Managed Eye Care Intrusions in the Doctor-Patient Relationship

eye check
June 3, 2021
James Ashford

As surgeries, tests and even visits with eye doctors have risen in price, patients have had to continually turn to insurance companies to be able to afford eye care. Insurance companies have decided that managed eye care is the best way to control costs.

But how has managed care impacted the relationship between doctors and patients? Are there alternatives to help patients afford eye care without having the insurance company drive decisions? Vision Care Direct of Oklahoma is the middle ground that you, as an optometrist in Tulsa, are looking for for your patients.

Managed care rundown

According to Medicaid.gov, managed care is a type of insurance set up to manage the cost of health care, how often and where services are available, and the quality of said services. Insurers use managed care to ensure that providers offer services that align with accepted standards and costs of care.

This might seem to be in a patient’s best interests. However, there are some aspects of managed eye care that can become a problem for them. For example, it may limit:

  • How often patients can see a doctor or provider every year.
  • What providers they can see (“in-network providers”).
  • What services a patient can get in the first place.

Plus, insurance has to approve some services in advance before they cover them.

There are a number of different managed care plan designs. Health maintenance organizations (HMOs) tend to more tightly restrict which providers and services a patient can receive. But they are usually the least expensive upfront (lower premiums, lower cost-sharing). Preferred provider organizations (PPOs) allow a lot more flexibility and freedom of choice but tend to have higher premiums, deductibles and out-of-pocket maximums.

Changes in managed care over time

Managed care came into “vogue” in the 1980s when health care costs began to accelerate. Insurance companies developed HMOs to limit costs and make sure that quality was being maintained. However, many people balked at the tight restrictions on provider networks and services that HMOs imposed.

HMOs later morphed into looser point-of-service (POS) and PPO plans, which allowed patients to see non-network providers at higher costs. With health care becoming increasingly costly, it appears that the pendulum is swinging back to HMOs, but with looser requirements than we had in the past.

Insurance and the doctor-patient relationship

In all types of insurance plan designs, the insurance company can act as the intermediary between the patient and their doctor. Insurers can decide which services to cover and which ones the patient will have to pay the full cost for.

This can mean that doctors and patients end up with services that aren’t exactly what the patient needs because they can’t afford the full cost of a non-covered service. In this instance, the insurer retains the power in the doctor-patient relationship, which can be frustrating for all involved.

Vision Care Direct offers an alternative to managed eye care

Vision Care Direct is not an insurance company. Instead, we are a pre-
paid vision plan that eye doctors own. We focus on the health of your patients’ eyes, not on making a profit. So, we offer many different plans at many price points. All of our plans include member savings on comprehensive eye exams. Our members can choose their own eye doctor in Oklahoma, rather than having to adhere to a strict network.

We provide offers for lenses and frames as well and include the features that many patients want, such as UV protection and no-line progressive lenses. Because we aren’t an insurance company or a managed eye care plan, you and your patients have the flexibility to choose the services and supplies that patients want and need. That is the Vision Care Direct difference!

Managed care has helped to keep eye care more affordable. However, it comes with some limitations that impact the patient-doctor relationship. Vision Care Direct provides a great alternative for patients and optometrists in Tulsa OK. We help make eye care more affordable, without the limitations of managed care. To learn more about how we can help you and your patients, contact us today.

Not sure where to get started with recommending self-funded plans? Vision Care Direct of Oklahoma is pre-paid plan provider with and extensive of specialists who deliver eye care in Tulsa and nationwide with excellent value for employers and plan recipients.

Find out more about our self-funded plans and other flexible options.

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