Eyemed on the Offense

[Quince]

Eyemed is taking independents and shaking 'em up.

I work for small business owner who has three retails and a lab- not doctor owned. Long ago, we got grandfathered in as a lab though we are not Essilux owned.

Now, as it turns out, we are being targeted big time. They have flagged us and apparently there is someone watching what we submit very closely.

The original discrepancy was that some add-on, scratch coat I believe, was charged for one patient and not another when they had purchased the same product. Personally, I think it's ridiculous that they should have a say in when we do or do not charge for such things- but hey, that's not what this is about.

A co-worker just submitted an Eyemed claim for a Hoya lens with Clearmax XC coating, which is not listed on any tier. 10 minutes later, we received a call that we had submitted wrong and that that was a tier 3 AR. Not true. The Eyemed representative was corrected and did admit fault and apologized after finding that in fact Clearmax XC is not listed and therefore is a set 20% off.

The point is- they are watching closer than ever.

[LENNY]

Old news...

[Kwill212]

These threads will always go back to the same question. Why are you letting an outside company dictate what you can and can not provide for you patients? How independent can you be if you are dependent on Eyemed?

[Quince]

These threads will always go back to the same question. Why are you letting an outside company dictate what you can and can not provide for you patients? How independent can you be if you are dependent on Eyemed?

They have nothing to do with what we provide, only how much we get paid for it. Not the ideal situation, but Eyemed patients make up 50% of our clientele. That's a big loss for us if we were to drop them.

Obviously they have been trying to pull everyone's strings for years, but I guess I figured other people might have run into the recent up in scrutiny

[Uilleann]

They only pull strings because docs keep buying into the silly group-think they're low hanging fruit.

Then comes the bear trap on the tenders...

...and some (thankfully) realize they ["insurance" companies] aren't their "partner" after all.

[kittyeyes]

Drop Eyemed and give your patients the out-of-network reimbursement option. You'll be able to enjoy your practice and if you've been open for as long as it sounds-the patients who like and trust you will stay your patients, they will realize that Eyemed only funds Lenscrafters, and they will be happy with their reimbursement while supporting you, the independent. You will give them more choice of quality materials, you will make them a better product and their purchase will "Make America Great Again" (if they are a Drumpf supporter)

[AngeHamm]

Let's please remember that the overwhelming majority of users on this board are not business owners and have no say over what insurances our office takes. The "Just drop EyeMed/VSP/Davis/Luxottica/Essilor" comments are just not very useful for most of us, and the noise they provide obscures the fact that we really just need answers to the question at hand.

[Uilleann]

It's not noise. Its a discussion that should be had in every office. Claiming otherwise only lends credence to the idea that survival is *only* possible under the jack boot of managed care. And that's just not true for EyeMed, or anyone else.

[AngeHamm]

It's not noise. Its a discussion that should be had in every office. Claiming otherwise only lends credence to the idea that survival is *only* possible under the jack boot of managed care. And that's just not true for EyeMed, or anyone else.

We've had the discussion in every office I've ever worked in. The answer has always been "We are keeping EyeMed."

When the question is "How do I deal with Difficulty X in EyeMed?" and 9 out of 10 answers are "Just drop EyeMed," it's noise by any definition. It isn't an answer to the question, and it isn't productive. Feel free to start a "Reasons to drop managed care" thread where you can discuss dropping EyeMed, if you like. I'll read it and contribute. I just respectfully ask that we should stick to actually answering the question being posed.

[Kwill212]

But there wasn't a question asked. It was just a statement complaining that they didn't like the way Eyemed was operating. The logical response is to drop Eyemed. Or at least complain to the decision maker of the office and not people who in no way can help.

But I think a question that could be asked of OP is what kind of scratch coat are you charging for and why? If the patient turns down the "scratch coat" what do they get instead?

[Quince]

I'll give you the breakdown of the original post:

50% warning
30% inquiry
20% venting

There was an unwritten question of 'Is anyone else noticing a recent increase in scrutiny?'

AngeHamm is correct that I do not control what insurances we take. If so, I would drop Eyemed. Then this business would fail. Eyemed happens to do a lot of free advertising by listing our office on their website. It's not a perfect relationship, but there is a benefit to putting up with flaming hoops.

The scratch coat issue is about when we are allowed to charge for it even though we do not offer uncoated lenses. This example comes from the fact that we cannot charge for SRC on finished poly (poly is not available UC), but we can on finished CR39. Too many people not on the same page is what got us flagged. The bottom line is consistency.

[LENNY]

The scratch coat issue is about when we are allowed to charge for it even though we do not offer uncoated lenses. This example comes from the fact that we cannot charge for SRC on finished poly (poly is not available UC), but we can on finished CR39. Too many people not on the same page is what got us flagged. The bottom line is consistency.

Essilor Labs charge for TD2 applied to poly lenses!
So why cant we charge?

[Quince]

Essilor Labs charge for TD2 applied to poly lenses!
So why cant we charge?

I totally agree. Doesn't do much good, but I agree.

[DanLiv]

Eyemed happens to do a lot of free advertising by listing our office on their website. It's not a perfect relationship, but there is a benefit to putting up with flaming hoops.

Not free advertising, the reduced profitability is the cost of the advertising. Insurance can be frustrating, but I think of it as a one-stop source for advertising. Instead of figuring out a unique marketing plan, hiring consultants, shopping for and purchasing various different types of marketing, and continuously maintaining the program, all one needs to do is get on panel, sit back and let them push the patients into the office. Rather than pay out my profits to advertisers, I simply take in less profit from the supplied insured patients. Certainly good idea to do BOTH, but one can sustain a comfortably profitable practice on primarily insurance patients.

The scratch coat issue is about when we are allowed to charge for it even though we do not offer uncoated lenses. This example comes from the fact that we cannot charge for SRC on finished poly (poly is not available UC), but we can on finished CR39. Too many people not on the same page is what got us flagged. The bottom line is consistency.

Yes you cannot charge for factory SRC on poly because all poly includes some applied SRC, it's part of the process for producing poly lenses and is built into the lab and chargeback pricing for poly. You can get raw uncoated CR-39 or factory SRC CR-39, so for that it is optional.

How are you billing? Though eyemeds portal you aren't even allowed to make that mistake, opting for poly eliminates the factory SRC selection.

Essilor Labs charge for TD2 applied to poly lenses! So why cant we charge?

You can charge for TD2, it's premium SRC. The OP's issue arises with factory SRC only.

[Quince]

How are you billing? Though eyemeds portal you aren't even allowed to make that mistake, opting for poly eliminates the factory SRC selection.

Huh... our system does not stop us. We order through the portal online. I know they are in process of switching to a new- and more irritating- model. Only specific plans come up in the new format though.

[LENNY]

You can charge for TD2, it's premium SRC. The OP's issue arises with factory SRC only.

And how you or eyemed qualifies that TD2 is premium coating? Its probably also available from Essilor as stock version!

[DanLiv]

And how you or eyemed qualifies that TD2 is premium coating? Its probably also available from Essilor as stock version!

Possibly, I'm not aware if they do. However if they did one would still price it out separately because Eyemed has deigned it premium SRC. It's listed as such in their catalog of lens options and fees, which is agreed upon by the provider contract. One does the same for a finished AR lens, price out the AR separately for billing purposes.

It's all the old-fashioned practice of lens+option+option+option, but it's the way it's been done and the insurers aren't interested in overhauling it unless it works more in their favor.

[Quince]

Has anybody heard of Eyemed having a three strike rule? This is a rumor I'm trying to flesh out. If it is real does anyone know if it is over all time or per year?

[ak47]

we don't deal with eye"med" any more, but i am familar with their three opinion rule. if anything tricky comes up and you need to call cust "service," they will inevitably give you answer (really just an opinion that they pulled out of you know where) that makes no sense. when you call them back and ask someone else, you will get a second opinion. the third opinion comes when they don't pay your claim because opinions 1 and 2 were both totally invalid. i miss that like a hole in my head