Insights From Our Editors

How a Potential New Law Could Loosen the Impact of Managed Care on Your Practice

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

June 2, 2021

The American Optometric Association-backed Dental and Optometric Care (DOC) Access Act was reintroduced in the U.S. House of Representatives and the Senate, seeking to preserve the doctor-patient relationship against what the AOA describes as “intrusive vision plans.” Here are the details on the possible new law, including how it could do away with restrictions on the labs you can use and the amount of money you can charge patients for your products.

Limits on a doctor’s choice of lab.
Sometimes eyecare professionals experience an optical laboratory that just can’t deliver. Whether the problem is a lack of on-time delivery of patient jobs, inaccurate prescription fabrication, or loss of patients’ frames, this is not a one-time event. When this happens many times over many years patient care is impacted. This situation is compounded when you are forced to use that laboratory by a third-party vision plan. You know there are better laboratories out there because you are using them with your non-vision plan patients, however, the vision plan forces you to use their chosen laboratory.

When an optical laboratory fails, patients blame you, the eyecare professional. Most patients do not blame the optical laboratory or even the third-party vision plan. No matter what you tell them, they ultimately blame you. This often results in patient loss and creates a group of people who go into your local community telling others about the terrible service they received in your office.

We used to say that one unhappy patient tells 13 others. Now we know that one unhappy patient tells hundreds to thousands on social media.

Mandates on non-covered services and materials.
A second, equally egregious problem we face with vision plans is interference in the doctor-patient relationship by dictating prices for non-covered services or products. Even though they may not cover a service or a product, they in effect enact coverage by forcing you to reduce your fees. When you question third-party representatives about this practice, they simply shrug their shoulders and say: “You signed the contract. If you don’t want to abide by the terms of the contract, then don’t sign the contract.”

THE LEGISLATION RE-INTRODUCED BY AOA AND ADA
On May 21, 2021, H.R. 3461 was reintroduced in the U.S. House by Reps. Yvette Clarke, D-N.Y., Buddy Carter, R-Ga., Darren Soto, D-Fla., and David McKinley, R-W. Va., and on May 24, S.1793 was introduced in the U.S. Senate by Sens. Joe Manchin, D-W. Va., and Kevin Cramer, R-N.D. (The bill was originally introduced into Congress in 2015, but didn’t make it into law.)

The 2021 bill is supported by the American Optometric Association and the American Dental Association. The bill combats abusive practices in the federally regulated vision and dental coverage markets by preventing:

• Limits on a doctor’s choice of lab.

• Mandates on non-covered services and materials.

Forty-three states have similar laws that already exist. The DOC Access Act applies these laws to federally regulated vision and dental plans.

 You should know that two of the nation’s most dominant vision plans provide coverage to roughly two-thirds of Americans. Through special legal treatment (vision plans often aren’t regulated like health insurers) and a lack of competition in the market, vision plans too often insert themselves into doctor-patient decision-making. This bill is an attempt to address this problem.

Sen. Kevin Cramer made the following statement: “It is past time we balance the scales and give doctors more choice in deciding the direction of care by allowing them to choose their own materials and lab services, and by increasing fairness in doctor-insurer agreements. Our bipartisan legislation would put decision-making power back into the hands of doctors without raising the costs on consumers.”

HERE’S WHAT YOU CAN DO NOW
We must fight for fairness in the marketplace. Act now by:

Visiting AOA’s Action Center to urge your House and Senate members to co-sponsor H.R. 3461/S1793 or text “DOC” to 1.855.465.5124.

Consider investing in AOA-PAC, the only federal political action committee dedicated to fighting and winning for optometry.

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