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Thread: VA HB 1444 passed through the State Senate!

  1. #26
    OptiBoard Professional Dirk's Avatar
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    I`m trying to understand the vision care system in the US from my Dutch point of view. In the Netherlands health insurance companies reimburse a fixed sum directly to the customer. The amount and frequency depends on the insurance plan. It almost never covers the cost exept for discount eyewear. Are there insurance companies in the U.S. that do the same?

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    Master OptiBoarder optical24/7's Avatar
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    Who needs eye insurance when you can get a free exam and 2 pair of glasses for 69 bucks?

    http://www.americasbest.com/schedule-eye-exam/

  3. #28
    What's up? drk's Avatar
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    Quote Originally Posted by Dirk View Post
    I`m trying to understand the vision care system in the US from my Dutch point of view. In the Netherlands health insurance companies reimburse a fixed sum directly to the customer. The amount and frequency depends on the insurance plan. It almost never covers the cost exept for discount eyewear. Are there insurance companies in the U.S. that do the same?
    Dirk...don't bother trying.

    P.S. Your Dutch system is a very nice idea.

    Truth be known, there is no "risk of loss" in vision care that you'd need "insured" for. VCPs over here are not insurance.

    What they are is a "pay to play" system: you (or your employer) pays upfront to access special discounts that "regular consumers" don't have access to. Or at least that was the original concept.

    Interestingly, the vision plans have done such a good job over the years selling the plans (mostly on behalf of private optometry at first, vs. optical stores or ophthalmology--which has been very beneficial to optometry, don't get me wrong) that now a sizeable proportion of U.S. workers have a vision plan. That means that I'd estimate about half or more of the people annually pay to have access to "special discounts".

    But with the vision care plans' constant need to 1. ridiculously enrich themselves, 2. keep themselves a "value proposition" in tough economic times, 3. keep ahead of the competition in a race to the bottom, 4. keep themselves perceived as relevant, all sorts of shenanigans have begun that make it increasingly undesirable to have them in the equation.

    It's not that they ever REALLY delivered a value, they just steered patients into private optometry offices for a somewhat hefty "marketing" price. Now, private optometry offices are suffering maybe/probably because our pimps are getting tougher on us. In fact, many ODs I know are only seeing the glass half-empty these days, and are dreaming about either getting out of the optical end and going all medical (pipe dream!) or going back to private transactions (a possible solution, albeit risky in many markets).
    Last edited by drk; 03-10-2015 at 04:54 PM.

  4. #29
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    Quote Originally Posted by drk View Post
    It's not that they ever REALLY delivered a value, they just steered patients into private optometry offices for a somewhat hefty "marketing" price. Now, private optometry offices are suffering maybe/probably because our pimps are getting tougher on us. In fact, many ODs I know are only seeing the glass half-full these days, and are dreaming about either getting out of the optical end and going all medical (pipe dream!) or going back to private transactions (a possible solution, albeit risky in many markets).
    So very true Doc! I remember back in the late 70's when this all started, mostly with the auto industry. The optician I worked for was always saying how much some were "whoring" out the industry. When you sell your soul, the devil wants payback.

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    Quote Originally Posted by drk View Post
    I think eventually it will become clear to the employers that their money isn't really going to a "vision plan", it's going to a retailer. At that point the jig is up.
    IMO they already realize that thus why they continue to subsidize their employees benefits so they save money at retailers. Again, let's no pretend VCP are causing prices to be what they are. Without VCP prices are still going to be high. You don't discount your non VCP private pay deals across the board when they come. To those that artificially "raise" their prices and try and blame it on the VCP, they are the ones at fault. If they can't afford or don't plan to honestly participate in the VCP's then they should just opt out and never sign up to be a service provider for them. There's a reason why they don't.
    Last edited by racethe1320; 03-11-2015 at 07:20 AM.

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    Quote Originally Posted by drk View Post
    Truth be known, there is no "risk of loss" in vision care that you'd need "insured" for. VCPs over here are not insurance.
    What they are is a "pay to play" system: you (or your employer) pays upfront to access special discounts that "regular consumers" don't have access to. Or at least that was the original concept.
    that's not entirely true. about 1/3 of the clients are self insured and rely on the VCP's to administer their claims. to the client, they don't have the resources to do this and the cost of doing so is the value. a portion of the remaining are paying into the program to cover the costs, but the VCP do carry some "risk" as not 100% of all the members benefits are covered. They do indeed roll the dice on utilization levels.

    Part of the reason many VCP have other business units such as labs and materials is to balance the costs incurred and profits redeemed during different periods of time. An example was back in the 2008-2009 US economy bust utilitzation was high and the managed care side of VCP's paid out a ton as utilization was high. Costs were incurred. However those with labs and materials also saw a higher utilization and were able to balance out the costs on the managed care side with higher revenues on the lab/materials side. Make sense?

    But with the vision care plans' constant need to 1. ridiculously enrich themselves, 2. keep themselves a "value proposition" in tough economic times, 3. keep ahead of the competition in a race to the bottom, 4. keep themselves perceived as relevant, all sorts of shenanigans have begun that make it increasingly undesirable to have them in the equation.
    1. VCP's just like any business have a right to enrich themselves. Gross profit is not a naughty word in a Capitalistic Society. They get the clients and are paid to administer claims. If you think paperwork at the ECP level is a pain.....2. the value proposition is gauged by the member/patient and during any time not just tough ones, a discount is what consumers are looking to get. Always "one low price" sales never work. Even Wal-Mart has specials, discounts and coupons. Saturn failed and GM tried one fixed price too. Again, not what consumers want to see. They aren't stupid. Frames and lenses are relatively cheap and today it's the service that retains the value. 3. not sure I understand your race to the bottom comment nor point 4.

    It's not that they ever REALLY delivered a value
    Really? discounts to member or the cost of administering claims isn't value? Again, be honest about retail pricing. ECP's have "raised" prices to account for "discounts" to consumers from VCP's because they are the unethical ones who shouldn't sign up to be panel providers if they aren't willing to accept what comes with that responsibility. Said discounts are the cost of getting patients into chairs. Please....keep it honest folks. Also, if there wasn't a real actual value to an employer, do you really think VCP's would still exist? Again, be honest or at least business smart.

    they just steered patients into private optometry offices for a somewhat hefty "marketing" price.
    that's the drill here. those patients are opting into discount programs because they are the ones seeing value in the savings being offered. The hefty price isn't so hefty when you look at it from a cost perspective. there's a reason why you DRK are still a panel provider right? You don't like managed care but the costs you would incur to "steer" patients to your chair without it would be exorbitant and you know it otherwise you'd have dropped from the panel just as some here have done.


    Now, private optometry offices are suffering maybe/probably because our pimps are getting tougher on us. In fact, many ODs I know are only seeing the glass half-empty these days, and are dreaming about either getting out of the optical end and going all medical (pipe dream!) or going back to private transactions (a possible solution, albeit risky in many markets).
    I agree that many do see it half-empty. In the end I don't care as IMO there are too many around already. VCP's don't need 35k+ service providers. Let those that don't get it or choose not to kill themselves off. More for the rest of us.
    Last edited by racethe1320; 03-11-2015 at 07:22 AM.

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    Quote Originally Posted by obxeyeguy View Post
    So very true Doc! I remember back in the late 70's when this all started, mostly with the auto industry. The optician I worked for was always saying how much some were "whoring" out the industry. When you sell your soul, the devil wants payback.
    True back in the 70's and 80's but if you choose to live in the past, the world today will surely have your lunch. Being successful today with VCP isn't difficult; it just requires people not live in the past and actually evolve to running a business in a different way. Great healthcare is still provided and great money is being had. The choices exist for all....
    Last edited by racethe1320; 03-11-2015 at 07:23 AM.

  8. #33
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    Quote Originally Posted by racethe1320 View Post
    True back in the 70's and 80's but if you choose to live in the past, the world today will surely have your lunch. Being successful today with VCP isn't difficult; it just requires people not live in the past and actually evolve to running a business in a different way. Great healthcare is still provided and great money is being had. The choices exist for all....
    Your right! I did evolve, as an independant optician office, I take no insurance at all. There are still some of us offering quality product and top service for a reasonable fee, and yes, making great money!

  9. #34
    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by racethe1320 View Post
    IMO they already realize that thus why they continue to subsidize their employees benefits so they save money at retailers. Again, let's no pretend VCP are causing prices to be what they are. Without VCP prices are still going to be high. You don't discount your non VCP private pay deals across the board when they come. To those that artificially "raise" their prices and try and blame it on the VCP, they are the ones at fault. If they can't afford or don't plan to honestly participate in the VCP's then they should just opt out and never sign up to be a service provider for them. There's a reason why they don't.
    VCP's have raised the costs to consumers. An ECP can't have reasonably low pricing AND accept a VCP because VCP's demand XX% off your U&C. Now, I know your response would be that those practices shouldn't join the panel of these VCP's. But that's not reality nor what happens. They ALL raise their U&C to make enough to survive taking the VCP. It happens daily across this country in virtually ALL panel offices, simply because you can't stay in practice giving your products/services away to VP members.

    Answer me this; you know I take no plans. Every single provider around me that accepts plans have U/C's nearly double what mine are. Why do you suppose that is?

  10. #35
    What's up? drk's Avatar
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    that's not entirely true. about 1/3 of the clients are self insured and rely on the VCP's to administer their claims. to the client, they don't have the resources to do this and the cost of doing so is the value. a portion of the remaining are paying into the program to cover the costs, but the VCP do carry some "risk" as not 100% of all the members benefits are covered. They do indeed roll the dice on utilization levels.
    So, you're talking about vision care plans (and health insurers) acting as "third party administrators" of self-funded vision benefits (or health benefits) for well-heeled companies that pay out of their own pockets for health benefits, not paying premiums and using insurers' dollars. That's an ancillary line of business that VCPs or health insurers take up. Whatever risk they undertake in that venture is not germane to a consumer, however. I'm talking about CONSUMER risk of loss, not BUSINESS risk of loss, though. My point stands that no American needs to "buy vision insurance or they may have some unaffordable vision expense".

    Now, your average schmoe doesn't understand any of this, and I'm not blaming the VCPs for promulgating this fallacy (entirely), but you have to have experienced how many numbskulls walk in off the street with their "eye insurance" vision care plan expecting that it takes care of their eyes. "What's your health insurance, Mrs. Biddle?" "VSP." "No, your HEALTH insurance." "I have eye insurance: VSP." <smacks forehead>. I'd pay for a vision care plan, too, every year, if I thought it would keep me from going blind.

  11. #36
    What's up? drk's Avatar
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    Part of the reason many VCP have other business units such as labs and materials is to balance the costs incurred and profits redeemed during different periods of time. An example was back in the 2008-2009 US economy bust utilitzation was high and the managed care side of VCP's paid out a ton as utilization was high. Costs were incurred. However those with labs and materials also saw a higher utilization and were able to balance out the costs on the managed care side with higher revenues on the lab/materials side. Make sense?
    No, it does not. Two words: billions of dollars in VSPs war chest.

  12. #37
    What's up? drk's Avatar
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    1. VCP's just like any business have a right to enrich themselves. Gross profit is not a naughty word in a Capitalistic Society. They get the clients and are paid to administer claims. If you think paperwork at the ECP level is a pain.....2. the value proposition is gauged by the member/patient and during any time not just tough ones, a discount is what consumers are looking to get. Always "one low price" sales never work. Even Wal-Mart has specials, discounts and coupons. Saturn failed and GM tried one fixed price too. Again, not what consumers want to see. They aren't stupid. Frames and lenses are relatively cheap and today it's the service that retains the value. 3. not sure I understand your race to the bottom comment nor point 4.
    1. WAR CHEST.
    2. When was the last time those profitable businesses have given us a freakin' increase in reimbursement? Like, never.
    3. I firmly believe that if EyeMed wasn't underselling VSP that VSP would be a better company to work with. Just my observation.

  13. #38
    What's up? drk's Avatar
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    Really? discounts to member or the cost of administering claims isn't value? Again, be honest about retail pricing. ECP's have "raised" prices to account for "discounts" to consumers from VCP's because they are the unethical ones who shouldn't sign up to be panel providers if they aren't willing to accept what comes with that responsibility. Said discounts are the cost of getting patients into chairs. Please....keep it honest folks. Also, if there wasn't a real actual value to an employer, do you really think VCP's would still exist? Again, be honest or at least business smart.
    In a macroeconomic sense, discounts are not really a big gainer for customers.

    Discounts are illusory. I went to Macy's and bought a tie from Calvin Klein that was originally $75 for $25. (Yes, it was a skinny one. What did you expect?) Was that tie ever "worth" $75? Is it "worth" $25? Who knows? It's what I want to pay.

    As to vision care, the best possible system would be a fair, straight, standard mark up or parts + labor set up. Then we wouldn't need claims. Then we wouldn't need calculators. Only silly consumers think discounts are real.
    Last edited by drk; 03-11-2015 at 11:43 AM.

  14. #39
    What's up? drk's Avatar
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    that's the drill here. those patients are opting into discount programs because they are the ones seeing value in the savings being offered. The hefty price isn't so hefty when you look at it from a cost perspective. there's a reason why you DRK are still a panel provider right? You don't like managed care but the costs you would incur to "steer" patients to your chair without it would be exorbitant and you know it otherwise you'd have dropped from the panel just as some here have done.
    Again, we've sold these patients the "need" for discounts.

    Yes, I will be a panel provider until they don't want me to be. I cannot serve my community very well without being a provider for the plans around here. People (or their employers) have paid their money to the vision care plans, and someone needs to help them get their investment back. It's mutually beneficial, because I need to pay the grocery bill.

    What's more, I kind of like being a lazy non-marketing slob. It's a very tangible marketing strategy, vs, say, radio or print ads. Also makes my life a lot easier. Costs a lot, though. (Kind of like when I "rent" a frame from one of the "Big Three" frame manufacturers.)

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    They can get their investment back OON, without you subsidizing the rental of their fishing "net"

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    Quote Originally Posted by obxeyeguy View Post
    Your right! I did evolve, as an independant optician office, I take no insurance at all. There are still some of us offering quality product and top service for a reasonable fee, and yes, making great money!
    Congrats and awesome! No you just have to amplify that success and expand :)


    Quote Originally Posted by optical24/7 View Post
    An ECP can't have reasonably low pricing AND accept a VCP because VCP's demand XX% off your U&C.
    Answer me this; you know I take no plans. Every single provider around me that accepts plans have U/C's nearly double what mine are. Why do you suppose that is?
    I trust you'll shed light on the why part. Anything I say would be but a guess.

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    Quote Originally Posted by drk View Post
    No, it does not. Two words: billions of dollars in VSPs war chest.
    I can't help you then if you seriously 1. doubt the model I explained above. 2. Seriously think VSP has Billion$ in the bank. Millions, no doubt, but Billions. Not likely. As an insurance co. they are required to keep substantial reserves also.

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    Quote Originally Posted by drk View Post
    1. WAR CHEST.
    2. When was the last time those profitable businesses have given us a freakin' increase in reimbursement? Like, never.
    3. I firmly believe that if EyeMed wasn't underselling VSP that VSP would be a better company to work with. Just my observation.
    1. Already covered.
    2. I've covered that before, but if you'd like, feel free to take to PM and I'll explain again to avoid enraging the VCP haters here. Although I'll cover again if so desired.
    3. I agree that EyeMed isn't helping the matter. Again, as it relates to #2, they can't raise fees and yes, part of it today is competition.

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    Quote Originally Posted by drk View Post
    In a macroeconomic sense, discounts are not really a big gainer for customers. Discounts are illusory. I went to Macy's and bought a tie from Calvin Klein that was originally $75 for $25. (Yes, it was a skinny one. What did you expect?) Was that tie ever "worth" $75? Is it "worth" $25? Who knows? It's what I want to pay.
    You're correct that the tie is valued at what you want to pay, but even at $25 is that a fair price? What if you brought 70M people to the store to buy the same tie? Do you think you might expect an even better price than the $25? I do. VCP discounts are there to pool the collective buying power of many to push down prices regardless of what the price is. That's the whole premise. Ironically it's what lots of "buying groups" in the industry try and tout. How many saps do you know pay to belong to VisionSource. LOL that's a joke.

    Only silly consumers think discounts are real.
    Again, see above. When you buy in bulk or go online and conduct "group buys" you get a very real discount.

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    DRK, wearing a skinny tie, old school Windsor knot or clip on.
    I didn't attend the funeral, but I sent a nice letter saying I approved of it. Mark Twain

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    Quote Originally Posted by drk View Post
    Again, we've sold these patients the "need" for discounts.
    Meh....don't be so hard on yourself or the industry. Buying power speaks to the wallet unlike anything else. A VCP pools lots of buying power in the form of captive patients and doles them out to a group of providers willing to provide a discount in exchange for being lazy non marketing slobs

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    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by racethe1320 View Post



    I trust you'll shed light on the why part. Anything I say would be but a guess.
    Ok, 1st off my rent is higher. I'm in a top end private medical center with free valet parking and marble waterfalls. We have higher than average cost frame lines. Our displays alone were about 80k. We have a top of the line finish lab including a Santinelli ME 1200 which we produce 100% of our work with. My employees are among the highest paid opticians in the area. So, if it's a cost of business associated difference, the higher costs go to me, yet the U/C is still higher all around me at private offices. (We of course have a couple of Wally's and an America's Worst move in recently.) What would be your guess as to why these VCP offices around me are so high? To me, it can only be either they're all greedy OD's or they HAVE to raise their U/C's to make an acceptable amount from these VCP's. ( I lean toward the later..)

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    Quote Originally Posted by optical24/7 View Post
    What would be your guess as to why these VCP offices around me are so high? To me, it can only be either they're all greedy OD's or they HAVE to raise their U/C's to make an acceptable amount from these VCP's. ( I lean toward the later..)
    They don't have to raise their U/C fees but they do choose to do so. They can make a living and do just fine with normal fees as I'm sure you could should you ever decide to be a panel provider. However the difference would be you'd have to want to expand and see more patients in order to increase revenue and match your previous. In your case you might not want to do that. Depends on what model you're after, smaller and efficiently profitable or larger and more profitable overall but at a lower percentage level per patient. I find a numbers game is easy to manage.

    My practice has been around for quite a while and there was a point where I could have walked away from managed care and increased profitability per patient for a single location and done well even only working a few days per week myself. However, I had much higher aspirations and found it far more profitable as a whole to open more locations and continue to fill their chairs with patients, the majority of which come from managed care.

    I was willing to sacrifice a percentage of the profit in order to double the volume and to have the capability to ramp up a new store in very little time. It didn't take a math genius to figure out I could make a lot more by and much faster by expanding the model as planned. We're up to 11 locations and growing. It's a great model and not a difficult one to manage. Key is hiring good people is all. It's also built me a nice retirement model as I have plenty of doctors working for me that are interested in taking over at some point. Even if none of them do, there are plenty of others who would love to move into an already established practice with managed care as it's foundation as that leads to consistency and predictable revenue from day one.

    If you can make it past 3 location you've crossed the hurdle for a predicable and successful model. The rest are dependent on how quickly you can afford to build them out.

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    Master OptiBoarder optical24/7's Avatar
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    Actually, we're opening our 3rd location this summer. ( 8 years in business). And you're right, personnel are the most important facet. Your success and ours shows there are differing ways to achieve the goals we all have. I wish you continued success with your model!

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    Will this allow independent opticians to become vsp providers? We have been discriminated against from vsp for years. They tell us we can not be a provider without a doctor.

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