Understanding Managed Care Restrictions

**HughMcManus** · 04-26-2018, 08:19 AM

I am trying to locate a comprehensive list to better understand the restrictions that various managed care programs place on optical practices. For example: If you want to do finishing work for VSP you have to source your stock lenses through their Plexus company. If you want to do EyeMed jobs you need to use their lab or a FastGrind machine.
I am specifically curious about the restrictions placed on Pearle Vision franchisees.

**Chris Ryser** · 04-26-2018, 11:05 AM

Originally Posted by HughMcManus

I am specifically curious about the restrictions placed on Pearle Vision franchisees.

Check it all out on their website ........................

http://www.ownapearlevision.com/pear...SAAEgKb5_D_BwE

**HughMcManus** · 04-26-2018, 12:35 PM

Thanks Chris. I looked at their site, and I wasn't able to find anything definitive. The only thing I found related to sourcing stock is,

"The company uses its market intelligence to help Pearle Vision optical franchise owners strategically stock their optical centers to maximize sales and margins by delivering the products that their patients desire and need."

While this may not seem nefarious on the surface, I suspect that the company's 'market intelligence' could preclude you from sourcing materials (lenses/frames) that our not under the Lux umbrella. I called the phone numbers they list. The most straightforward answer I got was that I could discuss that during the 'potential franchisee negotiation and contract review' process.

Which isn't that straight of an answer.

**Tallboy** · 04-26-2018, 03:06 PM

There are tons of restrictions on Pearle Vision Franchisees. There are likely to be even more in the coming years. If that is a concern of yours when deciding how to run your optical business, a Pearle Vision Franchise is not your best bet.

I may not know the specifics, but I've heard enough to know there are a ton. Over the last 10 years they have become even more so as well.

Guarantee you need to stock Marchon frames that they tell you which ones to stock. Guarantee you have a frame book of Lux frames that you can choose from. Those will be your frames, with a heavy lean towards the Lux frames. You will use an Essilux lab of their choosing. You will be "told" what lenses to sell because it will not be profitable for you in anyway if you don't use those lenses.

**AngeHamm** · 04-30-2018, 07:50 AM

Remember that this varies state-by-state. I'm fortunate to work in Virginia, where our House of Delegates created a law stopping insurance companies from dictating our lab choice.

**Tallboy** · 05-01-2018, 02:23 PM

Originally Posted by AngeHamm

Remember that this varies state-by-state. I'm fortunate to work in Virginia, where our House of Delegates created a law stopping insurance companies from dictating our lab choice.

I bet you this gets much murkier for Franchise business like Pearle though. I don't think an individual 7-11 could sell their own brand of hot dogs if they wanted too, it all is purchased from a central ordering center.

**AngeHamm** · 05-02-2018, 08:24 AM

Originally Posted by Tallboy

I bet you this gets much murkier for Franchise business like Pearle though. I don't think an individual 7-11 could sell their own brand of hot dogs if they wanted too, it all is purchased from a central ordering center.

Sure, but no doctor is prescribing 7-11 hot dogs. At least none of my doctors do.

**Tallboy** · 05-02-2018, 10:21 AM

Originally Posted by AngeHamm

Sure, but no doctor is prescribing 7-11 hot dogs. At least none of my doctors do.

Hot dogs are probably more heavily regulated than eyeglasses in my state.

What I mean is that if the same company OWNS the rights to the franchise AND the insurance company they can probably circumvent that law by saying it isn't the insurance company dictating where the lenses must be sourced from, but the franchise contract.