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General Commentary About Insurance-ODs-EyeMDs

on September 20th, 2007 | Filed under Optoblog

I had a great round of Golf with area O.D.s yesterday. Mount Ogden Eye Center sponsors a lunch, one hour of CE, and then a round of Golf for any northern Utah optometrist that is interested in taking the day off.

It was really cool to get together with local O.D.s who share the same concerns that I do about business aspects of practicing optometry in Utah.

I recently talked about a local HMO/Insurance Plan, IHC-SelectHealth, that discriminates against optometry. A lawsuit was brought against them by a group of individual optometrists which they later lost and now there can be no more appeals. My question was why wouldn’t the Utah Optometric Association or even the American Optometric Association get involved and sponsor the suit. The answer was not enough money and that there would be serious repercussions. The thinking is that IHC won’t counter-suit a bunch of individual optometrists, but they would the UOA, which could go bankrupt in such a scenario. Apparently a lot of optometrists were upset that there was a lawsuit in the first place because they thought there should be more diplomatic means.

I say the only diplomacy we need is with our state legislatures to enact an Any Willing Provider law so that IHC/SelectHealth’s discrimination would be illegal.

Another thing, this Insurance sponsored discrimination fosters an Us vs. Them attitude with ophthalmologists. The areas where both ODs and OMDs are all paneled is usually because early on, the OMDs went to bat for the ODs and got them on. In areas where ODs are not allowed, the ODs can start resenting the OMDs for not going to bat for them. Pretty soon, all our referrals somehow end up going to Ogden instead of staying local in the valley. Then the local OMDs get perturbed by not enough referrals from the ODs, so they might vow to never go to bat for the ODs. A vicious cycle.

The patients are the ones who really lose from this situation currently happening in Northern Utah. IHC/Selecthealth claims in their T.V. commercials that they are “Simply There” and according to their website, “SelectHealth offers members respect, convenience, excellent service, and affordable health coverage.”

Did you see the convenience part? How is it convenient to wait for weeks to see an eye doctor for a routine eye exam? I suppose it’s convenient for SelectHealth that people don’t want to wait for weeks so they go see an optometrist instead, and SelectHealth won’t allow optometrists to bill them and they won’t reimburse the patients either. I think that must be their evil master plan: subtly encourage patients to see non-network doctors so that they don’t have to pay out any money.

By the way, SelectHealth’s copay for eye exams is $35. So what’s another $10 to the patient to see a big box doctor for a $45 eye exam. Yet another way they encourage the OMDs to dislike the ODs for having such a thing as commercial optometry.

Insurance in general hasn’t done anything to help private practice ODs. We were much better off years ago when 90% of optometry exams were private pay. Vision Insurance is as worthless as haircut insurance. It only adds a middleman who takes from both the patient and the eye doctor. If we all just stopped taking vision insurance and slightly decreased our fees, the whole populous would be better off.

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