ATLANTA – Despite a history of successful advocacy, optometrists are still fighting discrimination in the reimbursement arena, according to a presenter here at SECO.
Optometrists can remove foreign bodies and perform punctal occlusion in all states, treat glaucoma in all but one state, administer injections for anaphylaxis in 26 states, treat lumps and bumps in four states and use lasers in three states. However, ODs are still challenged by patient access and pay parity, Deanna S. Alexander, OD, FAAO, said.
Optometry won a victory with the Harkin Law, which states that health plans cannot discriminate against providers who bill for services within their scope of practice.
Deanna S. Alexander
“Your scope of practice is key,” Alexander said.
Freedom of choice laws allow patients to freely choose between an optometrist or ophthalmologist within the panel for the same covered services, she added.
Direct access laws, implemented in only nine states, allow patients to self-refer to a participating optometrist or ophthalmologist. Payment parity laws, which exist in only 13 states, ensure that optometrists are paid the same as other doctors on the panel for the same service. Only 11 states have any willing provider laws, Alexander said, which requires insurance panels to accept any provider who wishes to be on the panel.
“With the narrowing of networks, you’ll start to hear an outcry from consumers,” she said. “You will see coalitions of health care – people coming together to pass these laws.”
Doctors sometimes sign contracts with insurers without reading them, analyzing the potential impact on their practice or attempting to negotiate better coverage, broader scope or better fees, Alexander said.
“Only you, the individual OD or practice, can decide what terms to accept from a third-party payer,” she said. Consult with your business advisers and review your plans annually. – by Nancy Hemphill, ELS, FAAO
Alexander DS. Thriving in the new era: Tackling access, coding and payments head on. Presented at: SECO. Feb. 24-28; Atlanta.
Disclosure: Alexander reported no relevant financial disclosures.