Eye Med not paying us recently for services...

[Uncle Fester]

Back office manager is going crazy with Eye Med in the last couple of weeks not paying us for exams and charges for eye wear.

Catching this on Tuft's Medicare Preferred and Fallon for now.

It's not happening to all of the submissions but some plans seem to have 2 different patient price fees where the initial authorization says no co pay but if we enter the group name and number with level there is supposed to be a charge.

All we get is a run around from Eye Med.

Are we alone in seeing this?

[Uncle Fester]

Hewitt Packard just went through without any payment for the exam and listing only patient pays amounts. No explanation of what the lab will be taking either.

This is apparently a growing problem that has huge implications for our bottom line.

The office manager thinks they tweaked the program and have made things much murkier in the name of making things "simpler".

[CathyO]

In our area many people now have multiple plans thru EyeMed and our insurance gal routinely looks at all of them for the lowest copay for the patient. Often now we have to bill a different EyeMed plan they have for the materials. The newer migrated plans do not show us EyeMeds reimbursements either. They have become even a bigger pain now then before.

[Uncle Fester]

Processed a benefit where the frame discounts to $98.80 but the print out says frame should be $128.00. Call to EM says when the statement comes in we will see the $98.80 charge and they do not know why the printout was off.

Looks more and more like somebody tweaked something on their side and we think this may be just the beginning of a huge problem trying to get fully reimbursed.

Tomorrow the back office will be drilling deeper to see just what's going on as we are very worried about the coming exams not being paid.

I'll be away from this office until the pm.

[Uncle Fester]

Our office now needs to access 2(!) Eye Med authorizations to be sure correct charges are applied to patient.

The back office is now telling us we need to take the initial authorization then under "Group Search" enter Group ID and obtain the benefit level number to find a second authorization page which will give accurate charges to patient to determine, say, as an example, if lenses only are limited to straight 20% discount only or lower charges apply. We're about to make $2 profit on the frame though!!!

Has this been the usual way you guys have done this?

Eye Med and their owner Essilor will be putting out out of business sooner rather than later unless how eye care is delivered and paid for changes significantly.

[rbaker]

Thankfully I retired from the retail end of the business in 1996. Back then we had a direct relationship with our customers, no middle men. We furnished eyewear to the customer and the customer paid us for our goods and services. If they had a third party payee we were happy to give them a statement which they could submit. However, they were responsible for payment and paid in full up front.

What the heck happened? Another nail in the coffin of the independent retail eyewear business. Will the optician ever be able to stand on his own two feet again or is it "Game over."

[Chris Ryser]

Eye Med and their owner Essilor will be putting out out of business sooner rather than later unless how eye care is delivered and paid for changes significantly.

What the heck happened? Another nail in the coffin of the independent retail eyewear business. Will the optician ever be able to stand on his own two feet again or is it "Game over."

This and all vision insurance is an exclusive trade practice, made for the USA only. The rest of the world has stayed normal, as it was stated by Dick Baker.

As stated by Essilor on their website, that expanding their online optical retail presence is one of the main goals of the newly formed company after the merger, which is going to happen anytime now.

[Uncle Fester]

So the back office went to the EM site and entered our office info and were able to printout what companies are in our Network. These are the plans you need to jump through hoops to obtain final pricing on the second Group authorization (be sure the group numbers match!).

But lately we were getting a lot of EM authorizations saying they had "unlimited" benefits but that's because the patient is out of our EM participating plans. You'll also see they have no reimbursement charges noted if you put it through the EM site.

So when the initial authorization comes through as "unlimited" they can get 20% and be treated as a private transaction regardless of what other authorizations say should be charged as they are out of network- to us anyway. We're considering sweetening the discount to 25% as this puts us very close to what most plans are ultimately giving the patient anyway.