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Thread: Managed Care - Is It Working For You!?

  1. #1
    Bad address email on file
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    This mornings headlines in USA TODAY - reads " HMO - Medical costs are rising and insurance premiums could jump 20% - signs that managed care isn't working".

    How many of my fellow Optiboarders are effected by MC - What are your reasons for joining some plans and exiting others?...When I opened my store I decided I was going to offer premium products i.e., mid-index plastic as my lens of choice, designer frames etc., - I just simply didn't want to compete for medical dollars...But now I'm thinking if I wanna get a few more people through my doors this coming year...perhaps I should review some plans and see if they would be to my advantage...How should we evaluate these plans?

  2. #2
    Bad address email on file Darris Chambless's Avatar
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    Redhot Jumper

    Hello EyeCon,

    "HMO - Medical costs are rising and insurance premiums could jump 20% - signs that managed care isn't working." I like that. I'm going to frame it :-) The reason I say this is because many moons ago on the "old board" ;-) I got into more arguments regarding this subject than just about any other. I even told those that were arguing for it (I was against ;-) that time would tell and I'd wait to see "when" (not if) I was going to be proven right.

    I believe it was early this year when I watched a documentary on three hospitals in Boston ("Front line" I believe it was) All three hospitals were insolvent. They had been operating in the red (way into the red) for several years. Over the course of the year that the hospitals were followed by the documentary team one of the hospitals managed to lessen their financial burden by nearly half. You know how they did it? They drop their providership for a good majority of third party plans, HMO's and PPO's that they took assignment on.

    If you just want traffic and numbers then that's the way to go. If you want to lose money by accepting what they will pay then they are still the way to go. Private pay is where you make money AND you don't have to wait 30 to 45 days (sometimes longer) for your money. My suggestion is don't fall for it. Managed care means the insurance companies manage your office and give you no say so.

    How to see if these managed care plans are good for your business? If they offer 100% reimbursement of usual and customary fees for your products and services. Anything else will mean that you discount and or accept less for the same products and services. It may look good on the surface but once you're caught up in it you won't think it looks so good.

    Take care,

    Darris "The Anti HMO" Chambless

  3. #3
    Sawptician PAkev's Avatar
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    When I first got into this business in the early 80's there were no Managed Care and hardly any other third party programs other than Medicare.

    Then someone got the bright idea to include optical benefits in these other health care programs. This is when we began to see patients march in as proud as a peacock, pick out the latest and greatest eyewear and expect their managed care program to pick up the tab. Many were in for a rude awakening when they learned how little the Managed care program actually paid.

    The next step was for the managed care programs to cut into our profit margins and request we accept less for our materials, professional service, and time since they were sending us so many patients. OK many of us did but were not that stupid to let them pull the wool over our eyes so we just increased our prices to make up the difference.

    Here in PA there is one popular vision/dental program which pays $24 for frames, $24 for SV lenses, and $46 for bifocals once every 24 months (God bless their so generous soul). The max benefit on this is usually around $70 but here's the real kicker. Patients(employees) and employers pay about $20/month for this coverage (about $10 each) which totals $480.00 over the course of 24 months. The program pays out $70 and then keeps $410 from these folks while the patient may also have to shell out another $150 to $200 in order to make up the difference between the $70 allowance and the cost of their eyewear.

    THIS IS A LEGAL SCAM!
    DUH............................
    NO WONDER WHY "MANAGED CARE" DOESN'T WORK!

    Any one of us can provide a few pairs of superior quality eyewear well below the $500 to $700 which is eventually being paid for those so called "Managed Care" specs.

    I've even seen some programs which charge the participant up to a $100/yr listing fee to be printed in their listing of participating providers.

    The sad thing about all this is the fact that the folks not buying into these "managed scams" have to pay the higher prices which were created to attract volume from the "managed scam" programs. If there are only a few folks you may loose a sale to because you are not a "Participant" I would stay away from these programs with a ten foot pole otherwise it can result in a no win battle when you have to increase your prices which then drives away your non managed care clients.

    If you are looking to see more folks walking through your door I wouldn't waste my time with Managed Care Programs but strongly consider visiting some local business and offer a group optical benefits program. You can be creative and develop it in many different ways to provide a win-win situation for you, the employer, and the employee. The result will be no premiums for them, better cash flow for you, and less paperwork for everyone.



    [This message has been edited by PAkev (edited 12-08-2000).]

  4. #4
    OptiBoard Apprentice
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    If you know how to manage "managed care" rather than "managed care" managing your office there is no problem.

    Proper management information systems, training, business management, and selection of plans are essential elements of profitability.

    Physicians have become wealthy off of managed care for years and this opportunity is finally being offered to eye care professionals.

    Do not miss out.

  5. #5
    Bad address email on file stephanie's Avatar
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    Redhot Jumper

    I agree with you Darris. I am very anti HMO. I have been arguing with my own insurance companies(yes that is plural). One was for an emergency room visit back in Oct. My insurance claims they pay 80% and I pay 20%. Good deal??? I think not. I received my portion of the bill way more than 20%. When I asked why I was told it was because I went to the ER for a non-emergency situation. I went to the ER thinking I had appendisitis when I told this to the woman at the ins co. she said well that is why...that is not a life or death situation and I should NOT have gone to the ER. Ok since when is appendisitis not an emergency??? In fact when I left the ER the doctors still didn't know what was wrong with me said it could be my appendicts or it could be the flu hmmmm... Had a similar experience with my vision ins. They paid for my exam but told me my husband did not have an exam. Interesting I was there I work in that office and friends with the doctor and am quite sure she did indeed give my husband an eye exam that day. He got a prescription. I would think that would be a little difficult considering he didn't have an exam. I personally think all of these ins companies are crooked!!! Hate it terribly. It doesn't matter that you pay your premiums. Unfortunately there is a Discover commercial that is pretty sickening but getting to be truer every day(has anyone seen this??) The guy is in the ER and before the doctors shock his heart back they slide his card it is approved and they continue to save his life. Sad but getting to be true.
    Sorry for this long post.
    Have a great day everyone!!
    Steph

  6. #6
    Master OptiBoarder OptiBoard Silver Supporter
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    Right up front...I HATE HMO insurance. I am telling you, if you are not busy, think about signing with some. But if you are somewhat busy and want to spend a a lot of time and really...make NO money, then sign on to a couple of plans. When all is said and done you might as well give them the glasses AT COST. Because thats about what happens. When you figure all your overhead and inventory costs and time involved...can you afford to make a 25-35 dollar dispensing fee for your services? Its not geting any easier but I am realizing its better to make a little less than waste your time and still make aboutt he same amount. Really what we should do is form our own HMO, everybody else is. The HMO plans are a dime a dozen.

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