Insurance companies of all types are known for being rather difficult to work with, and vision insurance is no exception. The first thing to accept is that vision insurance plans are more like “vision contribution plans,” with the plan “contributing” toward the patient’s out-of-pocket eye care and eyewear costs.
However, it is also well known that independent eye care practitioners accept a lesser reimbursement for being on the panel with any insurance company. In-network reimbursement rates are typically about one-half to one-third for a patient with a vision plan than the revenue made from a private-pay patient. The result is that the office must see more vision plan patients per day in order to make the necessary revenue to run an effective business. This is an unfortunate situation for the vision plan patients who may unknowingly have their appointments rushed.
Often, when independent practices set up their pricing for exams and eye wear, they typically set their usual and customary fees knowing that they must inflate their private-pay amounts to offset the dramatically low reimbursement rates from being in-network with vision plans. Ultimately, this can result in an unfortunate situation for your private-pay patients.
The great news, though, is that both of these unfortunate situations can be remedied if independent practices were able to control their own narrative. Without the contractual amounts and mandates of vision plans, offices can make more per exam, which allows for more quality patient visits, because the quantities are not necessarily profitable. The other benefit is that independent offices do not have to charge as much for their eyewear when they are profitable on every pair sold rather than selling most eyewear for a fraction of its intended value. That’s a win for everyone.
The problem is that most offices are already so established with vision plans that they fear a life without them. But what if offices did not have to cut their involvement with the plans completely? Imagine: independent opticals beginning to align their offices to become less reliant on the plans themselves, while still utilizing the plans in a modified way for patients they have in their offices.
What Does “Open Access” Mean?
Open access is a term I learned a long time ago from the founders of Anagram, a service that allows practices to pull out-of-network benefits for patients. This allows the practice to service all patients no matter their vision plan and no matter the in- or out-of-network status of the provider.
The opportunities that are found when an optical begins to align itself with an open access mindset are quite liberating. Practices will begin to see hope in no longer being controlled by vision plans, freedom from plan mandates, freedom from the rules of what products are utilized, and most importantly, freedom from contractual reimbursements. When an office is able to migrate toward an open access model, they begin to see the benefits of controlling the lens choices and prices from the lab, while charging their usual and customary pricing, and still having the ability for the patient to utilize their vision plan with their adjusted contribution rates — AKA, out-of-network reimbursement.
How Do You Become Open Access?
This is where things need to be done properly, as communication with patients is critical. Here are some things to avoid, and some things I’ve found to be successful when beginning the process of becoming open access:
- Do not drop vision plans cold turkey. There is a process for success.
- Do not tell patients you are changing to out-of-network. Patients think out-of-network means they will no longer be able to see you.
- Do not implement any changes without the entire team being onboard with the plan
- Teach the appropriate verbiage to the team so they can communicate what “contribution” means to the patient.
- Rehearse all of the objections and questions the patient could have with your team so they are well prepared with the proper responses.
- Practice, practice, practice. Invest in numerous team meetings with a lot of brain food and a high morale.
- Start implementing your open access alignment with vision contribution plans you are already out-of-network with.
- If and when your office does decide to go deeper into your open-access status, you will want to start with the vision plans that have the least influence in your optical and work your way up to the most influential plans.
- Incorporate refined sales training, ongoing education, depth of understanding, and execution when communicating with patients.
Working Toward More Independence
One of the best parts about being an open access provider is that your practice can operate in whatever way you feel most comfortable. You get to choose your level of independence from vision plans.
If you are one to typically fear change or take change a little slower, the open access principles and training allow for you to slowly adapt your mentality to become less dependent on your in-network status. For those who are risk takers, adopting the open access mindset can be a pathway to what you may have been pondering for some time.
Kayla Ashlee is the co-founder of Spexy, an international optometric speaker, a certified optician, and an optometric renegade. Her direct and relatable approach to training has set her apart in the industry.