Unfavorable vision plan policies often handcuff doctors of optometry to anti-competitive business practices, but an upcoming AOA conference and panel discussion on the subject may offer doctors a key.
The session addresses many of the issues of vision plan business practices in this rapidly changing marketplace.
The AOA State Legislative and Third Party National Conference, Oct. 23-25 in Denver, Colorado, seeks to mobilize the full advocacy resources of the AOA and state associations in responding to the challenges facing optometry, and vision plan advocacy is one area of special attention.
Already this year, AOA—working in conjunction with state associations—helped reform vision plan and health plan policies in nine states—Alabama, Arkansas, Connecticut, Kansas, Kentucky, Maine, Oregon, Texas and Virginia. Such policies included forced participation in vision plans to access health plans, mandatory discounts and fees for noncovered services, and restriction of lab choice, among others.
Gary L. Robbins, Kansas Optometric Association executive director, State Government Relations Committee member and panel speaker, says the profession is starting to see the benefits for optometric practices and their patients in laboratory choice and other ongoing issues in states that have been successful in this area.
"These state laws start the process of leveling the playing field for doctors of optometry with vision plans," Robbins says. "The vision plan advocacy session [at the State Legislative and Third Party National Conference] will provide state leaders with the tools to pass broad noncovered services bills addressing a wide range of [unfavorable] behaviors by vision plans."
Discussion during the vision plan advocacy session will include:
- Contract language and examples of unfair vision plans
- Changes in the vision plan market
- Antitrust considerations
- Legal tools to protect optometric patients
Jason Ortman, O.D., AOA Third Party Center Executive Committee member and panel speaker, says the session addresses many of the issues of vision plan business practices in this rapidly changing marketplace.
"Understanding the evolving business practices of vision plans in the marketplace is vitally important to practicing doctors of optometry," Dr. Ortman says. "Signing any insurance or vision plan contracts without fully understanding the various details of these legal documents and potential tying arrangements can be detrimental to practicing doctors."
As AOA and state affiliates continue working toward advancing fixes to plans regulated on the state level, an AOA-backed bill before the U.S. House, the Dental and Optometric Care Access Act (DOC Access Act), seeks to prohibit these anti-competitive practices on a federal level.
Vision plan advocacy panel speakers also include Zachary Steele, O.D., of Alabama; Thomas Lucas, O.D., of Texas; and Zoey Loomis, O.D., of Colorado.
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Vision plan advocacy is only one of several points of discussion during the conference. Others include legislative and third-party readiness, negotiating contracts, disruptive technology and value-based medicine, in addition to other advocacy sessions and more.
Also featured at the upcoming conference, speaker Tom Daly, Esq., AOA's longtime legislative counsel who drafted the Harkin Law, as well as the new DOC Access Act (H.R. 3323), will cover the enforcement of the national provider nondiscrimination law and specifics of the DOC Access Act during breakfast, 8 to 9 a.m., on Oct. 25.
The AOA has long championed nondiscrimination against doctors of optometry. The survey of doctors of optometry and AOA affiliates gathered responses from 47 of the 50 states plus the District of Columbia.
The prior-authorization requirement ended July 1, 2022, for all patients—except Medicare Advantage in Georgia and Florida—a year after the AOA and other groups decried Aetna’s decision.
Medicare Advantage Organizations’ denials of prior authorization requests raise flags in HHS report and prompt AOA’s third-party advocacy outreach on behalf of optometry practices.