It’s no secret that managed vision care has become a huge force in the optical industry. Thirty-five years ago, there were almost none of these plans, so those seeking eyecare paid out of pocket for their eye examinations and eyeglasses. This was also a time when many consumers went to an ophthalmologist for their eye examination and then to an optician to get their eyeglasses. Those two functions were separate in the mind of the consumer, just like going to the doctor for a cold and then to the pharmacist to get medication for that problem. Vision care plans changed all of that. With more than 55% of eyeglass sales somehow touched by managed vision-care plans, it’s easy to see that they have a huge influence on eyecare and eyewear delivery.
Optometry was reluctant at first to embrace insurance reimbursement for their services and product sales due to its fears of undue influence on the profession by managed vision care companies. In fact, it fought very hard for parity in payments from the insurance companies because in the early days of vision care programs, ophthalmologists were being paid more than optometrists for the same services, and optometrists were excluded for medical procedure reimbursements.
All this has changed, and optometry is now a huge part of the managed care network. Optometry positioned itself to be the primary point of entry for eyecare decades ago, and it has fulfilled that vision. Its success with managed vision care plans has been a study in foresight, planning, implementation, and perseverance.
After all this success, optometry is beginning to ask the question: Are managed-care programs beginning to go too far?. It is increasingly becoming a central issue precipitated by some managed care companies who are forcing offices to use their lab services. Optometrists are beginning to push back. In fact, lawsuits have been brought and won in several states. The first was in Georgia where a group of optometrists sued a managed-care company citing the state’s Patient Access to Eye Care Act. Lawsuits have also been won in Kansas and Vermont on similar issues and others will no doubt
This kind of action again begs the question, “Just how far should managed care companies go?” How much practice influence will the professions allow, and more importantly, how much should they allow? With predictions that managed care programs will cover approximately 75% of eyecare services within 10 years, these are important questions.
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