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Words of wisdom from eyecare pros who made (or are making) the move from managed vision plans to private pay.

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If you feel you’ve reached a point in your practice where you no longer want to be held captive by the low-margin traffic generated by insurers, you may be wondering how to break free. We reached out to eyecare businesses to find out what steps they took to throw off the shackles of dependency on vision plans. None of these tips will work unless you’re able to engender patient loyalty — and you don’t need us to tell you where that comes from ­— but here are eight tips to help you plot your escape from insurance.

1 Secure sources of self-pay patients that continue to deliver. Buena Vista Optical in Chicago, IL, is taking what co-owner Diana Canto-Sims calls “pro-active baby steps to transition away from vision plans.” After they run quarterly reports of the vision plans with the lowest reimbursement, they’re on the way to finding self-pay patients to replace those patients the next quarter. Among the places they have found them are career days at local schools — they send every student home with information including a package of exam and glasses for first-time patients with no vision plan — and collaborations with organizations that reach out to the uninsured, such as the consulates of Latin American countries. (Buena Vista has a fully bilingual staff). “These organizations are very appreciative that we collaborate with them and they send us self-pay patients weekly,” she says.

2 Brace for a pre-cutoff influx; remind patients to check their medical coverage. Whelan Eye Care in Bemidji, MN, quit taking VSP almost two years ago. Bridgett Fredrickson warns ECPs that there will be patients that get upset. “We are honest and tell them to check with their medical insurance as it may cover their exam as well, or they are always welcome to self-pay and we give them a 20% discount for same-day payment. Remember, she says, that you will need to send all of the current households a letter letting them know that you are no longer going to be accepting their insurance with an effective date and they need to receive the letter at least 30 days before that effective date. “With this, expect an influx of patients that want to get in before that date,” she says.

3 Phase your plans out. Dr. Robert Easton Jr. has had a solo practice in Oakland Park, FL, for 37 years. One year his CPA told him “that since I was providing comprehensive eyecare, my vision plan base was increasing faster than my major medical, PPO and Medicare patient base. We were concerned that vision plans were taking over my practice, which could eventually put me out of business.” After careful analysis, Easton eliminated the three lowest-paying plans first and kept the other two as a cushion. As the other two continue to become more corporate in nature and their low reimbursements fail to meet his cost of doing business, Easton plans to eliminate those one at a time.

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4 Get your team up to speed. Jenna Gilbertson says dropping VSP was the best decision McCulley Optix Gallery in Fargo, ND, ever made. However, she cautions, “Before you ever send the termination letter to the insurance company, have a plan in place. Make sure all staff is on board. Have scripts for what to say. And have a plan for your patients. Be over-prepared for every situation. We ran role-plays with our staff, and had them think of all the questions a patient might ask.” They marked everyone who was pre-appointed on the schedule. They then went through each of those patients to see who had a calendar year plan, and called those patients, explained the situation, and rescheduled them for before our termination date. Yes, it meant the doctor had to work extra days and times, “but it was totally worth it to make those patients happy,” she says.

5 Keep a list of complaints about the plan you’re dropping. Last year Focus Eye Care in Hackensack, NJ, made the decision to jettison Davis Vision. Prior to this, the largest employer in the area had switched from VSP to Davis, while a big-box retail chain associated with the latter began advertising discounts. Before Focus could make the split it endured a period in which patients had a long list of complaints about jobs that were now going through Davis. Managing licensed optician Vlad Cordero took notes: “We used the list of complaints to train our front desk and optical staff on how to handle objections when Davis members call in to schedule an appointment or inquire about eyewear.”

6 Find a niche, or team up with an OD who has one. “The most important key to dropping insurance is having a niche,” says Dr. Pauline Buck, a vision therapy specialist at Behavioral and Developmental Optometrists in Miami, FL. “I was building that practice up while slowly dropping off insurance panels.” Next is the hard part. “You really need to get out into the community and speak about your specialty. I host quarterly lectures with dinner in my office for other professionals… The cost of the dinner is offset by a single referral.” Finally, “for non-optometric professionals who would like to break the bonds of insurance I highly recommend approaching specialists and seeing how your services can help them… I refer out 80 percent of my glasses prescriptions,” she says.

7 Help patients collect out-of-network benefits. The Visionary in Allen Park, MI, took a long look at their profit margin with EyeMed and decided it was time to split. They knew they had patient loyalty on their side. And, says Annette Prevaux, “We make it easy for patients to get their OON reimbursements by having the forms ready when they come in.” She expects to keep about 60 percent of her EyeMed patients.

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8 Switch to independent brands; consider an OON service. Krystal Vision in Logan, UT, is in the process of dropping most vision plans. According to Travis LeFevre, being insurance-free goes hand-in-hand with carrying independent brands. “It’s an easy jump to make once you look at your margins while taking insurance compared to cash pay and filing a simple claim for the patient out of network,” he says. He cautions that “creative marketing is a must to stay relevant after dropping managed plans.” And after initially being unimpressed, Krystal Vision now uses Patch, an “online insurance assistant” that helps ECPs and patients negotiate out-of-network benefits and claim them digitally. LeFevre says Patch is now offering a better product than it did three or four years ago. “It allows us to know the exact amount of a customer’s OON benefits for their vision insurance. It gives us a breakdown … depending on the plan and insurer. Another useful part of Patch is the ability to accept payment for VSP and Cigna claims; this allows us to give the patient the reimbursement savings up front rather than making them wait [for the] check in the mail.”

After years covering some of the farther flung corners of the world of business journalism, Heath has more recently focused on covering the efforts of independent eyecare professionals to negotiate a fast-changing industry landscape. Contact him at [email protected]

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