How to Set Up Your Optometry Practice to Go Insurance-Free

Sep 6, 2019
8 min read
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Most of us have accepted the aches and pains of vision insurance as the norm. But what if you could be vision-plan free?

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Every doctor contemplates dropping all vision plans at least once in their optometry career. The idea that you can see few patients and have higher margins is every optometrist’s dream! We all dream of returning to the “good ol’ days” when patients paid in cash and we collected up front. For most of us, the aches and pains of vision insurance are what we’ve accepted as the norm.

What if you could be vision plan-free?

Here are some steps to consider when moving in that direction.

Educate your patients about insurance—today

Most patients know their insurance isn’t great anymore. As of a few years ago, we are all accustomed for paying high premiums for less coverage. Most of our patients have high deductible plans currently, and know that they must pay out-of-pocket. We strive to have a discussion with each patient to evaluate the rate they are paying vs their actual benefits. We also offer them the option of a cash discount.

It’s important to educate your patients about vision plans, especially the younger ones whose insurance is just pre-paying for their benefits. Essentially, they are handing over money to be given back to them if/when needed. If they don’t use their benefits every year, they are losing money. Most patients only visit an optometrist every 18-24 months, and if you point out the off years to them, they realize the money lost.

Educate your medical patients that, even if you are not in network with their vision plans, they can be seen by you under their medical coverage. Furthermore, one should discuss with their post-refractive surgery patients that it is no longer in their best interest to pay for materials.

If you are a new start-up as I was, I recommend a careful evaluation of plans prior to signing up for them. Some doctors may think more patients the better, but only you can evaluate your chair time. While it may bring you more patients in the beginning, it will make dropping plans more difficult. It’s easier to be fearless in the beginning!

Lastly, begin the discussion on speciality services with your patients. Becoming a orthokeratology or scleral lens practice does not happen overnight, it takes a conversation with each patient to assess their potential needs. When you have new parents, begin the conversation on children’s vision and the genetic/environmental factors that contribute to higher amounts of myopia. When you have a patient with astigmatism, instead of thinking about extended range torics, explain the benefits of a scleral lens. With each patient you have, consider the special services and vision plans you may provide for them.

Set a goal to drop one vision plan at a time

Look at your lowest-paying insurance or the one that may cause the most problems, and look to drop that plan first. A quick conversation with your staff can easily reveal which should be first to go.

When I first opened, I accepted one such insurance plan. It was low-paying, and seemed to bring more problematic patients and contract restrictions. I have been successfully able to convert about 15% of those patients, and seeing 1 is equal to 3.5 with the previous vision plan.

With a long-standing practice, dropping a plan should be easier than a start-up. You have spent years building patient-doctor relationships. The patients whose families, hobbies, and history you know are more likely to be loyal. As a start-up, it’s imperative that you focus on building those relationships.

Some vision plans require you stay on panel up to 3 months after giving them the notice you will be leaving the panel. This time should be considered in the transitional period.

Prepare for the transition

I would start this process up to a year prior to dropping the insurance company. I would recommend mentioning at their exam, as well as sending out a newsletter. It’s important to convey to patients the reason for dropping the plan as well as the reasons they will benefit to this change. I’ve provided a sample below.

“After much deliberation, we have decided to end our preferred provider status with Insurance Company effective Month-Day-Year. We will continue to accept your insurance; however, we will do so as an out-of-network provider.

We have always maintained a high standard of care for our patients, and are unwilling to cut corners due to an insurance companies’ shortcomings. Additionally, we have avoided using cheap materials and outdated technology. We want the best for you! In the current environment of managed health care, many insurance companies like your own are adding more restrictions on what they will allow their subscribers.

It has reached a point where it is impossible for us to offer the same high-quality products and services with X insurance company.

What does this mean?

You will still be able to have eye care at our office; however, you will need to read your specific insurance contracts to see how your coverage will be changed by going to an out-of-network provider.

Most of our patients have decided to pay discounted fees to see us directly. We will provide you with proper paperwork and receipts to submit to the insurance company directly for your reimbursement.

You will continue to receive the high level of care that we provide.

We appreciate your loyalty and hope that this change has only a positive impact on your vision care for years to come. Please call our office at Your Phone Number if you have any questions about your benefits.

Our office handles out-of-network claims by printing off the claim form for the patient and providing them with a receipt. These claim forms can be found on each insurance company’s website.”

Each staff member should be trained on how to address patients with out-of-network benefits. Please provide those answering your phones with a script.

“Thanks for calling, Mrs. Jones. We are an out-of-network provider with your insurance plan. We no longer contract with them due to issues with the quality of glasses and the requirements to use old technology lenses. We are committed to your healthcare and an insurance company should not be telling a doctor what is best for patients. We will provide you with a cash discount, and then you can submit your form to your insurance company for even more reimbursement. We will provide you with all the forms you will need to get your money back.”

Questions each staff member should be able to answer:

  1. What out-of-network submission means
  2. How to submit forms to each insurance company
  3. Most importantly, how going out-of-network benefits the patient

The ability of your staff to answer, and answer sufficiently, is vital to your success in capturing the out-of-network patient.

Lastly, I’ve read detailed exit strategies from doctors exiting plans that recommended calling patients on the vision plan, and trying to get them on the schedule one last time before you exit. I think this is brilliant! For instance, it fills up your schedule, and gives you another opportunity to talk to that patient in person. One last time to woo them!

Patient experience is paramount

When patients pay cash, the expectations are higher. Make sure you are rising to those expectations. Your staff and your exam should be of higher caliber. The benefit to having less patients is that you may spend more time with them. Typically, more time with patients leads to more revenue per patient.

I’m currently down to two vision plans—the Big Two. I’m focusing on the two niches of orthokeratology and scleral lenses. In the past, I found myself just going with the easy soft lens options. I’ve made it a goal of mine to become a successful specialty lens fitter, an experience I did not have in optometry school.

No matter the size or longevity of your business, the thought of dropping vision plans brings fear. Will I be able to pay my staff? Will I be able to pay myself? Will all my patients leave and go to my colleague down the street? I know, I’ve had them. Once you drop the first one, the others become a little easier!

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About Courtney Dryer, OD

Courtney Dryer is a 2011 graduate of SCO. She opened 4 Eyes Optometry in her hometown of Charlotte, NC in February of 2013. After 5 years, the practice name was changed to Autarchic Spec Shop to renew the practice's commitment to independent optometry. In addition to consulting with new graduate optometrists on start-up practices, she contributes regularly to New Grad Optometry and has guest blogged for Invision Magazine. The unique design of her boutique practice was featured in Women in Optometry. In 2015, Vision Monday named her a Rising Star, and one of the most influential women in optical.


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