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Thread: Ophthalmology and Managed Care Plans

  1. #1
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    Ophthalmology and Managed Care Plans

    Optiboarders, I'm curious to see if there's any fellow opticians out there that work in ophthalmology and see what your experience was/is in working with discount managed care plans.

    Within the past six months, I came into an established ophthalmology practice with an optical shop. My previous place of employment was an optometry clinic that contracted with every discount plan under the sun and I was curious to see there were other opticians in a similar position.

    I know the general pros and cons of contracting with discount managed care plans like VSP, Eyemed, etc. I'm curious if there any opticians that would seem to think that it's advantageous to contract with a particular one like VSP. Since our clinic is literally right next door to a hospital, all the physicians, RNs, etc. under employ of the hospital group have VSP and I think we're losing a lot of potential business.

    While life at my new optical shop is definitely more streamlined as I'm not spending as much time with insurance verification, fighting with claims departments, etc., my new clinic seems to be sacrificing volume.

    Thoughts?

  2. #2
    Master OptiBoarder optical24/7's Avatar
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    It's not worth it. Increased volume doesn't equal more profit, just more of your time, which will be taken from your full pay patients. I have one of the practices I run for OMD's at a hospital/professional building. All of the employees of the doctors and hospital have insurance. We simply give them a professional discount and give them an OON form to send in.

    Insurances usually cover only one pair and put a time limit on when they can use it again. We give this discount any time and for as many pair as they want ( immediate family included) . The vast majority come to us. Most say the price differential in minimal if any at all to their previous in network provider. We encourage them to use their health insurance to see one of our MD's and our pro discount for CL and eye wear needs. Most of these employees end up dropping their eye coverage, pocketing the money. ( A win for us and a blow to the insurance companies..)

    Just keep your pricing reasonable and get a bunch of business cards to take to every office in your medical complex that states the discounts (use dollar amounts, not percentages off). And don't just take them around once. Go hand them out every 6 months, at least until you are established with a lot of those employees. Once you get a reasonable share of them coming in, word of mouth will take you the rest of the way.

    Another plus side of doing it this way is that those employees and doctors will be wearing your products daily in front of their own patients. We have gotten a ton of referrals from these employees to their patient base. We have also increased the patient base of our own OMD's by encouraging patients to use their health insurance for their eye exam. We've grown to 3 locations with no advertising and not taking any eye glass insurance. Good luck!

  3. #3
    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by optical24/7 View Post
    It's not worth it. Increased volume doesn't equal more profit, just more of your time, which will be taken from your full pay patients. I have one of the practices I run for OMD's at a hospital/professional building. All of the employees of the doctors and hospital have insurance. We simply give them a professional discount and give them an OON form to send in.

    Insurances usually cover only one pair and put a time limit on when they can use it again. We give this discount any time and for as many pair as they want ( immediate family included) . The vast majority come to us. Most say the price differential in minimal if any at all to their previous in network provider. We encourage them to use their health insurance to see one of our MD's and our pro discount for CL and eye wear needs. Most of these employees end up dropping their eye coverage, pocketing the money. ( A win for us and a blow to the insurance companies..)

    Just keep your pricing reasonable and get a bunch of business cards to take to every office in your medical complex that states the discounts (use dollar amounts, not percentages off). And don't just take them around once. Go hand them out every 6 months, at least until you are established with a lot of those employees. Once you get a reasonable share of them coming in, word of mouth will take you the rest of the way.

    Another plus side of doing it this way is that those employees and doctors will be wearing your products daily in front of their own patients. We have gotten a ton of referrals from these employees to their patient base. We have also increased the patient base of our own OMD's by encouraging patients to use their health insurance for their eye exam. We've grown to 3 locations with no advertising and not taking any eye glass insurance. Good luck!
    Dovetailing in on this, it's good to have discounted private-label lens products in your pocket for just such a situation. We use Lighten Up and Synergy Crystal AR for private-pay SV and over the past few years have variously used Shoreview Digital, G-PAL, and Ethos Progressives. If you're going to be doing special discount pricing without any insurance reimbursement, your bottom line will thank you for using lower-cost lens options.
    I'm Andrew Hamm and I approve this message.

  4. #4
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    Thanks for the response, and for the ideas. I was looking to go on a 'goodwill tour' of sorts to introduce myself to neighboring clinics and create some brand awareness for new frame lines that we carry and whatnot, but the idea of doing so every six months is a good plan.

    Dovetailing in on this, it's good to have discounted private-label lens products in your pocket for just such a situation. We use Lighten Up and Synergy Crystal AR for private-pay SV and over the past few years have variously used Shoreview Digital, G-PAL, and Ethos Progressives. If you're going to be doing special discount pricing without any insurance reimbursement, your bottom line will thank you for using lower-cost lens options.
    I've never heard of Lighten Up or Synergy Crystal (I assume this is your lab's in-house AR), but the independent lab I predominantly use has some in-house IOT PAL designs that we offer at a lower cost along with an in-house AR that has proven to be fantastic. I'm familiar with Shoreview's Novel, but I don't know about their digital PAL. I thought Ethos was a VSP-exclusive design?

  5. #5
    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by grudyfan13 View Post
    I've never heard of Lighten Up or Synergy Crystal (I assume this is your lab's in-house AR), but the independent lab I predominantly use has some in-house IOT PAL designs that we offer at a lower cost along with an in-house AR that has proven to be fantastic. I'm familiar with Shoreview's Novel, but I don't know about their digital PAL. I thought Ethos was a VSP-exclusive design?
    Lighten Up Sentinel AR and Synergy Crystal AR are both available in stock from Nassau.
    I'm Andrew Hamm and I approve this message.

  6. #6
    Rising Star Lori's Avatar
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    Hey there- I work for MD's; one just retired so now we have one MD and one OD but an ophthalmology practice. I've been the optical manager here for 20+ years. Private practices all around us are being bought up by groups. I've consulted with the remaining (younger) doc and have advised him to keep the eye on the ball and not be swayed and scared- In the end all these sell-out shops will look the same and we will be unique. Not everyone is into the bargain basement lenses and frames. About 30 percent of our sales come from VSP & EyeMed; those are the only vision plans we accept, the others aren't worth it. We do make a profit from those two because we up-sell. Also, we are not VSP Premier (refuse to be intimidated to buy Marchon frames).
    If you provide excellent customer service, employ knowledgeable opticians who actually ARE opticians, have a frame buyer who knows the demographics and trends you'll succeed.
    My advice; don't operate in fear- establish your uniqueness and work on ways to up the capture rate.

  7. #7
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    About 30 percent of our sales come from VSP & EyeMed; those are the only vision plans we accept, the others aren't worth it. We do make a profit from those two because we up-sell
    My main worry (and that of my bosses) is how to integrate the managed care plans into ophthalmology in general. Our office has 3 MDs and 1 OD, so the bulk of our patients are not being seen for routine vision exams. If I were to credential with VSP, for example, all of our doctors would have to be credentialed as well, but how does your office balance that? Since most of our patients are being seen for cataract extractions, AMD injections, glaucoma treatment, etc., how does your clinic deal with the barrage of patients wanting to use routine vision benefits at a specialty practice? Our OD is only available a couple days a week at our location.

    If you provide excellent customer service, employ knowledgeable opticians who actually ARE opticians, have a frame buyer who knows the demographics and trends you'll succeed.
    As the lone optician and frame buyer, I have no worries about this. This clinic's frame boards had been stagnant for quite some time and I've brought in a better variety. We've already seen noticeable gains in the quantity of frames sold in the ~6 months I've been here.

    My advice; don't operate in fear- establish your uniqueness and work on ways to up the capture rate.


    I don't plan to (operate in fear, that is). I'm just looking at ways to find a good balance of bringing in more business without having to sacrifice too much of my time to nonsensical insurance plans (I'm looking at you, Davis, and I'm so glad I no longer have to deal with that) and still being able to provide excellent customer service to our patients here. Also, bringing in funky fresh frames for my myriad geriatric patients doesn't hurt.
    My general desire is to be swayed either way accepting/not accepting managed care plans. Anecdotally, it seems as though most opticians I've spoken to say that I shouldn't waste my time dealing with VSP and the like. Lori, you're the first optician that's responded in the positive with taking any managed care plans, and it's surprising that you talk about Eyemed in a positive light. At the optical shop I managed before this, the doctor there called credentialing with Eyemed his biggest regret due to poor reimbursement for the exams (his billing specialist also confirmed this sentiment). Somehow, your experience with Eyemed has been a positive one?
    Last edited by grudyfan13; 01-07-2020 at 03:07 PM. Reason: Formatting.

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