Risk or reward? Find out when it makes sense to keep or cut insurance plans. Photo Credit: Getty Images.
Evaluating the impact of insurance plans to make change in your business
Jan. 5, 2026
By Brittany Schauer, OD
When I purchased my practice in 2014, the office accepted nearly every insurance plan under the sun. On the surface it seemed to be a welcoming way to invite more patients to our practice. Yet behind the scenes, the work was tedious, time-consuming and confusing for the staff.
In 2018, we dropped our first insurance plan. Fast forward to today, we’ve now dropped a total of three and are left with just one. Here’s what we considered as we evaluated our insurance plans to decide if it was the right move for our practice.
ANALYZE PERCENTAGE OF INSURANCE REVENUE
Our first plan we dropped, let’s call it Plan A, was less than 1% of our insurance revenue. Yet the staff said the benefits were not great and there were many headaches involved with checking eligibility.
If you have an insurance plan with such a low percentage like this, ask yourself (and your staff!) if it’s worth the hassle. In this case, it was too much for nothing. We didn’t notice a difference in our patient volume after this change.
EVALUATE THE VALUE OF REIMBURSEMENT
Our office, like many others, was shut down for six weeks during the chaos of the COVID pandemic in 2020. Shortly after we got back to business, I received a letter from Plan B stating that they would be cutting contact lens reimbursements.
Again, I looked at our insurance payment percentage. This one was more significant at 11% of insurance revenue, yet the extreme cut in our reimbursements was enough for me to pull the plug.
With the rush of patients coming in after our COVID closure, we didn’t notice a dip in our patients.
REPLACEMENT INCOME
Plan C was a more difficult decision to drop. At 12% of insurance revenue, I examined the numbers in terms of how many exams we were doing and what it would take to make up the revenue. I determined that if I was able to keep 1 out of 3 of those patients with Plan C as a cash pay patient, it would put me ahead of where I was with three patients on this plan.
Still, I was on the fence about this one until a bad customer service experience pushed me over the edge. We were done dealing with the hassle.
ALWAYS LOOK AT THE NUMBERS, CASE BY CASE
We broke down the data to see the impact these changes had on our practice. The comparison below looks at three years, each is one year after we dropped a plan (in 2018, 2021 and 2023). Our schedules are lighter since dropping these three insurance plans, yet our average revenue per exam is on the rise since dropping these three plans.
| Year | Number of Exams | Average Revenue Per Exam |
| 2019 | 4,702 | $326 |
| 2022 | 4,611 | $403 |
| 2024 | 4,205 | $432 |
ONE PLAN LEFT
Our final insurance plan, Plan D, is about 44-47% of our insurance revenue. It’s huge and takes up too much of our revenue to consider dropping. If you can’t make it up, dropping it may not be in your best interest. Look at your books and schedule and see if it is going to be a good decision for you. Sometimes, it’s not!
BE HONEST WITH PATIENTS
We notify patients about these changes via a formal letter. We explain they can stay with us and submit their own claims. I’ve also had many honest conversations with patients. For the most part, they understand that I can’t give the staff raises or make ends meet when we accept very low reimbursements.
Some loyal patients will switch to cash pay to stay in our chair. Others won’t. You will have patients who will follow their insurance, and that’s OK. And some will come back a few years later because your service and experience made a lasting impression.
We encourage patients to talk to their HR departments about insurance coverage and the option of adding the plan that we do still accept. The staff also educates patients on how they can submit out-of-network benefits on their own. We provide them with the form from their insurance and their receipts, and the patient takes it from there.
IS DROPPING A PLAN A SMART MOVE FOR YOU?
Dropping three plans may not be the right decision for your practice. Even dropping one can be disastrous if you don’t look at all the scenarios. Start by considering the percentage of insurance revenue it brings to your office. Then think about how you can plan accordingly to replace a certain number of those patients with cash pay. Maybe a new service to cover the difference. With a proper strategy, dropping insurance plans can be another way that you work smarter, and not harder, in your business.
Read another article by Dr. Schauer on ROB here.
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Brittany G. Schauer, OD, is the owner of Vision Source Mandan in Mandan, North Dakota. To contact her: bschauer@visionsource.com |
