Table of Contents
The practices of US vision insurance companies do not always match up with state regulations. To avoid potential conflicts, employee benefits professionals need to take care when considering which products to offer to their clients. Vision Care Direct can help you make these decisions about providing affordable eye care in OKC, all over Oklahoma and nationwide.
Downsides of Dealing with the Larger Plans
Some of the larger plans see themselves and their providers as being simple sellers of products. Providers are expected to bring through as many clients as they can. If possible, they should do this by using the products and services closely associated with or owned by the large plan. In other words, the large plans, through their market power, can impose what are in essence conflicts of interest on the providers who use them. Professionals are torn between wanting to act in the best interest of their clients and providing the most profitable products for their plan. In the meantime, the actual professional services are reimbursed at really low rates, again putting pressure on providers to stress product sales over service.
Discount Practices
These conflicts of interest are particularly evident where discounts are involved. Large insurance companies have held firm to policies that require doctors to provide discounts, some of which conflict with state laws. This creates a danger of shrinking networks as these insurance companies are choosing to force doctors to give discounts that are illegal or go against their client’s best interests.
Additionally, because discounts are typically offered on non-covered items, this puts the insurance companies in a position to set the cost. This is one reason why balance bills are commonly over $500 even with built-in discounts.
By contrast, if providers are allowed to choose their own labs and are not forced to discount on certain items, balance bills could come down by as much as 30% which is the case with Vision Care Direct compared to large insurance companies.
Take care with reimbursement terms
Vision insurance companies that change their reimbursement terms can potentially violate state law. For example, 14 states have patient protection laws that prohibit limiting a healthcare provider’s choice of labs, materials, and suppliers. However, some large vision plan carriers violate the spirit of these provisions by limiting what they will reimburse. By doing this, they force the use of certain materials, labs, or suppliers. Indeed, one large provider’s recent differentiated reimbursement policy for some products and coatings will not only have the effect of restricting patient and provider choice, it will also undermine doctor-patient decision-making. Worst of all, it may well also violate patient protection laws of those 14 states. Some vision care providers and service plans are actively challenging these kinds of policies. They consider these policies as violations of the law and as possibly causing providers to violate the law.
Large plans throw their weight around
Large vision plans with millions of clients and contracts can afford to use their power to force health care providers to grant unreimbursed discounts and use specific labs or products. Their power in the marketplace makes it virtually impossible for a service provider to decline to contract with these providers. VCD of Oklahoma may have the solution you need for this.
Let Vision Care Direct help you offer affordable eye care in OKC and nationwide
Vision Care Direct of Oklahoma can help you steer clear of these legal issues. We are a pre-paid vision care plan, offering services paid for in advance. We are not a discount service. VCD helps you avoid any conflicts with state and federal laws. VCD also helps you protect patients while offering excellent affordable eye care in OKC.
