Be a better negotiator on payer issues

A doctor of optometry practicing in Washington state, Philip Williams, O.D., attended his first Third Party Center (TPC) conference seven years ago and has rarely missed a TPC event since.

So impressed was he by the educational and empowering content presentation at his first TPC foray, Dr. Williams now sits on the AOA Third Party Center Executive Committee, which is presently polishing preparations for the AOA Payer Advocacy Summit Nov. 15-16, from 7-10 p.m. ET each day. Register for the virtual summit.

The 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 Americans have access to quality eye care through their choice of appropriate provider.

“Conferences like the upcoming TPC Summit provide the education to members to advocate for the profession of optometry,” Dr. Williams says. “Armed with the knowledge gained from the conference, we can communicate and negotiate with third-party payers to reform policies that may be harmful to providers and patients.

“It also provides information to talk with state legislators about third-party issues that may require changes to legislation,” he adds.

Third-party expertise

The summit will feature 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 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.”

Dr. Williams was president-elect of the Optometric Physicians of Washington (OPW) in 2014, his first TPC conference.

“The OPW sends state officers to conferences like this to help them understand how the AOA works, as well as give them personal training to assist them as they begin their presidency,” Dr. Williams says. “Attending conferences like this provides invaluable information to officers but can benefit anyone who attends by educating them on issues involving third-party payers as well as how laws affect the payment of claims. They can then take the information back to their respective states to help with third-party issues.”

Nicholas Colatrella, O.D, also a member of the TPC Executive Committee who practices in Minnesota, called the summit a “great place” to get the latest information on the ever-evolving world of insurance, especially for busy doctors of optometry.

Dr. Colatrella, too, was president of his state association and was feeling overwhelmed by how much he didn’t know when he attended his first TPC conference eight years ago. He has attended each since, equipping himself with the knowledge of what he learned in order to inform and benefit his state association’s advocacy.

“It was a great event then, and each time it gets better,” Dr. Colatrella says. “And this year, it’s even free. What an awesome member benefit.

“When we think of advocacy we traditionally think about legislative issues,” he adds. “But advocacy also extends to the insurance world as well. When you have a problem with a claim, your reimbursements are changing, or coding issues are popping up—and you don’t feel like you are being heard—the AOA Third Party Center is your only voice and advocate for getting changes made. With the power of 40,000 members behind us, most insurers are responsive when we ask what is going on and at least willing to sit down and talk with us.”

Learn more about the TPC and the issues it takes on—clawbacks, downcoding and health and vision plan anticompetitive practices­­­­—on behalf of doctors of optometry.

Register now!

Want to learn more about third-party advocacy? Attend the AOA Payer Advocacy Summit? Here are the details.

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.
How: Register here.