Eye Med Consecrates (WACK!) the sacred bond...again!!!

**Uncle Fester** · 12-10-2021, 10:30 AM

Ah the joys of Eye Med!

Seeing benefits authorizations with a $200 allowance with 30% off the balance that seem straight forward enough but after processing are a significantly less charge.

Told by EM it's up to us to scroll through the 40 pages of "In Focus" to find out why their authorization is so misleading and our top notch office manager after a 20 minute phone call was still unconvinced they knew why this discount was so much greater.

She now wants me to enter the job immediately into EM while the patient is here to find the number. This is impracticable to say the least when it's busy (with profitable patients waiting!) so I'm thinking collect a $50- $100 deposit and if the amount due is different we will not face a refund and also explain if it is more, which is rare, I'll call with the higher cost to the patient before submitting.

I'm also tempted to just collect the amount I calculate and charge that- then call the patient only if it is more, but I'm not sure of how bad a spanking this will create if audited.

We require a financial disclosure form to be signed at the time of EM orders explaining to the patient we will not and cannot stop a job once ordered. Period. Which is I'm told EM's rule.

I'm all eyes to see your suggestions!

Thank you sir. May I please have another!!!

**KrystleClear** · 12-10-2021, 11:57 AM

Better work on your third eye so you can psychically predict the patient's out of pocket. All these insurances seem to make it complicated on purpose. Why can't it just be - okay we pay X amount for Y. Anything over that collect the difference. Voila. Nope, gotta make it cryptic and so mysterious that even the people who work for the insurance company have no clue. I hated Eyemed when I worked at a place that took it. I was always getting the amounts wrong no matter what and no one could provide me with a clear explanation of what I should be doing and charging.

I kind of do what you do - give them my estimate, explain the total may differ as the insurance plans don't provide straightforward pricing, but if it is more, we'll call and let you know before finalizing the order. Even with that, when we get the payments from the insurance, there's still discrepancies despite charging the patient what THEY said to charge.

**Uilleann** · 12-10-2021, 12:31 PM

I would have a VERY hard talk with your docs about the cost of doing business with companies like EM. Your time has a value as well, and the docs MUCT be made aware of the added expense to their practice in your time, for ever decreasing payments from companies like this. In no universe anywhere is accepting ANY of these plans truly a good deal for ANY practice. And the reality is that a practice can absolutely thrive withOUT the likes of EM / VSP / Davis etc etc. Just takes a bit of work to change mindsets.

**IIxIPariahIxII** · 12-13-2021, 08:53 AM

I've gotten extremely quick and adept at plugging in the "order" through Eyemed to see the cost to patient. But even then, you have to make sure each item matches the cost exactly. Or you stand a chance of them auditing you. -_- And the way they explained it, it's supposed to be discount first, then allowance applied. But I rarely ever get the numbers to match what they end up calculating. Such a headache

**Uncle Fester** · 12-13-2021, 09:33 AM

With frames I find it's allowance first then discount. With lenses it's discount first then allowance. The wording for the algorithm is ambiguous.
Most times my numbers match.

My problem was the new authorization that gave a big $200 allowance then simple 30% discounts right down the page but my $160 patient cost turned in to $50 when ready to submit and the refund is costing us a couple bucks. That seems like no big deal until you see how slim the margins are for EM and what drives the office manager over the edge.

**IIxIPariahIxII** · 12-13-2021, 10:09 AM

Originally Posted by Uncle Fester

With frames I find it's allowance first then discount. With lenses it's discount first then allowance. The wording for the algorithm is ambiguous.
Most times my numbers match.

My problem was the new authorization that gave a big $200 allowance then simple 30% discounts right down the page but my $160 patient cost turned in to $50 when ready to submit and the refund is costing us a couple bucks. That seems like no big deal until you see how slim the margins are for EM and what drives the office manager over the edge.

Oooo thank you for that! That crap drove me up the wall and they never explained it like that. I will remember that going forward. Leave it to Eyemed to muck everything up. Can't ever be simple. Yeah, the margins are ridiculous. and then if you're using another lab for the lenses, you gotta pay your full cost there. It's a headache

**Uncle Fester** · 12-14-2021, 10:02 AM

"With frames I find it's allowance first then discount."
I should add you always add the co pay (if any) last.

For the curious and fortunate enough not to work with Eye Dread here's an example of the frame algorithm:

$90 copay; 20% off balance over $130 allowance

And the progressive lens:

$90 copay; 20% off retail price less $120 allowance

**Alex Camblor** · 12-14-2021, 04:15 PM

Originally Posted by Uilleann

I would have a VERY hard talk with your docs about the cost of doing business with companies like EM. Your time has a value as well, and the docs MUCT be made aware of the added expense to their practice in your time, for ever decreasing payments from companies like this. In no universe anywhere is accepting ANY of these plans truly a good deal for ANY practice. And the reality is that a practice can absolutely thrive withOUT the likes of EM / VSP / Davis etc etc. Just takes a bit of work to change mindsets.

Our states largest insurer is outsourcing to EM starting next year and we will not be signing up. I crunched their reimbursement numbers and it didnt make much sense to participate with them.
Now the insurer is mailing all our patients saying we have not "renewed our contract" and they "highly recommend finding a new eye doctor." We have never had an EM contract to renew and we are still indeed contracted with the insurer to provide medical exams. The letter also fails to mention they are changing their vision rider and doesnt even mention the name eyemed at all! Just all very unethical IMO.

**Optical Roy** · 12-14-2021, 05:42 PM

Luckily I was able to keep Eyedred for benefits only, we no longer use "Their lab", so we get to collect the OB's from the patient and get a reimbursement "you even know what reimburse means" lol, from them. It's nice taking their money now.

**Uncle Fester** · 12-16-2021, 10:20 AM

It looks like they may be capping the reimbursement cost on some plans.

I had an order yesterday where the lenses previously charged were about $325 and the AR $132 after discount so we made some profit but after entering statement showed reimbursement of only $175 and $85 accordingly.

Apparently you need to go to "in focus" and look up each plan to see these charges.

The big squeeze is on for independents to drive patients to chains.