This is exactly what I've been talking about

[KHE]

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The following is a post on ODwire.org which is a forum I recommend for students of optometry. This poster illustrates EXACTLY what I've been harping about on here to students and prospective students.

THis is the type of thing that you need to plan for when you are selecting to be an OD, and/or where you want to practice. This is what I meant when I said you need to do SPECIFIC research and have a SPECIFIC plan for what you want to do when you're done school.

This is what I meant when I cautioned about having a notion of "working hard."

I couldn't help but shake my head in disbelief as I read this post as it could have just as easily been written by me.

Here we have an enthusiastic young doctor who has been shut out of caring for the largest segment of his population (other than "routine" care) and why? Not because his state license says he can't. Not because he is poorly trained. Not because he doesn't want to. No...it is because of the arbitrary policy of some faceless insurance company.

MAKE SURE YOU CAN ACCEPT MEDICAL PLANS IN THE AREA WHERE YOU WANT TO PRACTICE OR YOU WILL BE RELEGATED TO PROVING ROUTINE CARE AND SELLING EYEWEAR. IS THAT WHAT YOU WANT AFTER 8 YEARS OF POST SECONDARY SCHOOLING? I WOULD BET NOT.

In my state, Michigan, our largest employer is the auto industry (and their unions). They have BCBS medical in a self funded panel (NASCO). I was was excited when I was accepted as a new provider, just opening an office, to be included on the BCBS medical panel. My father worked for DaimlerChrysler or 31 years before his retirement and I now accepted his medical insurance.

However, my first few claims were denied by BCBS and I could not figure out why. I had many heated calls to the customer service reps at BCBS who sent claims for review, etc, etc, yet they all came back that with the response that "this code is not paid to this provider type."

Finally, after talking to a 'supervisor customer service rep,' I was able to elicit that optometrists were discriminated against by BCBS NASCO contracts. Medical services were only approoved to MDs or DOs for the services I was billing (normal 92004s, 92083, 92250, etc). Instantly, I learned about ERISA, any willing provider laws, and discrimination.

How could any insurance carrier discriminate against different providers, I asked (especially to a provider who probably charges lower fees for the same services that the OMD charges). The insurance industry had no answers for me.

I am on board to fight for our inclusion on any willing provider legislation nationwide. We need every OD and their support (moral and financial) onboard for this fight. We are being discriminated against in the public's image and in the insurance industry and we do not have to take it. We are qualified to provide primary eye care services and we should be compensated for our service. We should not have to be relegated to accepting only vision plans. We need to do all that we can to get the support of our colleagues to lobby this legislation in our own states. In the states that we are being discriminated against (LISTEN MICHIGAN ODS), we can fight this discrimination.

 

[rpames]

This discrimination by insurance is so frustrating. We will defeat it, but it will take time and effort. We all need to be involved. Earlier today I sent letters to my state rep. about HR5688 and another issue concerning ODs. We all need to contact our government reps so they know they have constituents that are following their votes. Wether we are fighting insurance companies or the AMA, be informed and get involved! Do not blindly follow every fight the AOA goes for either, but know what you supporting.

 

[Hines302]

Here we have an enthusiastic young doctor who has been shut out of caring for the largest segment of his population (other than "routine" care) and why? Not because his state license says he can't. Not because he is poorly trained. Not because he doesn't want to. No...it is because of the arbitrary policy of some faceless insurance company.

MAKE SURE YOU CAN ACCEPT MEDICAL PLANS IN THE AREA WHERE YOU WANT TO PRACTICE OR YOU WILL BE RELEGATED TO PROVING ROUTINE CARE AND SELLING EYEWEAR. IS THAT WHAT YOU WANT AFTER 8 YEARS OF POST SECONDARY SCHOOLING? I WOULD BET NOT.

This is very frustraiting!! As furture OD's we must get involved to make sure this type of discrimination can not happen. I believe with a little work and time this type of discrimination will eventually cease to exsist. Everything takes time. This is why it is so important to get involed in your local, state, and national associations and let your voice be heard (this includes doing more than complaining about it in an online forum..... 🙄 )

Please fill out this petition if you have not already done so... http://www.odwire.org/petition/

I would caution Ken not to paint such a grim picture of the profession. I think we can all agree that more OD's are accepted on medial pannals than were 10 or 15 years ago. In fact on odwire.org a poll showed that over 50% of OD's had little or no trouble getting on medical insurance panals. However any discrimnation at all... is too much.

 

[cpw]

This is very frustraiting!! As furture OD's we must get involved to make sure this type of discrimination can not happen. I believe with a little work and time this type of discrimination will eventually cease to exsist. Everything takes time. This is why it is so important to get involed in your local, state, and national associations and let your voice be heard (this includes doing more than complaining about it in an online forum..... 🙄 )

Please fill out this petition if you have not already done so... http://www.odwire.org/petition/

I would caution Ken not to paint such a grim picture of the profession. I think we can all agree that more OD's are accepted on medial pannals than were 10 or 15 years ago. In fact on odwire.org a poll showed that over 50% of OD's had little or no trouble getting on medical insurance panals. However any discrimnation at all... is too much.

well said , Hines. I'd also encourage all students to get involved in AOSA , and your state organizations to help fight things like this.

 

[KHE]

This is why it is so important to get involed in your local, state, and national associations and let your voice be heard (this includes doing more than complaining about it in an online forum..... 🙄 )

In fact on odwire.org a poll showed that over 50% of OD's had little or no trouble getting on medical insurance panals. However any discrimnation at all... is too much.

My good man,

You have no idea how much I tried to get involved in local, state, and national associations with respect to this issue. To them, this issue was a non starter. Their biggest concern was trying to prevent passage of the FCLCA and hassling optical shops. At meetings, the people in charge mostly poo pooed the issue saying it wasn't pressing and that we shouldn't be forgetting our "roots" What they failed to realize is that ITS THE BIGGEST DAMN ISSUE IN THE FIELD TODAY!

With respect to the odwire.org poll, more than 50% (I guess 50.91% is technically "more than 50%") means that just about HALF of ODs ARE discriminated against more often than not.

If you want a rewarding career in optometry, you better make damn well sure that you not in the latter group.

 

[ckyuen]

Don't feel like you guys are alone. A lot of insurance panels only let me bill vision services also, as an OMD. And a lot of panels are closed to me, can't get in just keep getting denied. And these are panels where my friends are on the board of directors. It just takes one person to say no from what I hear. Many insurances also have ridiculous application fees, often times thousands of dollars with no guarantee of any patients to follow.