As you are aware, the Affordable Care Act has stipulated that government-mandated plans for health insurers include a pediatric vision benefit.
According to recent reports, this is going to include materials benefits (glasses).
What are you going to do about it?
Abide by the law.
Can it possibly be worse them vsp? Which most people here are gladly accepting?
The Eye Med behemoth comeith-
Dental and Vision Benefits
Q6: What if my dental (or vision) benefits are structured as excepted benefits under HIPAA? Does that exemption except my dental (or vision) plan from the Affordable Care Act’s market reforms?
Yes. If benefits constitute excepted benefits under HIPAA, the requirements of the Affordable Care Act’s market reforms do not apply. Under HIPAA, dental (and vision) benefits generally constitute excepted benefits if they:
- Are offered under a separate policy, certificate, or contract of insurance; or
- Are not an integral part of the plan. For dental (or vision) benefits to be considered not an integral part of the plan (whether insured or self-insured), participants must have a right not to receive the coverage and, if they do elect to receive the coverage, must pay an additional premium.
Accordingly, if a plan provides its dental (or vision) benefits pursuant to a separate election by a participant and the plan charges even a nominal employee contribution towards the coverage, the dental (or vision) benefits would constitute excepted benefits, and the market reform provisions would not apply to that coverage.
Excepted or accepted?
It is poorly worded.Originally Posted by braheem24
I read it as exempt.
I don't read it as accept.
Yes? No?
Last edited by Uncle Fester; 03-18-2013 at 03:45 PM. Reason: deleted wrong reference...
Correct; it says "except", as in "exception", not "accept" as in "acceptance".
It's going to be way worse than VSP. Or EyeMed.
The way the insurers are instructed to flesh out the benefit is to choose from (or adopt, I forget) any of about five models that already exist in their marketplace. The one that has the most "lives covered" is the model for the benefit. (The feds don't want to reinvent the program wheel.)
In some states, the model will be the (apparently) dreaded "Federal VIP" program, which reimburses something like $20 for frame and about $17 for lenses (approximately...don't quote me on that). That's really low reimbursement.
I'm not sure if kiddos can buy up, but I'd suppose it could go either way: all or none, or upgrades allowed, etc.
I would think that pressure on congress would be enormous from all ECP and eyewear business fronts to allow buy up options otherwise it is unsustainable.
Unless Wally can live with that reimbursement.
I think cheap or no benefit would be better. That way, there's no encroachment into "non plan" eye wear. Encroachment is a biyatch.
I can also see it morphing into the Massachusetts model of exam and Mass Health glasses (limited collection the prison system making them) once a year for children every other year for adults.
No patient frame or buy up allowed.
This would allow independent opticals a chance.
Can it possibly be worse them vsp? Which most people here are gladly accepting?It's going to be way worse than VSP. Or EyeMed.
I have been looking into this for the past year and a half, but was waiting until the election to really study it. I am completely dumfounded at the apathy from the optometrists, as well as the opticians, concerning what is coming down the pike.
This past Friday, I was in a meeting with 2 industry executives, and we were standing on the 3rd floor, looking over the floor of the VEE. I commented on how, the more I learn about the mandate, the more frightening it becomes. The person that deals directly with third party plans said that there is a good chance, that if we stand in the exact same place, 3 years from now, you will see only 1/5th of the vendors that we see today. There will be absolutely NO market for MOST of the products displayed, save for the diagnostic equipment that will help a practitioner push more exams through. He agreed that we should all be VERY frightened.
Chances are VERY good that the mandate will mirror the medicaid plans of today. What will you need?
Opticians:
1. A box of frames
2. A PD stick
ODs
1. An exam lane and diagnostic equipment
2. A staff to handle a TON of volume, and handle the paperwork (forms) associated with it.
What you won't need:
1. Your marketing budget should be cut to almost nothing.
2. Your frame budget should be almost nill, unless you've carved out a niche of high end clients.
3. Most medicaid plans do NOT allow for upgrades, so save for a few back room tints, forget about upgrading.
It hasn't been announced HOW they will do it, but there is a chance that if VSP and other stand alone plans go down (as it is looking like they will), there will be an abundance of labs out there for the taking, which would allow for the government to produce the glasses as well.
Reimbursements? I've heard ODs saying that they expect to get close to the same reimbursements they are getting now. NOT A CHANCE. Putting the general population on the same plan will be a huge drain on the system, and the target number I've been hearing is close to $35 per exam. Medical exams? Good chance that will be MDs only, and the OD scope of practice will actually shrink.
Opticians? Again, if you've carved a niche, you'll be able to survive for a time, until the loophole is closed. Picture yourself dispensing 40 pairs a day to gross $600. Remember, you'll be competing with every other optician, as well as the ODs for the exact patients, seeking the exact care, and receiving (basically) the same (government provided) products (at the government approved prices).
I talked with a large vendor about what may happen, and his reply was, "I'm trying not to think about it." Well, from the looks of it, NOBODY is thinking about it!
Are you serious?? What kind of pressure is ANYONE putting on congress? Have you talked to your congress rep? Who do you think it going to put pressure on? VSP has been throwing TONS of money at the politicians, and ask them (VSP) how the fight is going. It's not looking good. Many ODs believe that that the government is better for them than VSP. I have always DESPISED VSP, but I would (and am) certainly backing them now. If they lose, we ALL lose.I would think that pressure on congress would be enormous from all ECP and eyewear business fronts to allow buy up options otherwise it is unsustainable.
Here's are 2 trivia questions for you:
1. How many times is optometry/optometrists mentioned in the Affordable Care Act?
A. 7 B. 13 C. 27 D. None of the above
2. How many times is opticianry/opticians mentioned in the same legislation?
A. 2 B. 11 C. 21 D. Non of the above
Answer to both: D Optometry is mentioned a grand total of 2 times.
Opticianry is NOT mentioned...not even once!
So...if the industry couldn't muster up enough pressure to even be represented in the bill, how much do you think they can accomplish once the law goes into effect? My guess is none.
Ophthalmic Optician, Society to Advance Opticianry
Could someone explain this concept in a simple nut shell so a foreigner from Canada might appreciate it ?
Johns, good post.
You're right about most of that. I think that it will take awhile for the pediatric benefit to "catch on". I've heard from the toques that many families now don't utilize the benefit. So there's that.
Secondly, there will always be the adult care. I don't see the system being able to afford any eyeglasses at all.
Thirdly, in socialist countries (as you allude) there will always be "the tier for the average schmuck" and the "tier for the rich/connected". You will see a re-emergence of boutique optical care. So many people will be willing to pay a premium to not wait in some crowded Department of Motor Vehicles-like or Emergency Department-like fiasco. Too many minivan mommies will turn their noses up at this box of "approved Altair frames" for their little precious. There's always that.
What will happen is that health insurers will be forced to provide this benefit, and they will turn to their vision insurance arms to provide the materials benefit (I wish there were none.) Aetna and Anthem are in bed with EyeMed. Cigna = VSP (but Cigna's not a huge player.) UHC has it's own Spectera. They are going to administer these crappy networks and super-minimal glasses plans. I'm virtually positive that anyone who wants in on it can get in on it.
The question is: do you want to have tons of kids in your office for (you are right) $35 eye exams, glasses that will break and need adjustment endlessly? You may get the parents. You may get the additional sale. You may get medical care (ODs won't get excluded; we work for cheap).
Here's hoping that the unintended result of this act in our industry is to wrest the control of eyeglass sales from the pre-paid plans and return the buying decisions to the customer, not his employer.
I am not so sure that there is not a provision for adults also. From the way I saw it, it was not only for pediatrics, but for the general population. Yes, the mini van moms may be choosey, but many will also not want to pass on their "benefit" if everyone is entitled.
Ophthalmic Optician, Society to Advance Opticianry
There's not. That's for certain.
Not for eyecare, or not for products?
Ophthalmic Optician, Society to Advance Opticianry
This sounds a lot like the 70's when Pearle opened in every city and then came Wal Mart and then along came internet and then...
Obamacare- THE END OF THE WORLD...
Yet Johns chance to be featured in a Michael Moore movie on how Wal-Mart destroys small business' gets left on the cutting room floor because he beats them at their own game!
Are there no ideas to work with this?
And wouldn't it make sense to try to lobby for single payer (Medicare for all) as a way to get private insurance out of the system? This may be something the Doc's don't/won't do but independent opticians should be embracing it with open arms. I think you're underestimating how few people would wear a stigmatizing pair of medicare/medicaid frames.
My teacher in the days of disco said that everyone will get one pair of glasses from Pearle then they'll come to you for all you'll have to offer.
Our business manager is no fan of the Affordable Care Act as he likens it to slavery. I say the way insurances are working now it's just a matter of who you want to whip you. And I say we have a better chance of influencing Uncle Sam than we do the limitless deep pockets of multinational corporations.
Last edited by Uncle Fester; 03-19-2013 at 09:05 AM. Reason: tweak...
Neither routine or materials.
Our business manager is no fan of the Affordable Care Act as he likens it to slavery. I say the way insurances are working now it's just a matter of who you want to whip you. And I say we have a better chance of influencing Uncle Sam than we do the limitless deep pockets of multinational corporations.[/QUOTE]
Once Uncle Sam controls so many aspects of our life, we will not be able to have any influence on our government, no matter who is in power. If we allow ourselves to become fully independent on federal government to decide what is best for us, we have given up everything this wonderful nation was founded on ,we become a nannny state, just as the city of New York is allowing itself to become. Where does it stop?
Birthing pains from a start up 20th (not a typing error) century concept of government provided health care for a first world economy.
For comparison how does Canada do it?
Any others from across the pond or Continentals?
I believe Canada and Germany to name 2 foreign countries with similar standards of living have a higher standard of health care than we do and aren't projecting 25% of GDP going to health care in the near future.
Last edited by Uncle Fester; 03-19-2013 at 09:00 AM. Reason: another thought...
It's a nanny state now. We can't even truly speak our own minds anymore. I am afraid I don't have the patients to read 7 feet of garbage so I'll never really be interested in obamacare.
Look out. These "Obama Glasses" for kids are going to be big loss-leaders. Expect advertisement galore on how you can get yours at ours.
...and here we go again with another let's bash Obamacare thread when we don't even know what the details of the coverage are going to be yet.
Can this thread be moved to the "bathroom" aka "Just Conversation" where it belongs?
That's the problem, it was passed without being read. We should have held our legislatures to the fire and had them read it before it was passed. If "we the people" had done that, we probably would not be having this discussion.
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