Eyemed Changes

[Fezz]

I am sitting here trying to read the 40 some page new contract and my eyes are glazing over and I am nodding off!

What are the main changes? I know that we have to process the jobs through an Essilor Lab (no thank you) or Walman (Ok-already use them).

My Walman lab rep explained to me that Eyemed is basically going to be like VSP. Like VSP, we will not be "billed" by the lab..they will bill Eyemed. Is that correct?

Any other changes that I am missing or not understanding through all of the legal speak and mumbo jumbo?



It may be time for a career change!

[Uilleann]

It may be time for a career change!

I think you got it - more or less like VSP (though they're taking their sweet time rolling it out back here.) But you are correct in that there shouldn't be a lab bill. There are also not likely to be profits of any discernible form either...but then what's new if you already take insurance right? LOL

[Judy Canty]

Wait 'til you get the 164 page Provider Manual.

[Fezz]

I can barely wait!

It is like reading hieroglyphics!!!!


Oh the joy!

[Judy Canty]

I'm telling you guys, run like the wind.

[fjpod]

I'm telling you guys, run like the wind.

The only problem is...consumers like to have "insurance" And when they have "it" they want to use "it" Even if it means leaving their longtime provider and going to a par provider only to spend several hundred dollars on extras there. My practice serves an area where virtually everybody has insurance. BTW, is anybody else having trouble using the return key when typing responses? I can't make paragraphs.

[Judy Canty]

BTW, is anybody else having trouble using the return key when typing responses? I can't make paragraphs.

Yup. Been that way for a while.

[optical24/7]

. BTW, is anybody else having trouble using the return key when typing responses? I can't make paragraphs.

Return key doesn't work here with explorer, but does with Firefox.

[Jacqui]

Works on this computer, Firefox with Ubuntu

[Jacqui]

It may be time for a career change!

Have you ever considered starting a brewery??

[sharpstick777]

Providers will have to soon choose whether they want to be:

1. A low paying, high-stress, 4-5 exams an hour, minimal service, minimal pay practice that takes managed care insurance... and then that insurance company determines which frames and lenses you offer.
2. A high end, 2 exams per hour, high service practice that is primarily referral, cash and medical based... and you can determine the lenses and frames you offer.

The only way to be the latter, is to simply stop taking managed care vision insurance.

Practice I was in a few days ago: "I was scared to drop VSP, but now, its the best thing we have ever done in 10 years of business. We see less patients but make more money"

[Happylady]

I was discussing this subject with an Essilor employee who is in charge of Eyemed for her lab. Of course she tried to convince us that this is a big improvement and we are going to make much more money. Finally, she did admit that like VSP, to really make the money you have to up sell on the frames and the lenses.

[Uilleann]

I was discussing this subject with an Essilor employee who is in charge of Eyemed for her lab. Of course she tried to convince us that this is a big improvement and we are going to make much more money. Finally, she did admit that like VSP, to really make the money you have to up sell on the frames and the lenses.

In reality, this is no different whatsoever from a practice that doesn't deal in managed care either. However, with the exclusion of the fat cats fifth summer home mortgage payment, the office NOT opting in to vision "insurance" will be able to cut costs and at the same time increase their black ink.

I think the term "managed care" is possibly the best description really. They manage to frighten oh so many into literally throwing money at them - all for doing absolutely nothing. Without insurance, eye exams still have to be given, and materials still must be created and dispensed. But, we American's love our bloated, over-complex, expensive, and inefficient systems like NONE OTHER! :)

[agr8194]

I was discussing this subject with an Essilor employee who is in charge of Eyemed for her lab. Of course she tried to convince us that this is a big improvement and we are going to make much more money. Finally, she did admit that like VSP, to really make the money you have to up sell on the frames and the lenses.

It may be be a little difficult to upsell your frames when the new EyeMed plan is going to require you to display 100 frames at $130 or less, which by the way will be covered by their insurance. Good luck getting them away from a "Free" frame.

[agr8194]

I am sitting here trying to read the 40 some page new contract and my eyes are glazing over and I am nodding off!

What are the main changes? I know that we have to process the jobs through an Essilor Lab (no thank you) or Walman (Ok-already use them).

My Walman lab rep explained to me that Eyemed is basically going to be like VSP. Like VSP, we will not be "billed" by the lab..they will bill Eyemed. Is that correct?

Any other changes that I am missing or not understanding through all of the legal speak and mumbo jumbo?



It may be time for a career change!

Fezz, You'll get to deal with chargebacks and everything. The lab will have a fixed cost for each lens style and your reimbursement will depend on the patient's plan.

Aren't you excited?!

[Fezz]

It may be be a little difficult to upsell your frames when the new EyeMed plan is going to require you to display 100 frames at $130 or less, which by the way will be covered by their insurance. Good luck getting them away from a "Free" frame.

I did not see that in the contract. Point me in the right direction to verify please?

[jewelzrulez]

Our "covered" frames are not on the floor with our brand name frames..instead, they are in special display trays in drawers for private viewing upon request so they can feel oh so special. They also may consist of mostly undesirables that only add value to our upgraded options :) I have noticed that frame requirement in that contract a long time ago...I'm not so sure that its new.

[scriptfiller]

With the passage of the Affordable Care Act, everybody will be mandated to have insurance or pay the fine. We will have to see as an industry how this will affect us next year when, for the individual, the ACA goes into effect. Then in 15' the other shoe will drop when employers are mandated.

We are going to have to adapt to the fact that our industry will be taken over completely in the next decade by insurance/managed care.

[Judy Canty]

Health insurance does not necessarily mean vision insurance. We shall see.

[Steve Machol]

With the passage of the Affordable Care Act, everybody will be mandated to have insurance or pay the fine. We will have to see as an industry how this will affect us next year when, for the individual, the ACA goes into effect. Then in 15' the other shoe will drop when employers are mandated.

We are going to have to adapt to the fact that our industry will be taken over completely in the next decade by insurance/managed care.

Actually according to the Vision Council:

What happened to vision care?

• There will be more Americans receiving vision care because of healthcare reform. However, there is no mandate for individuals to have vision coverage.
• Pediatric vision care will include individuals up to the age of 22 as a result of the extension of the Well-Baby Program, which includes vision care.
• By 2014 every state must have a health care insurance exchange up and running. Exchanges will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future.
• Insurance plans sold to individuals and to employers through the exchanges must include a core package of items and services known as "essential health benefits." The benefits are required to cover 10 categories: Ambulatory patient services, Emergency services, Hospitalization, Maternity and newborn care, Mental health and substance use disorder services, including behavioral health treatment, Prescription drugs, Rehabilitative and habilitative services and devices, Laboratory services, Preventive and wellness services and chronic disease management, and Pediatric services, including oral and vision care.
• Vision plans were not included as plans that could participate in the exchanges as standalone plans; however each state has the discretion to add them as standalone plans if they wish.

[drk]

Speculation, but I doubt that the vision benefits will expand. Just too expensive.

In those states that do include materials in their mandated benefits, I would think the pressure from consumers would be to keep costs down. That means less likelihood of "mission creep".

Face it: vision plans are a rip-off for the most part. Why pay for it?

[sharpstick777]

Insurance that drains your time, lowers your service level, and causes you to sell mediocre frames is hurting your practice in enormous, but subtle ways, such as fewer referrals, and loss of the 59% of patients who pay cash for their materials, and demand quality and service.

The only problem is...consumers like to have "insurance" And when they have "it" they want to use "it" Even if it means leaving their longtime provider and going to a par provider only to spend several hundred dollars on extras there. My practice serves an area where virtually everybody has insurance. BTW, is anybody else having trouble using the return key when typing responses? I can't make paragraphs.

[sharpstick777]

I believe the next few years will be rough, as VSP and Eyemed struggle to adjust and create turbulence. VSP lost 1 million members last year! Why do you think they are diversifying into Labs and Lenses? They predicted it. More medical plans will provide Exam coverage, but it will be simple coverage, with no or little materials benefit. VSP only existed because Medical Insurers wouldn't put OD's on their panels, now that they have their is no reason for VSP in the market really. The coverage will be simpler in the future, and a simple dollar off amount, say $150. In about 5 years the market will shift in our favor. One big help of Healthcare reform is that Insurance providers MUST return 80% of premiums in the form of Provider reimbursements, that will hurt VSP immensely. They probably return 20% now, since the patient is really buying everything.

With the passage of the Affordable Care Act, everybody will be mandated to have insurance or pay the fine. We will have to see as an industry how this will affect us next year when, for the individual, the ACA goes into effect. Then in 15' the other shoe will drop when employers are mandated.

We are going to have to adapt to the fact that our industry will be taken over completely in the next decade by insurance/managed care.

[Uncle Fester]

My guess is that states vision benefits will look like Massachusetts'.

Income based very basic glasses provided to the poor.

What we're finding is a bigger pool of new patients who often not only get a covered pair from a limited collection but another more stylish pair.

Those earning more than I believe poverty income plus 30% are simply not eligible.

As you choose a plan you can choose one that has a vision benefit (it's not insurance) but you'll find you pay extra for it so it's the patients choice.

I still see where more and more businesses affected by the ACA are going to realize that Medicare for All using this model would eliminate the big insurances altogether which is why they are so strongly opposed to the ACA. My congressman and senator may embrace it for my vote however.

I'm progressive and would rather be a slave to Big Brother who I have at least some small influence over than Big Insurance who's profit appetite can never be sated and who could care less about the small business I work for.

I know this is anathema to conservatives but we'll see over the next few years how this extremely complicated work in progress pans out.

[Johns]

Speculation, but I doubt that the vision benefits will expand. Just too expensive.

In those states that do include materials in their mandated benefits, I would think the pressure from consumers would be to keep costs down. That means less likelihood of "mission creep".

Face it: vision plans are a rip-off for the most part. Why pay for it?

Are you aware that Caresource just expanded benefits to their "members" ? Keep in mind that this is a medicaid plan. Members are now allowed, at no charge, to upgrade to progressives AND Transitions. Not bad, huh? Again, this is a medicaid plan, paid for by the state of Ohio.

No pressure from these "consumers". Keep the benefits rolling in!