Town hall draws hundreds as AOA and affiliate advocacy earns back millions

Since unveiling its multi-pronged strategy in January for curbing abuses by vision and health plans, the AOA and affiliates have worked to overcome what they call a power imbalance.

How? By securing millions of dollars resulting from direct action by the AOA and affiliates to resolve doctor complaints.

“Through these efforts, we have driven over $2.9 million back into doctor of optometry practices across the country,” AOA President Steven T. Reed, O.D., announced during the Oct. 29 AOA Town Hall on Reimbursement and & Coverage Fairness.

About 200 complaints by doctors over a 14-month period led to the dollars collected on behalf of optometry practices.

Day in and day out, Dr. Reed, the AOA and affiliates engage directly with plans over such issues as credentialing, claims denials, coverage concerns and more. These abuses are high priority, and Dr. Reed encouraged members to continue to call out abuse.

“I want to underscore that it's really important that, if you're getting a denial or you have an issue, it's likely not just a one-off issue,” Dr. Reed says. “Typically, these are larger systemic issues that we can (also) work to address.”

It was the second town hall of the year on vision benefit manager (VBM) abuses.

Polls confirm concerns of optometrists

During the town hall, doctors were polled on key issues they face in the industry. Among the results:

• What do you feel is the most pressing issue impacting optometry? The No. 1 answer was “challenges with health and vision plans” at 84%.
• 98% of respondents indicated plans create barriers to renegotiating fee schedules.

Poll questions such as these help inform the AOA’s advocacy. 

President-elect Jacquie M. Bowen, O.D., says the AOA continues to follow through on its multi-pronged strategy.

Keeping the pressure on

The Dental and Optometric Care (DOC) Access Act, House and Senate versions, continues to percolate. “The bill has the support now of more than 100 House and Senate lawmakers,” Dr. Bowen reports. “That’s a good number, and we are in a great place.”

In September, the AOA joined members of Congress who champion optometry’s causes and the consumer group Patients Rising for a briefing to discuss challenges faced by doctors of optometry, including VBM abuses.

Tommy Lucas, O.D., briefed attendees at the town hall on developments of Texas’ first-in-the-nation vision plan reform involving abuses by VBMs. Dr. Lucas is director of advocacy for the Texas Optometric Association, which has  joined the state’s defense of its landmark vision plan reform law.  

Fourteen months ago, the AOA launched its AOA Health and Vision Plan Action Report, a daily log of AOA  and affiliate efforts in support of full reimbursement and fair coverage policies.

And then there is the added scrutiny by congressional investigations and a state policy think tank.

Actionable advice

The town hall audience also heard from lawyers, Daniel Frier and Theresa DiGuglielmo, of Frier Levitt, who are outside counsel to the AOA.

Among the attorneys’ observations and guidance to practices:

• The aggressive expansion strategy of VBMs has increased their market dominance. As a result, many independent doctors of optometry have been subjected to contracts of adhesion that contain onerous terms and conditions. Contracts of adhesion, drafted by insurance companies, preempt negotiation.
• Many states have enacted vision care plan regulation acts. Doctors should challenge the terms of participation agreements that do not comply with state law.
• The AOA’s advocacy for greater transparency in the contracting process, including, for example, a requirement that proposed amendments be highlighted or displayed in tracked format, creates greater accountability. With proposed changes clearly indicated, vision plans cannot surreptitiously include objectionable terms and conditions in participation agreements.

It is important to insist that vision plans supply doctors with updated provider manuals and other ancillary documents, often incorporated into participation agreements by reference, contemporaneously with the proposed agreements or amendments so that doctors can cross-reference the other documents and understand what they’re signing.

“You must know what you're signing and push back when the agreement is onerous or unreasonable,” attorney Theresa DiGuglielmo says.

How can you help stop VBM abuses? 

If you experience challenges with a health or vision plan, please report this to stopplanabuses@aoa.org. 

You can also text DOC (D – O – C) to 855.465.5124 to learn more, including how you can join us in the fight to put a stop to VBM abuses.   

🏛️️Learn more about advocating on behalf of the profession.