Optometric Management Tip # 197   -   Wednesday, October 26, 2005
Dropping a Vision Plan

As we discussed in last weekís tip, practices that are dominated by vision plans are doomed to become average and they have a difficult time ever achieving high income levels because the fixed fees are so low. You may want to re-read that tip to set the stage for the mechanics of dropping a vision plan.

Run a test case

Dropping a vision plan is certainly scary because it can have far-reaching effects on many facets of your practice. The main concern is the gross and net revenue, but it will also affect the appointment schedule and staffing. To learn the impact of dropping a vision plan in your practice, I suggest you identify one small, low-paying plan as a test case. Study this thoroughly and you can see if it makes economical sense to drop another plan. The ideal outcome, which actually happens in some practices, is that you will see fewer patients but still realize the same net income. That is a scenario we can all go for!

If the plan you choose to drop represents only a small group of patients, it protects you from being financially hurt. Hopefully some of the patients will remain with your practice even though you no longer accept direct payment from the plan. If you lose some patients, allow them to go elsewhere gracefully and respectfully, and offer to forward any information the new doctor may need. Keep in mind that some of these patients may want to come back after they try another practice under this plan Ė especially if you have elevated your services well above the norm. You want to keep the door open and make people feel like they can return without embarrassment.

The Mechanics

Here are some points I would recommend if you wish to drop a plan. What should you say?

Patients can make a strong case for wanting to see you for eye care, but act like they have no choice and canít possibly come to you if you arenít on the plan. It may be tempting to make exceptions for good patients, especially if you need to fill the appointment schedule, but resist. Donít let it become personal; itís a business decision and you are either on the plan or your not. It is not your fault that the patientís employer chose a vision plan that has poor benefits.

What explanation can you offer to patients who ask why you donít accept a specific plan, or who want to know why you used to be on a network, but no longer participate? Your response is important, so make sure your staff is thoroughly trained. Keep the response simple, honest and in plain English. Here is what I would say: ďThat insurance plan will not pay our usual fees. The payment they offer is so low that we canít provide our usual high quality service.Ē You may then move into a discussion about filing out-of-network claims, but no further explanation is needed about the plan policies. Whining or complaining about the problems in our industry does not interest patients.


Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management