Coordination of Benefits: The Independent Advantage No One Talks About

A growing sentiment in independent optometry casts vision plans as the enemy, suggesting that dropping them is the only path to independence.

There’s a scene in “Inherit the Wind” where attorney Henry Drummond stands alone in the courtroom, weighing he Bible in one hand and Darwin’s “On the Origin of Species” in the other, acknowledging that there is truth to be found in both.

In independent optometry, we face a similar duality between rejecting vision plans in pursuit of full independence and choosing to integrate them as a strategic tool within a modern practice. Just as Henry Drummond stood recognized the truth in both, independent optometry doesn’t have to stand alone—true independence and participation in vision plans can coexist.

Listen, dropping vision plans can be successful under the right conditions—namely, a unique specialty or a high-demand market that drives patient volume without third-party referrals. However, going cash pay is not a universal solution. We have all seen practices ditch vision plans only to face immediate revenue gaps and, in extreme cases, bankruptcy. The narrative that dropping plans automatically equals independence is a dangerous oversimplification that ignores the financial realities of most modern practices.

OPTIMIZING THE PATIENT ENCOUNTER

Vision plans aren’t going away. If anything, they’re expanding. Employers continue to offer vision benefits to attract and retain employees, and patients with those benefits are far more likely to choose an in-network provider.

So the question isn’t whether vision plans should exist in your practice. It’s how you leverage them as a tool that enhances patient care and practice revenue.

Many independent practices consider vision plans a cost of patient acquisition. That narrow mindset leaves a massive opportunity for revenue optimization on the table.

In my opinion, optimizing each patient visit comes down to two underutilized strategies: revenue stacking and coordination of benefits (COB).

REVENUE STACKING

A patient’s budget for their eyes is relatively fixed. Say $500. Without a vision plan, that $500 comes entirely out of pocket. With a vision plan, those insurance dollars “stack” on top of the patient’s existing budget, significantly increasing the total revenue potential of the visit.

That’s revenue stacking.

The misconception is that vision plans replace patient spending. In reality, they supplement it. We see this clearly with contact lenses. When a patient combines plan benefits on top of manufacturer rebates, the perceived cost is lower, making annual supply more attainable. That’s a win for both patient loyalty and practice revenue.

But this isn’t just about revenue. True stacking goes beyond just hardware. Patients today don’t want to navigate the confusing line between vision and medical insurance—they just want their benefits to work. The practices that make this experience seamless are the ones that will win.

That’s where COB comes in.

COORDINATION OF BENEFITS

COB allows you to split the billing for a single visit: medical insurance covers the clinical health evaluation, while the vision plan covers the refraction and materials. When used as a secondary payer, the vision plan can even help cover the patient’s medical copay. When done correctly, it completely changes the economics of the exam.

Let’s take a very common scenario for example.

Without COB, a vision plan exam might reimburse $70 with a $10 copay. You’re at $80.

Now layer in a mild medical component like diabetes or allergies—something we already manage every day.

With COB, that same visit might allow $150 on the medical side, with insurance paying $110 and the patient being responsible for $40, while vision benefits are still used for materials. In some cases, the patient’s out-of-pocket can be minimal or even zero.

Now you are at roughly $150 instead of $80.

Same patient. Same doctor. Same chair time. Just a different way of running the play.

This is where independent practices have an edge, and we don’t talk about that enough. You have clinical autonomy. You can lean into medical care without being boxed into a rigid system. You can train your team to listen for medical symptoms first, moving away from the habit of categorizing every visit as routine by default. And because patients trust your expertise, they are receptive to the shift from routine to medical.

But this opportunity is also where things break down.

WINNING WITHIN THE SYSTEM

COB is not difficult, but it does require consistency. Technicians miss medical complaints, doctors fall back into routine habits and billing teams lack confidence. And ultimately, most practices lack a clear system for when to trigger the COB protocol.

That’s really the issue. It’s an execution problem, not a knowledge problem.

When you get it right, revenue per exam goes up. You get paid for the level of care you are providing, rely less on optical alone to balance the books and attract patients who value care, not just price.

Instead of asking, “Should I drop vision plans?” perhaps the better question is, “How do I maximize every patient encounter that comes through a vision plan?” Because those patients are already in your chair.

COB is how you turn a patient visit into something more meaningful, both clinically and financially.

Independent optometry doesn’t win by avoiding the system. It wins by understanding it and using it better. COB is one of the clearest examples of that. Most practices are sitting on it.

Patients benefit because the experience is simpler. Practices benefit because they’re paid appropriately. And yes, even the plans benefit when things are used the way they were intended.

There’s a line rooted in Proverbs that says, “He who troubles his own house shall inherit the wind.” If we spend all our time fighting the system instead of learning how to use it to our advantage, that’s exactly what happens.

This isn’t about choosing sides. It’s not independence versus insurance. It’s about mastering the intersection of both.

And the practices that do it well are the ones that are going to win.

Read more on managed care here.