Surveys say patient and doctor concerns about health industry middlemen on the rise

New national research findings validate active policy-based initiatives in Washington, D.C., and state capitals—strongly backed by the AOA and its affiliates—to investigate and crack down on abusive polices of health and vision plans.     

According to the 2025 Healthcare Pulse Survey: 

• 72% of respondents give the U.S. health care system a C grade or lower. 
• Many blame insurance companies (66%) and drug companies (60%) for what’s wrong with the health care system; others blame politicians (42%) and fraud, waste and abuse (34%). 
• Only half say they can get the medical care they need when they need it (51%); only half can afford their insurance premiums (51%) or their prescriptions (49%). 
• 35% worry more about the rising cost of health care than the rising cost of eggs, meat and other food staples.

“Patients clearly understand how industry middlemen are working against doctors and quality care, and they are demanding accountability and new safeguards for doctor-patient decision-making,” says AOA President Steven T. Reed, O.D. “That’s why AOA and our affiliates will continue to directly take on an out-of-control industry by restoring unfairly withheld reimbursement and growing support for a nationwide crackdown on plan abuses.” 

Additionally, a new research report by The Vision Council exposes key areas needing vision plan attention, raising serious concerns about whether they are truly advancing patient care.  

New data confirms AOA findings on doctor of optometry concern with valuation of care and vision plan contracting processes  

Finding: On average, only 25% of providers reported being satisfied with existing reimbursement rates and only 20% are satisfied with rate negotiation process. 

“While not surprising, docs are not happy with their reimbursement by a three-to-one margin,” says Steven Loomis, O.D., chair of AOA’s Health Policy Institute and a member of the AOA’s Research and Information Resource Team. “It’s huge.” 

The data from The Vision Council confirms the findings of AOA’s Reimbursement and Coverage Fairness Town Hall hosted in October 2024. During the town hall, doctors were polled on key issues they face in the industry. Not only did doctors voice concerns with the rate negotiation process, but also 98% of respondents indicated plans create barriers to renegotiating fee schedules.  

The AOA has focused advocacy efforts on the need for greater transparency in the contracting process and will continue to prioritize this effort. Recognizing these serious member doctor concerns, the AOA provides resources to support an improved contract negotiation and contract review. This guidance can assist doctors both in contract evaluation and the rate negotiation process. 

Patient satisfaction is tied to the doctor-patient relationship  

Finding: Eye exam coverage has the highest reported satisfaction among employer-sponsored plan members in 2024, with 88% of respondents being somewhat or extremely satisfied. 

This finding shows that patients are happy to have access to their optometrist, Dr. Loomis says. “The vision plan really doesn’t have anything to do with the eye examination experience,” he says. “That’s really between the patient and the doc.” 

Finding: Optometrist co-location with an optical store is one of the least important factors to respondents when purchasing prescription eyewear. 

While vision plans often encourage optometrists to carry or promote certain brands of frames and lenses, Dr. Loomis says, this finding indicates that access to material products isn’t as significant to the patient as access to their doctor. “Again, it’s clear the important thing is the doctor-patient relationship,” he says. 

Finding: Greater engagement with the plan exposes members to more complexities, that alters their perception of their vision insurance plans. 

Patients tend to like their vision plan—until they must interact with it, Dr. Loomis says. “A big piece of that, at least in my experience, was about the limitation of what a vision plan provides,” he says. 

If a patient is healthy and only needs an annual eye exam and a glasses prescription, the process is likely to be smooth. But that changes when a medical issue is detected and coverage for care gets more complicated. “That’s when the interaction (with the vision plan) becomes complicated,” Dr. Loomis says. 

AOA, affiliates’ advocacy for optometry achieving results 

Tens of millions of Americans rely on their local doctors of optometry for their comprehensive eye health and vision needs, and even despite historic advancements in optometry’s scope and level of care provided, plans haven’t sufficiently advanced alongside the profession. Toward that end, the AOA and affiliates continue a multi-pronged approach to achieving reimbursement and coverage fairness.   

📺WATCH: Patients Rising video on stopping VBM abuses.   

In addition to supporting states’ advocacy, the AOA continues to advocate at a federal level, as well as directly with plans on behalf of members. In fact, this direct advocacy is already having an effect: over $2.9 million has been driven back into optometry practices.  

Here’s how else the AOA is championing vision benefit manager reforms:  

• Federal legislation. The recently reintroduced Dental and Optometric Care Access Act, a bipartisan effort by Reps. Buddy Carter, R-Ga., and Yvette Clark, D-N.Y., would lower vision costs and put decision-making power back into the hands of patients and their doctors by targeting ERISA plans. 
• Federal investigations. Three Congressional investigations into VBMs, their policies and market actions, are currently ongoing by the U.S. House Oversight Committee, House Energy & Commerce Committee and U.S. Senate Appropriations Committee. 
• Direct plan advocacy. Doctors can email stopplanabuses@aoa.org with a health or vision plan challenge and the AOA will help fight on their behalf. Additionally, the AOA offers resources to empower doctors in these issues, including responding to automatic downcoding programs.  

Additionally, the AOA continues to review and monitor such plan mandates and challenges alongside anti-trust experts, as well as provide enhanced transparency behind these actions with the AOA’s Health and Vision Plan Action Report. This daily accounting of the AOA’s actions regarding health and vision plans can be found in members’ First Look emails, Monday through Friday.