EyeMed IOF Program and Virginia Law

[AngeHamm]

I've been receiving termination threats from EyeMed due to our non-compliance in their in-office finishing program (we aren't using Nassau for our stock lenses). My understanding of Virginia's new law is that no insurance company can dictate what source we use for our lenses. Do I not have that right? I'm trying to figure out if this is a ditch worth dying in, or if I should just sign us up to get lenses from Nassau.

[Uncle Fester]

Sounds to me like a question for a lawyer.

[PartTimer]

If you are in an "opt out," environment where you are legally allowed to source your own product regardless of an insurer's policies, that would depend. I believe Virginia is. Georgia and Texas, as well as some other states, are also set up this way, due to recent lobbying and legislation changes. If you signed a contract setting your reimbursement at a certain rate, etc., with the understanding that you were tied to using their model ("opt in" or "dispensing" model), then you won't have a choice but to be dropped, and apply for a new contract ("opt out"). You may be lucky to get out of it without an audit requiring repayment. I don't believe they have the right to keep you off panel if you reapply (believe this would fit into some sort of legal definition of discrimination), but the insurance company compromise with this type of legislation is usually tied to reimbursement: you can sign up for a new contract, but your reimbursement will go down, something on the order of 7-15% depending on your region and old contract terms.

Signing up for a new contract will take persistence and time, but it is better for your business and your patient in the long run. Every person who works for EyeMed will either not know, or pretend not to know, about this course of action: it will take lots of escalation. If you source intelligently, you can offset the reimbursement difference (we net more now than we used to by opting out for Eyemed).

If you are already "opting out," and have a contract set up as such, they have zero ground to stand on, and you will definitely win that front. Of course, going out of network, as we have with VSP, is much cleaner, and really clears your head, to boot! (if you have that choice)

You should of course take my meandering opinions and facts for what they are worth and ask a lawyer. I honestly send you lots of luck.

[skt]

we are on Georgia and opted out....much better!