- AOA, affiliates take on VBM lobby’s attacks on optometry
- Surveys say patient and doctor concerns about health industry middlemen on the rise
- AOA to update profession on health, vision plan advocacy efforts
- VSP warned on campus misinformation, efforts to divide the profession
- Talk of the townhall: Doctors view plan abuses as threat to doctor-patient relationship and quality care
- Don’t miss how AOA and affiliates are fighting against vision plan abuses
- AOA, state affiliate tracking California lawsuit alleging VSP monopolistic practices
- When getting paid will cost you
- Optometry’s wins over abusive vision plans stacking up
- What defines the value of care we provide?
- AOA survey finds discrimination by health and vision plans
- Aetna Prior Authorization
- Medicare Advantage claim denials
- AOA, affiliates prompt changes to MAC claims processing
- Payer issues hot topic at AOA on Capitol Hill
- AOA and state associations target plan abuses
- Be a better negotiator on payer issues
- Anthem stops unilateral downcoding of eye codes
- Congress probes vision plan policies
- vision plan reimbursment
- aoa challenges VSP plan
- AOA fights back against discriminatory vision plans
- SGRC-TPC-Conference
- AOA affiliates assemble advocates to address evolving payer issues
- NAVCP Patients doctors come out ahead in states vision plan fights
- VSP spells doom gloom
- AOA never stronger takes issue with VSP practices
- Health plans changing tone vision plans not so much
- SGR TPC 2017 Conference
- Conference delivers vital advocacy tools knowledge
- Vision plan advocacy What doctors need to know
- State third party conference offers advocacy essentials
- AOA backed DOC Access Act targets health and vision plan abuses
- AOA secures important wins in historic SGR reform legislation
- AOA continues fight for permanent SGR fix advises members to hold claims
- House advances SGR fix AOA secures key role for ODs in sweeping Medicare changes
- AOA and Congress work toward permanent SGR fix
Town hall draws hundreds as AOA and affiliate advocacy earns back millions
October 31, 2024
AOA and affiliate advocacy wins result in nearly $3 million retrieved on behalf of doctors of optometry in 2024. Read how the AOA and affiliates are fighting for fairness. They were updated at a profession-wide, live-streamed town hall on Oct. 29.
Tag(s): Advocacy, Third Party
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.