Third Party
Optometry’s wins over abusive vision plans stacking up
The AOA and affiliates in Illinois and Georgia score wins against vision plan abuses in a year in which doctors of optometry are making inroads across the country. When all else failed, including talks with the plans and appeals to one state’s insurance commissioner, affiliates did the hard work of helping push through bills in their legislatures that address the abuses.
What defines the value of care we provide?
Health and vision plans have not adapted and grown with the care we deliver but hold back optometry’s momentum.
AOA survey finds discrimination by health and vision plans
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.
Aetna reverses AOA-opposed cataract surgery pre-approval policy
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.
Overpower Payer Issues
The AOA's Third Party Center, working continuously to monitor plan policies and actions, is the profession's payer advocacy nerve center.
AOA escalates concerns to DOJ over Medicare Advantage claim denials
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.
AOA, affiliates prompt changes to MAC claims processing
Direct third-party advocacy remains a critical component of the AOA and affiliates’ mission, helping support practice success by ensuring patients can freely access the broadening scope of eye health and vision care delivered by optometry. But advocacy requires a team effort, and optometry’s advocates have an opportunity this spring to help bring about the payer changes the profession needs.
Payer issues hot topic at AOA on Capitol Hill
The agenda for AOA on Capitol Hill April 24-26 will be dominated by issues uppermost on member-doctors’ minds. Open to doctors of optometry and optometry students, register now.
AOA and state associations target plan abuses
Payer Advocacy Summit gathers “all-in” doctors from every state as AOA legal team takes next steps in fight against anti-doctor and anti-patient policies.
Be a better negotiator on payer issues
Register now for the virtual AOA Payer Advocacy Summit, Nov. 15-16.
Anthem stops unilateral downcoding of eye codes
The insurer noted 99000-series codes are still subject to E/M review; however, the AOA Third Party Center continues to challenge health plans’ downcoding schemes as inappropriate.