WOW I can't provide medical eyecare to cigna pts.

[HOLLYWOOD]

I can't provide medical eye care to cigna pts. . They said ods should not provide medical. So they just kicked me off. I also heard ods in fl can not provide medical eye care is that true? Well it's true for my friends. This profession stinks.

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[jchod]

I can't provide medical eye care to cigna pts. . They said ods should not provide medical. So they just kicked me off. I also heard ods in fl can not provide medical eye care is that true? Well it's true for my friends. This profession stinks.

Per their web site you can, as a "Out of Network Provider".

 

[Ben Chudner]

I can't provide medical eye care to cigna pts. . They said ods should not provide medical. So they just kicked me off. I also heard ods in fl can not provide medical eye care is that true? Well it's true for my friends. This profession stinks.

Contact your state association and try to get the law changed to "Any willing provider". Good luck!

 

[cpw]

You cannot do medical eye care for certain plans. I know I can't provide medical eye care for Humana in Florida.

 

[KHE]

Contact your state association and try to get the law changed to "Any willing provider". Good luck!

A great idea in theory, but be careful what you wish for.

"Any willing provider" is almost certainly going to come back and bite optometry when commercial interests force VSP to open up to them since they (the commercial interests) will be "willing providers."

Many private practices are hanging on by the VSP thread. What will happen to private practice optometry when VSP is suddenly taken at every commercial outlet in town?

 

[KHE]

You cannot do medical eye care for certain plans. I know I can't provide medical eye care for Humana in Florida.

How big is Humana in Florida? Please correct me if I'm wrong, but my understanding is that its the largest managed care company down there.

So what do you do with your "medical" patients? You send them to their PCP? To an ophthalmologist? Basically, a significant portion of the patient population is off limits to you.

Great for the patient, but what message does it send? It tells the patient that unless you have ANYTHING WRONG WITH YOUR EYE OTHER THAN A NEED FOR GLASSES OR CONTACT LENSES, EVEN IF ITS A SIMPLE PINK EYE, THIS OFFICE IS NOT THE ONE TO GO TO!

And I maintain that this type of situation does as much, if not more damage to optometry than all the Walmarts in the world combined.

 

[Ben Chudner]

A great idea in theory, but be careful what you wish for.

"Any willing provider" is almost certainly going to come back and bite optometry when commercial interests force VSP to open up to them since they (the commercial interests) will be "willing providers."

Many private practices are hanging on by the VSP thread. What will happen to private practice optometry when VSP is suddenly taken at every commercial outlet in town?

Any willing provider refers to medical, not routine vision plans.

 

[cpw]

How big is Humana in Florida? Please correct me if I'm wrong, but my understanding is that its the largest managed care company down there.

So what do you do with your "medical" patients? You send them to their PCP? To an ophthalmologist? Basically, a significant portion of the patient population is off limits to you.

Great for the patient, but what message does it send? It tells the patient that unless you have ANYTHING WRONG WITH YOUR EYE OTHER THAN A NEED FOR GLASSES OR CONTACT LENSES, EVEN IF ITS A SIMPLE PINK EYE, THIS OFFICE IS NOT THE ONE TO GO TO!

And I maintain that this type of situation does as much, if not more damage to optometry than all the Walmarts in the world combined.

yeah, it drives me nuts. Humana has "pods"... you have to send them to the OMD in their pod. they don't really get to choose which one they go to. They have to call and figure out who the OMD is for their area/pod.

In my area, most patients have United Health Care.. who does let ODs on panel.

The office I'm currently in deals with this by just not taking any medical insurances at all and lets people file out of network for themselves. The only thing we take it Eyemed (because we have to.. thanks Luxottica) This way, I still have two or three red eye patients a day. It's easier for them to pay me 45 dollars to come in than to try to get in to see an OMD the same day their eye hurts through Humana.

 

[KHE]

Any willing provider refers to medical, not routine vision plans.

I know thats what you (and most ODs) are talking about when you speak of any willing provider legislation.

But what would stop any commercial entity from using the "any willing provider" laws to force VSP to open up their panel to them?

 

[KHE]

yeah, it drives me nuts. Humana has "pods"... you have to send them to the OMD in their pod. they don't really get to choose which one they go to. They have to call and figure out who the OMD is for their area/pod.

.

Its kind of odd that Florida puts you guys through such a ridiculous examination when a significant number of managed care plans, including the largest in the state won't allow ODs to bill medical claims.

 

[HOLLYWOOD]

Its kind of odd that Florida puts you guys through such a ridiculous examination when a significant number of managed care plans, including the largest in the state won't allow ODs to bill medical claims.

I agree I went to school in FL. And that brings up another point many people talk about medical eye care but most of my patients don't need medical eyecare and the ones that do go to mds. My second point is that it's not so easy to get on these panels and once your on its not so easy getting paid.

 

[HOLLYWOOD]

Its kind of odd that Florida puts you guys through such a ridiculous examination when a significant number of managed care plans, including the largest in the state won't allow ODs to bill medical claims.

I agree I went to school in FL. And that brings up another point many people talk about medical eye care but most of my patients don't need medical eyecare and the ones that do go to mds. My second point is that it's not so easy to get on these panels and once your on its not so easy getting paid.

 

[Ben Chudner]

I know thats what you (and most ODs) are talking about when you speak of any willing provider legislation.

But what would stop any commercial entity from using the "any willing provider" laws to force VSP to open up their panel to them?

They way VSP works, there would be no advantage for the patient to go to a corporate doc that takes their insurance. The copays are all the same no matter where you are seen, as are the overages. I believe when given the choice, patients with insurance would prefer not to go to the mall to get an exam unless they have to. The truth is, I would not miss VSP very much unlike a lot of other docs, but I seriously doubt private docs would see a big change.

The real issue is whether or not VSP can discriminate based on having an optical. That's why corporate docs can't take VSP now. They are required to have an optical with at least 200 VSP covered frames. Since this is a requirement all docs have to meet, including private practice OD's and OMD's, I don't think this will ever change.

 

[Ben Chudner]

I agree I went to school in FL. And that brings up another point many people talk about medical eye care but most of my patients don't need medical eyecare and the ones that do go to mds. My second point is that it's not so easy to get on these panels and once your on its not so easy getting paid.

This is state specific. In my state, for example, we are on all medical panels. I agree that the majority of patients seen in an OD practice do not need medical eyecare, but with the proper education you can help ensure that when they do need it, they see you. My office also educates local MD offices, so that they refer to us as well. The advantage we have is that we are not booked up 5 months out like the OMD's.

 

[Hines302]

The advantage we have is that we are not booked up 5 months out like the OMD's.

If most OMD offices are booked up that far in advance now (assuming they are).. does that not mean that OD's will have to deal with more pathology, and pre/post surgical visits in the future... as the baby boomers age? Won't OMD's be to busy in the OR?

 

[KHE]

If most OMD offices are booked up that far in advance now (assuming they are).. does that not mean that OD's will have to deal with more pathology, and pre/post surgical visits in the future... as the baby boomers age? Won't OMD's be to busy in the OR?

You would think so wouldn't you?

But go ahead and pull out your yellow pages and start phoning around to a few ODs and OMDs in your area. I will bet $10 that 95% of OMDs will have waiting lists of at LEAST 4-6 weeks. I will also bet $10 that you can get an appointment with 95% of ODs within 2 days and a lot of them will have large yellow page ads that proudly proclaim "walk ins welcome"

There is no real reason to think that this trend will not continue. As long as ODs are being denied onto managed care plans, you are not going to be seeing any pathology or pre/post op cases.

As long as OD schools continue to not train their students in proper hospital based settings (by that I mean, NOT the VA) there is no reason to think that primary care physicians will refer to you.