Health and Vision Plan Advocacy
The AOA, affiliates and doctors of optometry across the country are standing up for reimbursement and coverage fairness, supporting optometric practice success and doctors' ability to deliver quality patient care.
Key Resources to Address Health and Vision Plan Challenges
Addressing Down-Coding Programs
The American Optometric Association (AOA) opposes automatic downcoding programs that systematically downcode reported codes without records review. The AOA has engaged directly with insurance companies that utilize these systems to raise our concerns on behalf of the profession of optometry and on behalf of the patients doctors serve.
If you are included in a downcoding program based on your claims reporting history, please notify the AOA at stopplanabuses@aoa.org.
As we continue to advocate to change these programs, practices must appeal downcoded claims to be removed from the downcoding program.
If a high percentage of ALL downcoded claims are overturned, doctors are typically removed from the program.
Please report results of your appeals to the AOA at the email above.
By following these links, you will find a template appeal letter and an example of strong documentation to support the level of care provided. Strong documentation is critical to successful appeals. A template for appeals related to 99xxx codes is available here.
Hot Topic Resources
- Risk Adjustment Audits/Records Request
- Best Practices for Offering Discounts to Private Pay Patients
- Understanding the Difference Between Vision Exams and Medical Eye Exams
- Medicare Advantage and Vision Benefits Explained
- Antitrust Compliance
- Third-Party Contract Review
AOA's Approach to Health and Vision Plans
The AOA and affiliates are fighting for reimbursement and coverage fairness through:
- Direct advocacy against the vision plan industry's lobbying group, the National Association of Vision Care Plans.
- Direct action to resolve doctor complaints with health and vision plans.
- Direct dialogue with plan CEOs.
- Advancing state advocacy through legislative and regulatory efforts.
- Advancing federal advocacy through bipartisan legislation, congressional intervention and regulatory efforts.
- Building alliances with doctor and patient organizations.
- Formulating legal strategies and next steps in consultation with anti-trust experts.
If you experience challenges with a health or vision plan, please report this to stopplanabuses@aoa.org.
Below you'll find more information about the AOA and affiliates' mobilization to secure relief for optometry practices.
If you or your practice experience challenges with a health or vision plan, please report this to stopplanabuses@aoa.org.
...93% of survey participants say vision plan policies create a barrier to delivering quality care? *2024 AOA Townhall
...94% of survey participants believe that vision plan policies do not support the patient-doctor relationship. *2024 AOA Townhall
Join Now: Become a Member
$12 million recovered for doctors through AOA’s targeting of plan denials, credentialing and claim edit errors
The AOA, buoyed by dedicated Third Party Center committee doctor volunteers, celebrates ongoing wins for optometrists.
Aetna and Humana collaborate with AOA to exempt optometrists from auto- downcoding edits
AOA advocacy has resulted in a first-of-its-kind organizational agreement to eliminate certain automatic downcoding programs, which have been targeting optometry practices across the country.
Doctors questioning Superior Vision auto-enrollment with Davis Vision
Received a notice from Versant Health? Here’s what to know.