Recent state bills that reduce the negative impact of some vision plans.
August 23, 2023
“The Illinois Optometric Association (IOA) saw its precedent-setting legislation signed by its governor and, in Georgia, a large vision plan notified that state’s affiliate that it would no longer require doctors to offer discounts on their materials and service after a legislative victory,” the AOA reports.
“This significant piece of legislation regulates vision care organizations, ensuring fair fees, transparency and freedom of choice in materials and suppliers. It requires disclosure of out-of-network recommendations and allows doctors to negotiate contract changes. It aims to enhance doctors’ control and patient communication while promoting accountability,” says Chelsey Moore, OD, president of the IOA.
“We want to work with the insurance plans,” Nacondus Gamble, OD, Georgia Optometric Association (GOA) president, says. “But we don’t have to just take whatever they give us when it doesn’t benefit patients and optometry. This is a clear-cut message to these plans that we’re not going to play ball. I feel like this has set a precedent.”
Illinois Bill Gives Doctors Choice Versus Vision Plan Demands
S.B. 764, or the Vision Care Plan Regulation Act, was signed by Gov. JB Pritzker on Aug. 4. What does Illinois’ bill do?
- Prohibits vision care plans from issuing a contract that requires an eyecare provider, as a condition of participation in a vision care plan program, to offer services or materials at a set fee when those services and materials are not covered under the plans.
- Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eyecare provider.
- Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees.
- Prohibits a vision care organization from restricting an eyecare provider’s freedom to choose suppliers, materials or labs, or from requiring an eyecare provider to purchase materials from a source owned by the entity that issued the vision care plan.
- Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan, may not be changed unless mutually agreed to in writing by the eyecare provider and the vision care organization.
- Set forth prohibited contract terms that may not be required by a vision care organization as a condition of contracting with a medical plan.
Georgia Perseveres Against Vision Plan Discounts
Georgia’s new law, S.B. 27, passed in May and closes a key loophole in its state law—VSP continued to require discounts on non-covered services in order to be part of its Premier Edge program, despite a bill passed in 2021, Dr. Gamble says. The GOA appealed to the Office of the Insurance and Safety Fire Commissioner, “but got no satisfaction,” according to the AOA.
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“We already had a law in place here,” Dr. Gamble says. “The ink was barely dry on the document and it was out of compliance with the spirit of the law. That did not sit well with us because our goal was to make it uniform across the board. The goal was not to force discounts on the eyecare provider.”
When all else failed—talks with the vision plan and then an appeal to the insurance commissioner—the GOA decided to draft new and clarifying language and take it to the legislature, and in May the bill was signed by Gov. Brian Kemp. And last week, the GOA got further confirmation that indeed VSP would comply with the law this time and would notify doctors of optometry in the state that it would no longer require doctors to offer discounts on non-covered services under its Premier Edge program.
Doctors of optometry participating in the Premier program can opt out of the discounts on non-covered services and continue to be in the program. A summary of the bill says vision plans are now prohibited “from requiring an ophthalmologist or optometrist to extend any discounts on services that are not covered eyecare services in order to receive increased payments, better reimbursements, preferential treatment.”