms. It’s fine to want the freedom that a plan-free practice can provide, but you need to have an answer to the question: How are patients going to find me?
Vision plans are frankly the easiest passive marketing available to an optometric practice. You join a plan and are on the list, making it easy for patients to find you. A patient searches, and you’re just there. You don’t have to “sell yourself” or convince anyone. The plans have already done the heavy lifting of letting the patients know that (a) you exist, and (b) they can afford to see you. From here, just as Dr. Arora describes, trust and education can do the rest.
The alternative—building a practice that doesn’t depend on this—is absolutely possible. I’ve seen multiple practice owners do it very well. But it’s a whole job on top of the job of being a doctor. It means putting the time and effort into building relationships with providers who will refer to you (and putting the time and effort into providers who will never refer to you because you don’t know until you know). And showing up in your community consistently enough that people remember your name and who you are. And having clear messaging, both inside and outside the practice, so referring doctors and people in the community understand what sets you apart—and so you and your staff can confidently answer, “Why should I come to you?” when the insurance company’s marketing is telling them otherwise.
So when a doctor tells me they want to build a practice without vision plans or drop a plan that accounts for a high percentage of their existing patient base, my first question is whether they are willing to make marketing and patient acquisition an ongoing part of what they do. Because something or someone has to bring patients in. And if it’s not the plan, then it’s you. And although some practice owners love the hustle, not everyone is enthusiastic to take this on as a second job.
THE BUSINESS MODEL MUST MATCH
Taking or not taking plans isn’t a standalone choice. This decision needs to determine how the rest of the practice is run, and both Dr. Hamblet and Dr. Arora illustrate what happens when that match is done well.
Dr. Arora’s model works because she doesn’t treat the reimbursement from a vision plan exam as the endpoint; she sees this as the entry point into other services that carry the practice financially.
I’ve seen other practices struggle because they try to participate heavily in low-reimbursement vision plans while still providing a high-touch customer service experience—beautiful space with all the extras, 30+ minute exams, staffing to give each patient one-on-one attention, but no real strategy to convert that volume into anything more profitable. As patient volume grows, the practice takes on additional costs, and the economics become challenging.
I’ve also seen practices struggle because they’ve made a reactive decision to drop a plan without making any other internal changes to support it. Dr. Hamblet didn’t just walk away. She describes deliberate action in the months leading up to her decision—finding independent labs, reworking pricing and making financial projections before she gave up even one plan.
IT DOESN’T HAVE TO BE FOREVER
It’s worth saying that participation in vision plans doesn’t have to be a permanent identity for a practice. It can be a stage.
Plenty of practices start in-network, sometimes in most or all plans available, because that’s how they solve the hardest problem a new practice faces—getting people in the door—while they’re still building everything else, like reputation, referral relationships and a financial cushion.
Practices can be dependent on vision plans at first, and then make strategic decisions to exit plans as it makes sense for the business—using the plans when they need them, and then making calculated moves to drop plans as it’s in the best interest of the practice to do so.
And practices that drop plans under one set of circumstances can later rejoin plans as circumstances and goals change. I’ve worked with a practice owner who deliberately dropped plans to limit patient volume and protect her time, as she had young kids in school. Fifteen years later as she prioritizes the most profitable exit strategy, rejoining panels to grow volume and revenue makes far more sense than it did before. The vision plans didn’t change; the owner’s goals did.
THE REAL QUESTION
So maybe the more useful question for the practice owner isn’t “Should I take vision plans?” It’s closer to “Do the vision plans I take make sense for the practice I have now and the one I want to have in the future?”
Dr. Arora and Dr. Hamblet arrived at very different answers to the first question and very similar answers to the second. Thank you to both of them for showing, in very different ways, what it looks like to build a practice on purpose.
Read The Divide vision plan debate here.
Read more insights from Dr. Fishbein here.
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Bethany Fishbein, OD, is a practice owner, practice management consultant and certified executive coach. She can be reached at bethany@leadersofvision.com |
