Antitrust Dos and Don'ts

Impermissible Actions under the Antitrust Laws

  • Coordinate with competitors to engage in joint negotiations with third party payers on the reimbursement policies.

  • Facilitating concerted action with competitors to increase fees or reimbursement rates. Such concerted action would include:

  1. A recommendation by AOA that its members withdraw from contracting with a third party payer (group boycott);
  2. An AOA resolution that its members should not participate in a third party payer's plan or prohibiting members' participation in the plan;
  3. An AOA recommendation that its members not disclose certain patient medical information requested by a third party payer;
  4. The AOA members pledging that they will not submit patient information requested by a third party payer;
  5. An AOA recommendation that its members protest or challenge every reimbursement made by a third party payer; or
  6. The AOA coordinating the mass resignation of members if the third party payer's policies are not acceptable. 

Permissible Actions under the Antitrust Laws

  • Provide educational information to third party payers regarding the procedures performed by ODs and explain-where appropriate-that such procedures are identical to the procedures of ophthalmologists.
  • Educate third party payers on the costs to ODs for providing various procedures.
  • Obtain information from third party payers regarding the justification for the disparities in reimbursement rates.
  • Educate third party payers on the scope of an ODs practice as authorized by various states.
  • Educate third party payers as to the reasons that AOA believes having full participation by ODs adds value to the plan.
  • Explain to third party payers the reasons that ODs and ophthalmologists should be provided with the same opportunities within networks and plans.
  • Obtain information from third party payers on whether the rates for identical procedures within individualized plans for ODs and ophthalmologists are different; and if there is a difference, seek an explanation for that difference.
  • Advise third party payers that reimbursement rates are too low for ODs as compared to ophthalmologists.
  • Lobby state legislatures or other governmental bodies on behalf of the AOA's members for governmental action.
  • Individual members may take whatever action they deem appropriate, as long as the individual member has made the decision to take that action unilaterally and is not taking the action based on a collective agreement with competitors.


Revised April 2009