Nov. 7, 2024 — The American Optometric Association (AOA) recently held a Reimbursement & Coverage Fairness Town Hall, offering updates on its efforts to address systemic issues in vision and health plan reimbursements for optometrists. This was the year’s second town hall focused on problems with vision benefit managers (VBMs), entities that mediate between insurers and optometry practices.

AOA president Steven T. Reed, O.D., announced that, since the launch of a multipronged advocacy initiative in January, the AOA and its affiliates have reclaimed over $2.9 million on behalf of optometry practices, the organization shares. These funds were returned after direct intervention by the AOA in response to approximately 200 complaints over a 14-month period from optometrists regarding issues like credentialing, claim denials, coverage concerns, and more.

“I want to underscore that it's really important that, if you're getting a denial or you have an issue, it's likely not just a one-off issue,” Dr. Reed says. “Typically, these are larger systemic issues that we can [also] work to address.”

During the virtual town hall, a poll of attending optometrists revealed significant concerns over health and vision plan practices. Key findings included that 84% of respondents saw “challenges with health and vision plans” as the most pressing issue facing optometry, while 98% reported difficulties with fee schedule negotiations. These results inform AOA's ongoing advocacy, according to AOA president-elect Jacquie M. Bowen, O.D., who reaffirmed the organization’s commitment to addressing these challenges.

In legislative efforts, the Dental and Optometric Care (DOC) Access Act, which seeks to address these concerns, has garnered support from more than 100 lawmakers. Additionally, the AOA has joined forces with Patients Rising, a consumer advocacy group, to brief Congress on challenges optometrists face, including those tied to VBMs. Notably, Texas has enacted a landmark vision plan reform law, marking the first legislation of its kind to tackle VBM practices.

AOA outside counsel Daniel Frier and Theresa DiGuglielmo shared guidance with optometrists on the legal aspects of dealing with VBMs, noting that VBM expansion has increased contractual pressures on independent practices. They highlighted the prevalence of “contracts of adhesion,” which are nonnegotiable agreements that can impose unfair terms on providers. The attorneys encouraged optometrists to review these contracts carefully, insist on up-to-date documents for cross referencing, and to challenge terms that may violate state regulations on vision care plans.

The AOA continues to press for transparency and accountability in VBM contracts, pushing for clear disclosure of any proposed contract changes. “You must know what you're signing and push back when the agreement is onerous or unreasonable,” says attorney DiGuglielmo.

Any challenges with health or vision plans can be reported to stopplanabuses@aoa.org, and more about AOA’s advocacy efforts can be found here.