Insurance Advice From Current Od's

[nova2010]

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I know I will learn what I need to know to practice optometry, but I have heard a lot about insurance nightmares. How do you decide what insurances to accept in your practice? Where can I learn more about that? Also, what computer system have you found that works best? I talked to one doc that used maxieyes. Any help would be appreciated.

 

[Ryan_eyeball]

I know I will learn what I need to know to practice optometry, but I have heard a lot about insurance nightmares. How do you decide what insurances to accept in your practice? Where can I learn more about that? Also, what computer system have you found that works best? I talked to one doc that used maxieyes. Any help would be appreciated.

Repeat...Medical Insurance = Good
Vision Insurance = Suck

Best Vision Insurance = VSP, but controlling i've heard

The best dream practice = taking no vision plans, and all medical ones in your practice.

 

[nova2010]

I know you can only vision insurance for a routine eye exam. How do you file for other tests, like oct, for example? Do you have to fill with their medical insurance instead of vision? Also, are od's on a provider list like md's.? What would u recommend as far as hiring qualified people in your office that are familiar with insurance?

 

[Ryan_eyeball]

I know you can only vision insurance for a routine eye exam. How do you file for other tests, like oct, for example? Do you have to fill with their medical insurance instead of vision? Also, are od's on a provider list like md's.? What would u recommend as far as hiring qualified people in your office that are familiar with insurance?

Take their vision insurance on the date of the original exam. If you notice they have a large C/D on the original exam with undilated 90D view. Have them back for a dilated glaucoma workup on a different day. Bill that visit as a 99xxx include procedures: fields, gonio, photos, pach, and scanning laser (if you can afford one). Make sure you have an extended history form to start with to meet the 99xxx coding criteria. Some medical insurances will only allow certain procedures for say a glaucoma workup on one given day. Or you can only bill certain procedures throughout the year (example alternating photos, vs visual fields every six months).

Vision insurance will NEVER pay for any of these procedures. If you practice in area where you can't attain acceptance onto medical panels you'll never be able to get paid for them. Repeating KHE's rant. And no patient will ever pay out of pocket for them, as i know I wouldn't.

If anyone every wants to work as an independent contractor, I would steer clear of Target, Sears, or Lens Crafters. They pretty much require you to take EyeMed/Cole vision insurance. Worst insurance out there by far in my opinion. The MOST EyeMed will pay that I've seen is $49, average $42, an eye exam, and Cole is as little as $30. Now if you can work at these places as an employed doctor than its not so bad, because you have a guareented salary (but not many states let you work for a corporation).

The only vision insurance that I would take in private practice is VSP, at least you're doing a little better at around $62-$68 for an exam. If your practice can survive without it you're in a great area.

 

[eyeguy03]

I know you can only vision insurance for a routine eye exam. How do you file for other tests, like oct, for example? Do you have to fill with their medical insurance instead of vision? Also, are od's on a provider list like md's.? What would u recommend as far as hiring qualified people in your office that are familiar with insurance?

You might be a great restraunt owner but you still have to have a great chef, bartender, waiters/waitress to help all those you plan to serve. Spend the money needed to keep great and highly qualified people to help you. The better help you have, the more you can concentrate on what you were trained to do.

I could bill, answer the phone, do exams, cut lenses, take care of problems, go to the post office, order more materials, keep up on education, vacumme the floor and file charts, BUT NOT ALL AT ONCE. Hire good staff to do everything they can for you.

my two cents

 

[paremyd]

I know I will learn what I need to know to practice optometry, but I have heard a lot about insurance nightmares. How do you decide what insurances to accept in your practice? Where can I learn more about that? Also, what computer system have you found that works best? I talked to one doc that used maxieyes. Any help would be appreciated.

Every state is different, so just try to learn the basics. Insurance can change from now to the time you get out of school. You should try to accept the ones that pay comparable to what Medicare pays you. Vision plans can be terrible, but you will make that decision once you are in practice. Some plans are tied to together i.e. Specterible & UHC.

Nightmares can vary and everyone has their own stories to tell. You might not learn from another's nightmare until it hurts your pocketbook. Then you will learn really fast and not do it again.

Software programs have evolved in which they will help you select a code appropriate level of service based on the tests that you performed and the history that you have taken. Maximeyes is good but expensive. Officemate/Examwriter has a large customer base. Practice Director is up and coming that is affiliated with Williams Consulting Group.

As far as learning what tests you can do on the same day and what codes to bill, my advice is to shadow or do a rotation at a referral center. Watch what they do on the same day and ask questions then.

 

[posner]

Repeat...Medical Insurance = Good
Vision Insurance = Suck

Best Vision Insurance = VSP, but controlling i've heard

The best dream practice = taking no vision plans, and all medical ones in your practice.

Best dream practice= cash only

VSP for our practice pays $90 for routine examination including refraction; not good but there are plenty that are far worse. We dont generally accept the vision plans that pay poorly. We are providers for most medical plans including a couple HMOs(although reimbursement is not great for the HMO).

As for Software, we use Maximeyes in both offices are almost totally paperless. Maximeyes and Compulink are among the better software systems available in my opinion. While they may seem expensive(about $55K for our two offices just for the software) they more than pay for themselves if you use them as they were designed. Officemate is cheap for a reaosn; it is garbage. I say this as someone who bought it and began to use it before demanding my money back and going with something better. I could see Officemate being barely useful in a very small practice that does not do much if any VSP.

Posner

 

[wrx04]

Best dream practice= cash only

Do you know anyone who is successful w/ this type of practice?

 

[KHE]

Best dream practice= cash only

Do you know anyone who is successful w/ this type of practice?

I know maybe a half dozen people who have cash only practices and make a decent living at it but they all are essentially providing routine exams for glasses and contact lenses on young healthy patients or they are just renting themselves out as independent contractors to do eye exams at various small private optical stores.

 

[wrx04]

What if you accepted medical insurance for all medical claims and just used their vision plan (VSP) for materials....have the vision exam be cash only? Can you do this?

 

[posner]

My point was missed. I do not know anyone that is successful in this type of practice(we are about 30-35%cash). My point was that it would be great if your patients would pay any of your fees in cash, no insurance. No need to hire a person to bill and or follow up with insurance companies that deny claims, etc, etc. The associated salray of that person, medical insurance you would pay for them, the associated increase in your workers comp premiums based on your office payroll, etc etc. Furthermore, no need to deal with declining reimbursements and procedures that are no longer covered or paid for. That was my point! You said "dream" practice.
All of you that own your own practices know that there is a large difference between gross charges and revenue. Wouldnt it be great if your gross charges equalled your revenue( and I dont mean after your set up your office computer to adjust off allowed amounts for specific insurances)?
Posner