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
Here are some points I would recommend if you wish to drop a plan.
What should you say?
- Always follow the terms of your plan contract for stopping participation. Review the agreement
to see if you need to give notice in writing to the plan administrator and how many days notice
- I would not send a letter to the patient base about the decision to drop the plan. Why do
so? I strongly believe in determining any insurance coverage with each patient over the phone
when they call to schedule, and if you do this, you will have the opportunity to let the patient
know if you accept their vision plan or not. The practice may change its vision plan participation
from year to year just as patients (or their employers) change their plan membership. Discussing
this over the phone also gives your staff the opportunity to quote the exact exam fee if it is
payable at the time of service. Patients appreciate this straight forward approach and it
eliminates misunderstandings at the front desk.
- You should know if patients can file their own claims for out-of-network benefits with this
plan. If itís possible, be prepared to let them know this and assist them with the process.
Even though the benefit may be less than with a network provider, getting some reimbursement may
be all your patient needs to stay with you.
- I would not offer a discount to vision plan members if they stay with you. I know this is a
fairly popular idea but I donít like it for two reasons: 1) The discount was what you were trying
to get away from. They are very damaging to your bottom line, so why trade one discount for
another? You are worth your full fee. 2) It seems a little desperate, which is bad for your
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