(PRESS RELEASE) ST. LOUIS, MO — Problematic downcoding, large-scale coding and editing issues, and issues with vision plans and Medicare credentialing can quickly erode profits in optometry practices. Ongoing, direct advocacy by AOA, affiliates and the strong network of AOA’s Third Party Center volunteer doctors restored more than $12.1 million in reimbursement payments to thousands of AOA and affiliate members since 2024.
The Third Party Center Committee, chaired by Steven Eiss, O.D., has worked tirelessly to ensure that time-intensive records requests, inappropriate denials, Medicare Risk Adjustment audits and downcoding delays were adequately compensated or halted, with a total of over more than $4.6 million restored during the last six months.
AOA President Jacquie M. Bowen, O.D., says there is more to do, and implores doctors of optometry to report plan abuses immediately, no matter how large.
“We are committed to doing all we can to support our member practices, help them thrive and break down any barriers to care,” Dr. Bowen says. “Uncompensated and undercompensated care doesn’t just hurt optometrists’ financial sustainability. It drives up the cost of care and lowers accessibility for those who need it most.”
Fighting Financial Burdens from Payers
Along with time-intensive records requests, several other actions can create undue financial burdens on providers. Fielding unfair or automated denials by health payers costs $43.84 to fight a single denied claim. Although 97% of claims are eventually paid, providers spend $19.7 billion annually for the administrative labor to make that happen.
Downcoding that delays or reduces payments, contract renewal issues, and credentialing issues diverts staff resources from patient care. In September 2025, AOA won a huge victory with the halt of Aetna’s downcoding program. AOA reached a first-of-its-kind agreement with the payer, ending auto-downcoding of 92xxx EMR codes. This change alone represents thousands in savings for impacted optometrists. Providers who were previously downcoded by Aetna can still file appeals with AOA’s backing and administrative support. partnering with providers to demand compensation for administrative labor for these requests.
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A victory like this is evidence of the value of the Third Party Center. Instead of expecting doctors to shoulder this undue financial burden, the AOA acts as an extra administrative staff member to fight claim denials, inaccurate network directories, or a host of other issues that arise. Often, it only takes one doctor’s report to uncover a problem that affects doctors statewide, or even nationwide, such as new codes and system updates that can lead to claim denials across the industry.
The Third Party Center Committee is ready to investigate and advocate on doctors behalf. Connect with the Third Party Center Committee at [email protected]
