Kansas Insurance Department puts vision plans on notice

In late August, the Kansas Insurance Department (KID) sent a memorandum to vision plan insurers, reminding them about the provisions in the state’s Vision Care Services Act (VCSA) and their intent to continue enforcing those provisions. The act went into effect in 2014 and includes provisions that restrict vision plans from setting rates for noncovered services, limiting doctors’ choice of labs and materials and reducing flexibility in contracting.

The KID memorandum, from Vicki Schmidt, Kansas insurance commissioner, affirmed concerns brought to the state insurance department by the Kansas Optometric Association (KOA) on behalf of member doctors who had expressed frustration regarding some vision plans’ failure to comply with the law.

“The Department continues to receive information from the vision care services provider community and insurers regarding application of the VCSA in practice,” Schmidt says. “Upon a valid complaint, the Department will exercise its authority to enforce the VCSA.”

Jeannette Holland, O.D., the KOA’s Third Party Committee chair, calls the memo “invaluable” to doctors of optometry practicing in the state. It is not uncommon for vision plans to claim they are abiding by the Kansas law when, in fact, portions of the contract may be clearly in violation, Dr. Holland says.

“This will give Kansas optometrists an additional resource when negotiating contracts with vision care plans and insurers, and an additional contact to discuss violations,” she says.

Affirming the vision act

In her memo, Schmidt reminds insurers of key provisions of the vision services act:

• “No contract issued or renewed shall contain any provisions which requires the vision care provider to participate in a vision care insurance or a vision care discount plan as a condition to participate in any other health benefit plan or vision care plan, regardless of whether such vision care plan is a plan of insurance or a vision care discount program which is not an insurance plan.
• Contracts shall not require a vision care provider to provide services or materials to an insured at a fee limited or set by such vision care insurance plan or health benefit plan unless the services or materials are reimbursed as covered services under the contract.
• No vision care insurance policy shall change the terms, discounts or rates provided therein without the concurrence and agreement at that time of such change by the vision care provider.
• No vision care insurance policy that provides covered services for materials shall have the effect, directly or indirectly, of limiting the choice of sources and suppliers of materials by a patient of a vision care provider.”

Schmidt adds in the memo, “...if the Commissioner determines after notice and opportunity for a hearing that any person has engaged or is engaging in any act or practice constituting a violation of any provision of Kansas insurance statues or any rule and regulation or order, the Commissioner may in the exercise of discretion, order payment of a monetary penalty of not more than $1,000 for each and every act or violation, unless the person knew or reasonably should have known such person was in violation of the statute, rule, regulation or order, in which case the penalty shall be not more than $2,000 for each and every act or violation.”

A victory for doctors and patients

The memo, which was sent to insurers and entities that write vision care insurance in the state, reaffirms the position of the KOA. Association spokespersons say they appreciated the effort of KID to educate insurers about the law and its willingness to enforce the law.

When it passed, the VCSA was hailed for being among the first pieces of legislation in the country protecting doctor and patient choice. It had taken strong advocacy by the KOA, relationships with legislators and grassroots efforts to get the act over the finish line, Dr. Holland says. She notes that implementation of the law had required provider education—it is the responsibility of doctors of optometry to read, review and edit contracts, if needed, before signing.

Now there is a new reminder for insurers.

“VCSA works for vision providers by allowing practices to choose which plans work specifically for their practices, without having to take all the related plans or take a discount plan to maintain provider network status with their patients’ health insurers,” says Dr. Holland. “Not allowing contract changes without the concurrent agreement of the doctor allows practices to be able to decide which plans work best for their patients and offices, without a ‘moving target’ or having to join or drop provider panels frequently.

“The act also benefits patients with a more consistent doctor-patient relationship and reduces ‘surprises’ in coverage changes,” she adds. “VCSA also works for patients by allowing practices to set their own market-driven prices for noncovered services instead of artificially driving up usual and customary charges, for all patients, to cover a required (insurer-driven) discount. Patients are not or cannot be limited by the plan’s choice of materials, sources or suppliers under the VCSA.”

Save the date

Want to learn more about third party advocacy?

The AOA Third Party Center advocates for the inclusion of full-scope optometric care and the inclusion of comprehensive ophthalmic examinations as a core benefit in all medical insurance and ERISA plans so that all Americans have access to quality eye care through their choice of appropriate provider.

On Nov. 15-16, The AOA Payer Advocacy Summit is hosting a two-day educational workshop for state association leaders and third-party payer advocates from around the country. Conducted by the AOA’s Third Party Center, the conference features experts in the field, optometry leaders and all-important discussion groups on top third-party topics and advocacy issues.

“We always try and provide information on how to read and possibly negotiate payer contracts,” says Steven Eiss, O.D., chair of the AOA Third Party Center Executive Committee. “We plan to have some payer medical directors to speak on topics such as policy determination. We also will focus on the state associations and how to develop and improve their Third Party Committees and to advocate at the local level.”

What: AOA Payer Advocacy Summit
When: Monday, Nov. 15, and Tuesday, Nov. 16., 7-10 p.m. ET
Who should attend: State executive directors, state affiliate presidents, presidents-elect and third party coordinators and committees, plus AOA members with an interest in advocacy and addressing issues with health and vision plans. The event is free to AOA members and member staff.

Registration will open in October. Stay tuned to aoa.org/news and AOA communications for more information.