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 By Neil B. Gailmard, OD, MBA, FAAO, Editor October 26, 2005 - Tip #197 
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Dropping a Vision Plan


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Additional Information

As we discussed in last week's 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 - 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.
  • 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 is required.
  • 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 it's 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 don't 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 image.
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 can't possibly come to you if you aren't on the plan. It may be tempting to make exceptions for good patients, especially if you need to fill the appointment schedule, but resist. Don't let it become personal; it's a business decision and you are either on the plan or your not. It is not your fault that the patient's employer chose a vision plan that has poor benefits.

What explanation can you offer to patients who ask why you don't 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: "That insurance plan will not pay our usual fees. The payment they offer is so low that we can't provide our usual high quality service." 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,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


A Proud Supporter of

Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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