Wisconsin Medicaid paying for contacts.

[TEC]

Just wanted to vent this cause it is making me crazy. I hope some of you have the same view as I.
So I recently recieved a letter from Opticare/Managed Health Service HMO Badgercare that states my new contract additions are as follow:
Effective 11/01/2012 contact lenses and contact lens fittings will be covered for all patient with Opticare HMO Badgercare.
We will allow $80.00 for contacts/Reimbursement of $64.00
We will allow $100.00/Reimbusement of $60.00 for frames outside the usual selection.
We will allow $35.00 contact fitting regardless of type of lens.
As a provider I have a few issues with this:
1) As you all know, contact lenses have a very small margin so on many of my contacts, I would lose money.
2) If you only cover $80.00 for contacts who is going to pay for the rest of the years supply? Badgercare has many low income participants, so they probably wont be shelling out more money for cls that year. Doesn't this promote bad contact lens habits/over wear of most contacts?
3) Why would I give a 40% discount on eyeglass frames. I don't need the sale THAT bad. Plus exam fees and lens payments are already reduced.
4)If you fit a Bifocal contact, you would get paid the same as a sphere. I am not willing to cut my fitting fees by over 50%.
As a Tax Payer:
I have insurance that I pay about $800.00 a month for me and my family. It does not cover contacts, eyeglasses or contact lens fitting. Not even the eye exam. So why do I have to use my tax dollars to supply contacts to a person when they already get glasses for free?
The state of wisconsin is almost bankrupt already, should we realy give away more?
Just FYI In wisconsin the state will also pay for your cell phone and cable tv if you qualify!
Do any other states allow contacts on the state funded program?
I will interested in hearing your opinions and thanks for letting me vent.

[becc971]

this is what happens when big wigs make the decisions without consulting anyone in the industry. contact lenses are NOT a necessity, they're cosmetic. unless they're RGP's. they could be using that money to help people who are in need of food fuel and everything else and instead they're allowing garbage reimbursement for contacts. i hope they don't do that here! i'd just quit! thats obnoxious!!!

[kentmitchell1961]

If you take medicaid do you have to do CL's also? If so, then dump medicaid. As more and more places stop taking it, maybe they will get the point and recind the sillyness..

[Mr. Finney]

TEC, I agree completely. I'll also point at that for the privelege of being an Eyemed provider, we get to give pretty much every Eyemed patient 40% off their frame, in addition to enjoying a $40 reimbursement for a comprehensive eye exam with dilation and refraction. Gotta love insurance!

[TEC]

If you take medicaid do you have to do CL's also? If so, then dump medicaid. As more and more places stop taking it, maybe they will get the point and recind the sillyness..

I can opt out of the contact portion which I may do. As for not taking badgercare, I would not have any business if I stopped badgercare all together since Wisconsin has given it out to most uninsured and poverty level people. About 70% of my patients are now on badgercare which may put me out of business anyway!

[jmainwar]

We have perfected the art of letter writing and are receiving approvals for most of the medically necessary contacts we do, but what you say is just bad, bad, bad. I remember when we lived in Massachusetts they were giving out cars with AAA to some and that went over like a lead balloon. I would suggest that you only fit dallies if you are forced to do fittings, this just reeks of non-compliance. Otherwise brush up on the coding and billing for all of the corneal ulcers and other fun that accompanies irresponsible contact use.

[OHPNTZ]

Fit spheres only. I agree with non-compliance and also hygeine issues...sounds like alot of headaches and keratitis/ulcers to me. The state assistance pts who pay for CL in NY are the absolute worst.