Time to Fight Back Against 3rd Party Plans

[CraigS]

I see many message/threads containing complaints about third party plans. Now there is an organization dedicated to defending eye care professionals from the predatory and anti-competitive, anti-consumer practices of these plans. These plans are now regulating our profession. Setting our fees, telling us what products we can use, what labs we can use, what discounts we can, and can NOT, offer. AADO is about restoring normal competition by challenging these onerous rules and contracts, and allowing us to do what we do so that consumers -- all of them, not just those with Plan X -- get the best care and best products for the best price.

I'm not going to outline or repeat here the Mission of the AADO. Please visit http://www.theaado.org, read about it, and consider joining. Until and unless eye care providers start pushing back, you have no reason to expect anything but more of the same. AADO is already working hard to stop the momentum of the plans. More information will be coming soon. In the meantime, AADO needs members to support its activities.

Craig Steinberg, O.D., Esq.
Executive Director, the AADO
admin@theaado.org
http://www.theaado.org

[opticianjoe]

I have sent you a pm

[Uilleann]

Not to disparage this new group - whoever they are - but I find this extremely ironic.

The very doctors that caved in to the imaginary FEAR created by the "insurance" companies for the sole purpose of lining their (the 'insurance company's) pockets with cash are now forming a support group to help them deal with said FEAR.

The answer is so simple, and it just escapes them every time: STOP TAKING FAKE "INSURANCE". When EVERYONE stops supporting optical "insurance", these plans cease to exist. Have you ever stopped to wonder why all the shops who refuse to accept to deal in this hogwashery do very well for themselves?

STARVE THE TRUE BEAST.

[CraigS]

Not to disparage this new group - whoever they are - but I find this extremely ironic.

The very doctors that caved in to the imaginary FEAR created by the "insurance" companies for the sole purpose of lining their (the 'insurance company's) pockets with cash are now forming a support group to help them deal with said FEAR.

The answer is so simple, and it just escapes them every time: STOP TAKING FAKE "INSURANCE". When EVERYONE stops supporting optical "insurance", these plans cease to exist. Have you ever stopped to wonder why all the shops who refuse to accept to deal in this hogwashery do very well for themselves?

STARVE THE TRUE BEAST.

Fair enough. However, it's not realistic. Many offices currently derive 40% or more of their revenue from these plans. In California 20% of the population is covered by VSP alone! When you're talking about materials only, it is more product/consumer driven. But when you add in professional services, MANY patients will go only where they have coverage. Period. If your office happens to be located adjacent to a large employer that signed on with a VCP, chances are very good that your office is dependent on that VCP, like it or not.

Moreover, under the ACA, the number of insured individuals will increase, and more offices will become more dependent on 3rd party payers.

So, you are right. In a bubble you're dead on. But in the real world of professional services, not so much.

Craig

[Uilleann]

Fair enough. However, it's not realistic. Many offices currently derive 40% or more of their revenue from these plans. In California 20% of the population is covered by VSP alone! When you're talking about materials only, it is more product/consumer driven. But when you add in professional services, MANY patients will go only where they have coverage. Period. If your office happens to be located adjacent to a large employer that signed on with a VCP, chances are very good that your office is dependent on that VCP, like it or not.

Moreover, under the ACA, the number of insured individuals will increase, and more offices will become more dependent on 3rd party payers.

So, you are right. In a bubble you're dead on. But in the real world of professional services, not so much.

Craig

I disagree - but I do understand and appreciate the point your making.

However, the singular fact remains: the only reason there are currently only localized bubbles, and that these insane vision plans are allowed to flourish coast to coast in any way shape or form is the oh-so-perfectly marketed FEAR that these companies create, and then prey upon. It would simply taking the docs across the country to put their big girl panties on, and do like dentistry did - thumb their collective nose at these "insurance" plans. Starve them, and it doesn't matter WHO'S employer offers this "perk" - solidarity is required yes, and that is something extremely difficult nationwide due to ingrained FEAR in the thinking of ODs.

Perhaps someday, they may wake the **** up. But I agree with you in as much as I doubt it.

[EyeCare Rich]

To quote you Craig, (and I am happy to see someone speaking up), "MANY patients will go only where they have coverage. Period." If Uilleann's concept worked, there would not be a place for these patients to go, making them utilize out of network care, and undermining the power and fear created by these companies you are trying to go after. As long as there are OD's taking the insurance out there, they will continue to do what they do best. Well said Uilleann!!!!!

[opticianjoe]

[QUOTE=Uilleann;473158]Not to disparage this new group - whoever they are - but I find this extremely ironic.

The very doctors that caved in to the imaginary FEAR created by the "insurance" companies for the sole purpose of lining their (the 'insurance company's) pockets with cash are now forming a support group to help them deal with said FEAR.

The answer is so simple, and it just escapes them every time: STOP TAKING FAKE "INSURANCE". When EVERYONE stops supporting optical "insurance", these plans cease to exist. Have you ever stopped to wonder why all the shops who refuse to accept to deal in this hogwashery do very well for themselves?

STARVE THE TRUE BEAST.[/QUOTE

What is a "fake insurance"? Stop complaining about mistakes made 15 years ago, the issue at hand is to combat what Eyemed and Vsp are trying to do to us in the future.

[opticianjoe]

Does the new Eyemed policy violate any anti- trust or HIPPA laws?

[Barry Santini]

If I'm a good/fine restaurant, and a major employer near me partners with McDs, should I be worried no one will come to me with their food voucher?

No? Why? Ask yourselves what is different? Ah - it's that we're commodities, right?

Well then, there's your answer: start today NOT being a commodity!

B

[becc971]

Not to disparage this new group - whoever they are - but I find this extremely ironic.

The very doctors that caved in to the imaginary FEAR created by the "insurance" companies for the sole purpose of lining their (the 'insurance company's) pockets with cash are now forming a support group to help them deal with said FEAR.

The answer is so simple, and it just escapes them every time: STOP TAKING FAKE "INSURANCE". When EVERYONE stops supporting optical "insurance", these plans cease to exist. Have you ever stopped to wonder why all the shops who refuse to accept to deal in this hogwashery do very well for themselves?

STARVE THE TRUE BEAST.

Just a thought, but this group could be a stepping stone to everyone being able to present a united front instead of all of us just crabbing about the insurance. And maybe the first step to stop taking the "fake insurance" ... so lets give it a chance eh? if our office refuses to take VSP, but the 6 around us still take it, you can bet most of our VSP patients will go where they take their insurance for the glasses at least, and probably about 50% will go for the exams as well. that would be a pretty huge hit to our business. so unless we all stopped taking it together we would be SOL.

[Diane]

If I'm a good/fine restaurant, and a major employer near me partners with McDs, should I be worried no one will come to me with their food voucher?

No? Why? Ask yourselves what is different? Ah - it's that we're commodities, right?

Well, ill, there's your answer: start today NOT being a commodity!

B

Well said.

I told a very good OD friend of mine many years ago, not to start and he would make better money. He said he was afraid not to accept insurance. He had a very successful practice before taking insurance. He was talked into it by all of the insurance companies. He died a couple of years ago, and was working harder than before for soooo much less money.

Diane

[optical24/7]

In survey after survey that we conduct and do on an on going basis the top reasons our client shop here are (in order);

* Customer service
* Knowledge
* Products
* Location
* Price

Notice price is last. They don't come here because of their insurance (we take none). And the argument that if you have a large patient base area that has insurance and you have to accept it, well that's simply not true. Barry's on Long Island. Lot's of folks have insurance there. I've got Shell, Conoco-Phillips world headquarters down the road. Halliburton up the road. A huge HP facility close by. All these employees have some kind of VCP. Yet we continue to grow at double digit percentages yearly, while the numerous OD shop that are all around me complain of little to stagnate growth.

There is life outside these VCP's. You have to learn how to attract clients with means other than being *on panel*.

[Uilleann]

Some providers and Doc get it - but the majority are too blinded by manufactured FEAR to get a grip, grow a pair, and jettison the dead weight of optical "insurance". That's the bottom line - simple and oh so black and white.

Guess which providers are happier, work much less for positive growth, provide better service, quality, turn times, and back end support...

Go ahead, guess...

[CraigS]

I disagree - but I do understand and appreciate the point your making.

However, the singular fact remains: the only reason there are currently only localized bubbles, and that these insane vision plans are allowed to flourish coast to coast in any way shape or form is the oh-so-perfectly marketed FEAR that these companies create, and then prey upon. It would simply taking the docs across the country to put their big girl panties on, and do like dentistry did - thumb their collective nose at these "insurance" plans. Starve them, and it doesn't matter WHO'S employer offers this "perk" - solidarity is required yes, and that is something extremely difficult nationwide due to ingrained FEAR in the thinking of ODs.

Perhaps someday, they may wake the **** up. But I agree with you in as much as I doubt it.

I'm not going to disagree with you. You're probably right. However, and it is a big however, it is illegal under anti-trust law for any TWO OR MORE to collectively agree to "boycott" an insurance plan. All it takes is TWO docs, over lunch, to agree to drop plan X and they have committed a felony! So, don't look for anyone to lead any collective action that might lead to a group boycott. Hopefully nobody is that dumb. Individual doctors, acting alone, can certainly decide to drop a plan for whatever reason. One of the things that keeps them from doing that is the FEAR that they'll be the only one, and the impact will just be that their patients will go to the doc down the street that did NOT drop the plan. It's the anti-trust conundrum!

[CraigS]

Just a thought, but this group could be a stepping stone to everyone being able to present a united front instead of all of us just crabbing about the insurance. And maybe the first step to stop taking the "fake insurance" ... so lets give it a chance eh? if our office refuses to take VSP, but the 6 around us still take it, you can bet most of our VSP patients will go where they take their insurance for the glasses at least, and probably about 50% will go for the exams as well. that would be a pretty huge hit to our business. so unless we all stopped taking it together we would be SOL.

EXACTLY! That's what AADO is all about. Nobody is even standing up to the plans, so it's no surprise they keep imposing more and more rules on us. AADO is going to try and create some headwinds. If nobody is willing to do anything, if YOU are not willing to support an organization that's going to TRY and do something, then you have no ***** and no right to complain.

Craig
http://www.theaado.org

[Uilleann]

I'm not going to disagree with you. You're probably right. However, and it is a big however, it is illegal under anti-trust law for any TWO OR MORE to collectively agree to "boycott" an insurance plan. All it takes is TWO docs, over lunch, to agree to drop plan X and they have committed a felony! So, don't look for anyone to lead any collective action that might lead to a group boycott. Hopefully nobody is that dumb. Individual doctors, acting alone, can certainly decide to drop a plan for whatever reason. One of the things that keeps them from doing that is the FEAR that they'll be the only one, and the impact will just be that their patients will go to the doc down the street that did NOT drop the plan. It's the anti-trust conundrum!

You raise an interesting point. Can you assist me in finding the particulars of the federal law that stipulates that an eye doctor is forced to take X,Y or Z optical "insurance"; and by refusing to do so that they are in direct federal violation of anti-trust statutes? This sounds highly suspicious, though I freely admit this is the first I have ever hear of such a stipulation for optical providers. I am interested in learning more about this interesting and alarming federal requirement to accept any/all vision "insurance".

[CraigS]

You raise an interesting point. Can you assist me in finding the particulars of the federal law stat stipulates that an eye doctor is forced to take X,Y or Z optical "insurance"; and by refusing to do so that they are in direct federal violation of anti-trust statutes? This sounds highly suspicious, though I freely admit this is the first I have ever hear of such a stipulation for optical providers. I am interested in learning more about this interesting and alarming federal requirement to accept any/all vision "insurance".

Perhaps I wasn't clear or something. No law requires anyone to TAKE any plan. What I said is that two or more doctors cannot agree to DROP or refuse to deal with a plan. Any INDIVIDUAL doctor can choose to drop a plan or refuse to join a plan.

But two or more cannot AGREE to collectively drop a plan or refuse to join a plan. The law is the Sherman Anti-Trust Act and its related laws, the Clayton Act, etc. This is old news. You can Google about what happened to the dentists in Arizona that tried that. (United States v. A. Lanoy Alston, DMD, P.C., et al., where the dentists were sent to jail for threatening a group boycott unless the dental plan raised copayments).

[MakeOptics]

Uillean,

Don't you get it, you can't fight a third party plan first party, you need a third party fighter. Everyone just drop the plan if you feel it doesn't work for your business or the profession. F#$% the law, it's just good business.

[Paul Smith LDO]

This is deja vu all over again. Can the AADO serve in some capacity as the little guys champion, probably not. The big boys have too deep a pocket and have most of the OD's scared. They have been employing strong-arm gorilla tactics reminiscent of the Chicago mob. If you don't want to be treated like a second rate citizen by some insurance company breathing down your neck, threatening your lively hood, then make a stand and separate yourself from these companies.

[Uilleann]

Uilleann,
Don't you get it, you can't fight a third party plan first party, you need a third party fighter. Everyone just drop the plan if you feel it doesn't work for your business or the profession. F#$% the law, it's just good business.

This was my point. And I will certainly have to look at the historical precedent of those horrible dentists "conspiring" against the poor hard done big in$urance co. The fact remains - there is no need to fight anything. There is no need to "organize" anything. Absolutely NO NEED for any new "group", "organization" or "faction". All providers need to do is figure out one, single, overly-simplistic concept:

Being screwed out of money sucks if you're in business. STOP DOING IT TO YOURSELF!

[Stan Tabor]

I am a little surprised at the response in this thread. Here we have an organization whose goals is aligned with the sentiments of the vast majority of posters on this board. If this organizations goal is to level the playing field by organizing ECPs in dealing with insurance companies, this is a good thing. If you think a winning strategy is trying to convince ECP to drop accepting vision insurance, I just do not see this as a plausible solution. ODs will just end up at the chains and independents will die out.

To get something done, the best solution is to organize and combine resources.

[jpways]

The problem is the law are written to the advantage of the insurance companies while neither side is allowed to collude to create a desired outcome there's are whole lot less pressure on their side to collude because they control more money. And the stated goals of these organizations makes it hard to be optimistic about their success especially in light of the AOA's lobbying inepptitude.

[opticianjoe]

I see many message/threads containing complaints about third party plans. Now there is an organization dedicated to defending eye care professionals from the predatory and anti-competitive, anti-consumer practices of these plans. These plans are now regulating our profession. Setting our fees, telling us what products we can use, what labs we can use, what discounts we can, and can NOT, offer. AADO is about restoring normal competition by challenging these onerous rules and contracts, and allowing us to do what we do so that consumers -- all of them, not just those with Plan X -- get the best care and best products for the best price.

I'm not going to outline or repeat here the Mission of the AADO. Please visit http://www.theaado.org, read about it, and consider joining. Until and unless eye care providers start pushing back, you have no reason to expect anything but more of the same. AADO is already working hard to stop the momentum of the plans. More information will be coming soon. In the meantime, AADO needs members to support its activities.

Craig Steinberg, O.D., Esq.
Executive Director, the AADO
admin@theaado.org
http://www.theaado.org

Craig, I see no mention of opticians in your group, are we allowed to participate?

[MakeOptics]

The problem is the law are written to the advantage of the insurance companies while neither side is allowed to collude to create a desired outcome there's are whole lot less pressure on their side to collude because they control more money. And the stated goals of these organizations makes it hard to be optimistic about their success especially in light of the AOA's lobbying inepptitude.

You are allowed to do anything you want to do this is America. Uillean gets it, just drop the plan. If you provide no other value then you take XYZ imsurance then stop moaning about what they pay you, obviously its too much if you got time to moan and groan here with extra dollars to join a group.

[Fezz]

Does this industry really need another group, organization, bunch of snakes taking dues and spending it at "CONventions", marketing, and lawyer/lobby handouts?

Isn't there enough groups, associations, fellowships, and organizations squandering away member dues already?