August 21, 2026
Vision insurance can open the door to care for more patients, but it can also shape how an optometry practice is built and how freely doctors can deliver care. The Divide, a point/counterpoint series from Review of Optometric Business, explores two sides of the conversation.
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Vision Plans Open Doors
Photo credit: Dr. Arora
By Karishma Arora, OD
I accept a lot of insurance, both medical and vision, and that has been a big part of how I practice. I know it is not always the easiest decision from a business standpoint, but for me it matters because it helps patients actually access care. A lot of my patients can come in without worrying as much about cost, and that is important to me.
A PERSONAL IMPACT
Growing up, I needed glasses myself. Like so many families, we relied on our vision insurance to make regular eye care possible. The insurance coverage my dad received through his job ensured that our family could get the care we needed. That experience has stayed with me throughout my career.
In fact, the only reason I ended up seeing the optometrist who would have such a profound influence on my life was because we had vision insurance. That single eye exam changed the trajectory of my future and ultimately inspired me to become an optometrist.
Because of that experience, I believe vision plans serve an important purpose. They give patients access to care and often become the first point of contact between a patient and an eye doctor. My philosophy has never been to reject vision plans. It has been to use them as a gateway to build lasting patient relationships, educate patients about their eye health and introduce them to services that can truly improve their quality of life.
Patients may initially come in for a covered eye exam, but when they trust your expertise and understand their options, many choose advanced treatments or medically necessary care that extends far beyond the limitations of their vision benefits. That is how I balance accessibility for patients with a sustainable, specialty-focused practice.
ACCESS TO CARE THAT PATIENTS NEED
Vision benefits offered through managed vision plans fit the patient population I see. Costco is incredibly diverse, and I see all people there of different ages, backgrounds and cultures. It really is a melting pot. That diversity was another reason I wanted to take insurance. It makes the practice more welcoming and more practical for the community I serve.
NOW THEY’RE MY PATIENTS
Perhaps most importantly, many of the patients who come to me because I am a provider for their managed vision plans now know me as their eye doctor. Over the years, I have diagnosed medical conditions as well as refractive errors. We’ve been able to help patients understand that their ocular health reflects their systemic health.
My conversations with them may contribute to them being more compliant with their other medications. Or perhaps their visit to my office was their first encounter with any kind of healthcare provider.
In addition, when these patients need other eyecare services, it’s me that they come to, whether we’re billing their medical insurance or a private pay at that point.
THE BUSINESS IMPACT
A low overhead, specialty-focused practice is the foundation of my business model. While accepting vision plans helps bring in a high volume of patients, many people mistakenly believe they must use their vision insurance for every eye care need. In reality, the long-term success of my practice comes from offering high-value, out-of-pocket services and specialty treatments.
Of course, some patients simply need a routine eye exam and a glasses prescription. However, it’s not uncommon for a patient who initially comes in using a vision plan to choose a $2,000 dry eye treatment after learning about their options and the benefits. These specialty services provide value to patients while supporting the financial health of the practice. We currently offer IPL, RF, Thermal Expression, LLLT, myopia management and many more self-pay services.
OPPORTUNITY TO EXPAND THE RELATIONSHIP
I also successfully convert many patients from routine vision care to medically necessary care. When appropriate, we bill their medical insurance for services such as glaucoma evaluations, diabetic eye exams and other medical office visits. If we do not participate with their medical insurance, patients have the option to proceed as self-pay.
This hybrid approach using vision plans to attract patients while focusing on specialty services, medical eye care, and cash-pay treatments creates a sustainable, profitable practice without relying solely on routine vision exams.
Educating patients is the biggest important point in running a successful practice that takes vision plans. Being clear about pricing and costs has always been my main priority. Once patients understand the difference between medical and vision insurance they start to agree rather than fight you on it. Once they see the value in you and your services the more they will accept your treatment and protocol. You don’t have to let vision insurance dictate what you do but it is a great way to bring these patients to your door.
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Karishma Arora, OD, is the owner of Arora Vision Associates with two Costco lease locations in Cherry Hill and East Hanover, New Jersey. |
Do you have a topic you want to discuss on The Divide? Email us about a point/counterpoint conversation.
Freedom to Practice on My Terms
Photo Credit: Getty Images
By Samantha Hamblet, OD
I opened my practice in 2019 with a clear vision: a high-end, luxury optical that felt artistic, fashion-forward and independent. I wanted it to feel more boutique and creatively driven, and that philosophy has shaped the practice from the beginning.
I also made a deliberate decision to be selective about the vision insurance plans I participate in, and for me that choice has been about freedom. I wanted the ability to practice optometry on my terms: full scope and medically focused. I wanted to be careful that vision insurance wasn’t dictating how I cared for patients or what I could offer in the office.
The model continues to bring strong results with an average of around $800 to $850 in revenue per patient, a 65% capture rate and 2.5 doctors per day seeing patients. Here’s how I got there.
MAKING AN INFORMED DECISION
In my county, more than 20% of residents are employed by the State of Washington. These employees, for many years, had a vision benefit through their medical insurance that paid very well for exams. It also gave each patient a cash allowance for glasses. Having opened my practice in 2019 just a mile from the State Capitol complex, a very large portion of my practice was state of Washington employees. Effective January 2021, the vision benefit for these same patients changed to a major vision insurance. They no longer had access to the medical vision benefit.
However, effective January 2021, Washington state shifted these employees to one major vision insurance, meaning they no longer had access to their former medical vision benefit. My business went from 29% of patients using vision insurance in 2020 and 58% using a medical vision benefit to 61% on vision plans and 12% on medical in 2021. The exam reimbursement alone was cut by 60% with this switch, let alone all the changes that happened to my optical choices with vision plans.
I watched other offices struggle with that shift, and I kept thinking: How can we control this creatively?
TAKING CONTROL
So I began to carefully examine where we have more control. With our own edger, we had more autonomy on turn around time and quality and more control over product choice and cost of goods. I also started looking closely at our pricing, our cost of goods and independent labs. I was able to find a lab that provided high quality lenses at a reasonable turnaround time and price. I penciled out what our profit on frames and lenses within the vision plan and their labs. This gave me a framework to see if I could develop a pricing strategy to match or increase that profit.
Initially, the pricing to the patient stayed exactly the same, matching copays and discounts, when we left all vision plans. Because vision plans control all material costs, in most states, switching to working with non-branded lens designs our profit margin is better while still passing a significant savings on to the patient vs. paying full cash price. If we don’t get paid the measly amount from a vision plan via submitting OON claims, fine we will pivot as needed.
We also tracked how patients found us for more than six months. Less than 5% came through the vision plan website.
What I realized was that with better oversight of our costs, I could control what I offered patients without having to let the plan dictate those decisions.
FEWER LIMITATIONS, MORE FLEXIBILITY
That freedom has allowed me to build something more comprehensive. I wanted patients to come in and feel like they could get a real eye health evaluation, not just a quick glasses visit. If I want to pursue dry eye care, specialty testing or medical billing, I can do that.
We gave patients significant in-network discounts on frames and lenses. We offer a comparable discount on annual supplies of contact lenses. The experiment worked well. There was no negative impact on the patient experience, and the practice remained strong.
I don’t want to be boxed in by a plan that limits how I care for people. If someone is looking for the lowest-cost option above everything else, that’s okay. We may not be the right fit. For the patients who want thoughtful, full-service care, this model works really well.
THE FINANCIAL IMPACT
One of the biggest surprises was how little the vision insurance company actually represented in our bottom line. Even though roughly 70% of our patients had this vision insurance, less than 10% of our receipts came from its checks. That told me a lot. It confirmed that the practice was being supported primarily by the patient experience and optical capture, not by the insurance reimbursement itself.
After about six months of testing, my staff and I worked together on the wording. Then we exited this vision plan network. The hardest part came right after that, when the managed vision company sent a letter to every patient making it seem like they couldn’t come here anymore. It was definitely an intimidation tactic, especially when they listed on this letter all the other clinics nearby that they “allowed” the patient to go to.
A BETTER FIT FOR THE RIGHT PATIENTS
We had already sent emails and posts explaining that we were still offering significant discounts and a great experience, and that nothing about how patients paid in my office was really changing.
There was some pushback at first. If patients ask if we take that vision insurance benefit, the answer is yes. But we explain how we use the benefit. My staff is trained to say that I was not comfortable with stipulations that limited how I could care for patients, and that this gives me more freedom to choose the best frame, lens and lens design.
That mindset has been important for our optical too. We have a lot of walk-ins, and 20% to 30% of our optical business comes from that traffic. We carry independent lines and offer affordable options, but we use labs and lenses we trust. That improves turnaround time and gives us more control over quality. We don’t try to be everything to everyone, and there are locations nearby for patients and customers who want more of a bargain deal.
STRONGER, MORE SUSTAINABLE GROWTH
Being selective also helped us stay financially strong and grow in a way that made sense. Instead of relying on vision insurance checks to drive the practice, we focused on the patient experience and optical quality. We tell a clear story about what we offer. That allowed us to stay flexible, especially when the market changed.
We saw how quickly revenue could be affected when a benefit changed. I didn’t want to be in that position. By making the transition intentionally, we were able to keep our patients happy while we tested and protected the practice from being overly dependent on any one insurance relationship.
For me, that’s the real financial lesson: when you build a practice around your values, you can create something that is both clinically fulfilling and financially sustainable.
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Samantha Hamblet, OD, is the owner of Eye Love Olympia in Olympia, Washington. |
Do you have a topic you want to discuss on The Divide? Email us about a point/counterpoint conversation.
Read more on managed care here.
