No more insurance labs for Texas?

[Wes]

I just got the following in an email:



LATEST NEWS


Texas Law Will Prevent Managed Vision Care Companies From Requiring Optometrists to Use Their Labs

AUSTIN, Texas—The Texas legislature has approved a bill that prohibits managed vision care companies from requiring providers of optometric care to use an optical laboratory the vision plan owns. Texas Governor Greg Abbott has until June 21, 2015, to either sign or veto House Bill 3550/Senate Bill 684, and those who are following this bill expect him to sign it. Once enacted, the law would go into effect on Sept. 1, 2015, and it would apply to contracts entered into or renewed on or after that date.

Specifically, the law prohibits managed care plans from restricting or limiting an optometrist’s choice of sources or suppliers of services or materials, including optical laboratories used by the optometrist to provide services or materials to patients.

In addition, the law also prohibits managed care plans from controlling the professional judgment, manner of practice, or practice of an optometrist or therapeutic optometrist; paying an optometrist for a service not provided; or requiring an optometrist to disclose a patient’s confidential or protected health information unless the disclosure is authorized by the patient or permitted without authorization under HIPAA.

The law also requires optometrists to disclose to a patient any business interest the optometrist has in an out-of-network supplier or manufacturer to which the optometrist refers the patient.

The impetus for the legislation, according to analysis of the bill in the Texas House Committee report, was based on the fact that interested parties assert that some vision plan companies “require optometrists to disclose confidential medical diagnoses of their patients in order for the optometrist to remain in compliance with plan rules” and “the parties report that some vision plan companies also require optometrists to use an optical laboratory the vision plan owns, even when the optometrist knows that a different lab can produce glasses for a patient more quickly, at a lower price, and with better craftsmanship and quality control.”

A similar law passed in Georgia in 2010 was upheld by the Georgia Supreme Court in December 2013.

[mervinek]

It will never come to us in PA. I wish it would but doubt it.

[newguyaroundhere]

It will never come to us in PA. I wish it would but doubt it.

Agreed. Nothing would be better than telling Highmark to go take their business elsewhere.

[AngeHamm]

We just passed a similar bill in Virginia. Everyone is holding their breath to find out what our managed care is actually going to look like in 2016.

[Jarhead Daddy]

Very interesting. And the big tangled web begins to unravel?

[EyeCare Rich]

Just as VSP clamps down their jaws in a few select states with their "Choice" plan, cutting Hoya out of the picture. Interesting. Gotta grab all that cash before it all comes crumbling down?

[David_Garza]

That would be great for Davis and Specterible patients!

[optical24/7]

Nothing in these bills stop an insurance company from offering *incentives* to use their products and dis-incentives to use competing products. I think most practices will still order from the insurance labs since their parent insurance company controls re-imbursement amounts.

[iD]

if the incentives are right then I agree optical24/7. However, I hope this law would come to CA.

[Paul Smith LDO]

Hey folks, not to burst your bubble but these managed vision care plans will utilize the internet even more to sell their members, their product, and thru their labs. Some have been doing so for several years (VSP) and it will get worser and more specteribler but good for the state of Texas.

[Tallboy]

Nothing in these bills stop an insurance company from offering *incentives* to use their products and dis-incentives to use competing products. I think most practices will still order from the insurance labs since their parent insurance company controls re-imbursement amounts.

Maybe I misread the law but didn't it say that it would be forbidden for a managed care provider to " paying an optometrist for a service not provided" ?
Maybe I'm taking that to mean something it doesn't, but I would think those nice little Unity Spiffs on the payment check would be considered being paid without an attached service code.

[Tallboy]

Hey folks, not to burst your bubble but these managed vision care plans will utilize the internet even more to sell their members, their product, and thru their labs. Some have been doing so for several years (VSP) and it will get worser and more specteribler but good for the state of Texas.

This is an inevitability though, and will massively downgrade the amount of perceived "benefit" a subscriber will feel they are getting for their $ or their hard work. Just the same as that person feels slighted if they have to go to a "lesser" optical shop without great service.

I'm ready to deal with the internet, the lab thing needs to be fought though.

[Paul Smith LDO]

This is an inevitability though, and will massively downgrade the amount of perceived "benefit" a subscriber will feel they are getting for their $ or their hard work. Just the same as that person feels slighted if they have to go to a "lesser" optical shop without great service.

I'm ready to deal with the internet, the lab thing needs to be fought though.

It's a novel ideal but the hard reality is that people want to use their insurance and they have been buying glasses from the internet for over 10 years now. As to the members "perceived" benefit, the insurance brochures spin a pretty tale and each member does work hard for their benefits. Besides, they can go to you to have their glasses adjusted, I charge too much.

[optical24/7]

Maybe I misread the law but didn't it say that it would be forbidden for a managed care provider to " paying an optometrist for a service not provided" ?
Maybe I'm taking that to mean something it doesn't, but I would think those nice little Unity Spiffs on the payment check would be considered being paid without an attached service code.

There's nothing to stop an insurance company from providing you lower cost (thus higher re-imbursement) for Rx work you send to them or to tier their own products so they are more lucrative than going to another supplier. I highly doubt any office will go elsewhere if it costs them more to do so. There's simply not enough margin to do so. If an office is able to move their clients out of plan products altogether, more power to them. But how many here lament about patients wanting only what their plan covers?

[mervinek]

Agreed. Nothing would be better than telling Highmark to go take their business elsewhere.

My office is right across the street from the highmark building! THEY ALL HAVE IT! I would say 75% of our patients all have Davis. It stinks. Big time.

[mervinek]

Nothing in these bills stop an insurance company from offering *incentives* to use their products and dis-incentives to use competing products. I think most practices will still order from the insurance labs since their parent insurance company controls re-imbursement amounts.

Sadly this is prob true.

[ak47]

So, how has this panned out in GEORGIA ? I thought Virginia was the only state with this type of law and too new there to assess the impact.

[David_Garza]

I like it! It may actually make me reconsider taking Davis and Specterible (if I am not required to use their Labs to for the optical materials). Faster turn around better quality. I don't see how this can be seen as a bad law for either VCP patients or practices.

[Craig]

This new law will end up helping push the internet as the first option for all insurance patients!

This law has to cause the optical insurance to look at internet direct as the low cost option on all new plans going forward. The second tier option will be paying a small co-pay to have the glasses dispensed at an OD office and a little more if you want to have them fit you for a frame and lenses.

This is the future and it will now arrive sooner than later with all insurance and they will also just open their own retail locations.

It looks like the rx part and glasses will all be on-line as the low price option.

Thoughts from those who take insurance and must learn to evolve with the new laws that will force new distribution of glasses.

I maintain this is the best thing to happen for anyone who wants to not take insurance going forward. The worse the industry becomes the more we and others can shine.

[optical24/7]

I like it! It may actually make me reconsider taking Davis and Specterible (if I am not required to use their Labs to for the optical materials). Faster turn around better quality. I don't see how this can be seen as a bad law for either VCP patients or practices.

I doubt the insurance companies will willingly take a hit with this new law. I'm sure they will find a way to jack with your reimbursement. If I recall correctly, race came on here when the Georgia law was mentioned and said something to the effect of "Be careful of what you wish for". Those may turn out to be prophetic words...

[optical24/7]

I maintain this is the best thing to happen for anyone who wants to not take insurance going forward. The worse the industry becomes the more we and others can shine.

Amen brother!

[Browman]

Any idea if/how this would effect Eyemed jobs?

[Tallboy]

If and/or When insurance patients start going to an internet provider in droves, it will be no more insurance for us here. We still take VSP but thats it, beyond medical for part of the exams.

I'll gladly kick them to the curb when that happens, just as I will gladly start charging fees for people who buy internet glasses that want to have them serviced at my shop, it hasn't happened yet so the market hasn't forced my hand yet in that way.

[opty4062]

I can't really speak to what has panned out in Georgia because my lab of choice (and heart) was an eyemed lab already. That was the only managed care company that we still take that was a problem. I do know that business for my lab increased a great deal due to more offices 'having' to use them. They have handled it wonderfully and we have not had any slow down in service.

[LENNY]

Watch out! You will do the job and get paid the same as their lab would do the job.....