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AOA initiative shows insurers the benefits of using ODs for care

"The goal is to have optometrists be included as participating providers in all provider networks for all health plans."

Major changes in the American health care system are prompting health insurance plans to "rethink" eye care—and the AOA is ready to guide their thinking.

With that goal in mind, the AOA Third Party Center launched "rethink eyecare." This timely initiative aims to help public and private insurance plans recognize the advantages of using optometrists for all primary eye and vision care.

"The goal is to have optometrists be included as participating providers in all provider networks for all health plans," said Stephen Montaquila, O.D., AOA Third Party Center Executive Committee chair.  

What the rethink eyecare program does

The rethink eyecare program includes a major outreach effort to insurance plans across the nation. The AOA Third Party Center also is working with benefit managers who already use optometrists to develop ways to better explain the benefits to those who do not.

Central to the effort is, a website where plan administrators can find information on the new federal provider nondiscrimination rule, as well as the quality and cost-effectiveness of optometric eye care. Visit the website and see how the AOA Third Party Center is working to represent optometry to insurance plans.

Changes driven by government and the market

Many factors are causing policymakers, health plan administrators and even patients to reconsider how eye care is—or should be—provided, including legislation and emerging integrated systems, such as accountable care organizations (ACO).

For example, the Harkin Amendment will prohibit health insurers from arbitrarily excluding optometrists from provider panels. Effective Jan. 1, 2014, this landmark provision of the Affordable Care Act should dramatically increase optometrists' participation in provider networks and patient access.

In addition, over the years, many benefit managers have come to realize that optometric practices can treat eye diseases and ocular symptoms of systemic conditions—plus eye-related emergencies—more quickly and far less expensively than emergency rooms or other providers.

"Increasing numbers of large Fortune 500 companies, such as General Motors and Chrysler Corporation, as well as medium-sized companies, such as Maryland's Shore Health System (SHS) and Michigan's Art Van furniture chain, are beginning to utilize optometrists for all eye care services—including medical eye care—under their benefit programs."

November 5, 2013

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