Insurers See Red Over Bill Allowing Optometrists to Opt Out of Vision Plans

Andrew Kitchenman | January 8, 2016 | Health Care
Optometrists argue it’s about offering consumers more choices. Insurers counter it’s about charging patients more for basic services

eye chart optometrists
Optometrists are pushing for a newly passed bill that they say would give consumers a wider choice in eye-care providers. But the insurance companies that oppose the measure say it’s not about choice, but a strategy to raise prices for typical vision expenses like eye exams and eyeglass frames.

With the bill on Gov. Chris Christie’s desk, he will have to decide which argument to back.

The bill, A-1035/S-2040, would allow optometrists to participate in insurers’ medical plans,which cover services like screening for glaucoma and cataracts, without also participating in their vision plans, which cover normal eye exams, as well as eyeglass lenses and frames. Currently, insurers require optometrists to participate in both medical and vision plans — typically offered by a company hired by the insurer — in order to offer discounts to patients.

While insurers say that this keeps costs down, bill supporters say that it prevents consumers from choosing to go to optometrists who only want to offer services covered by medical plans. The insurers counter that the legislation will allow the optometrists to charge more for regular eye exams and other services covered by vision plans.

Similar legislation has been enacted in 10 other states, part of an ongoing tug-of-war over the rules that determine the scope of practice offered by different eye-care providers.

Leaders of the New Jersey Society of Optometric Physicians argue that the bill is necessary to prevent patients from being denied access to optometrists who choose not to participate in visions plans.

“Optometrists want to be in-network — they want to be in-network for medical care,” said Christopher Quinn, an optometrist who’s practiced in the Woodbridge area for 30 years. But bill opponents are concerned that some optometrists will seek to raise prices for normal eye exams and other services covered by vision plans.

Bill sponsor Sen. Gerald Cardinale (R-Bergen and Passaic) also argues for the bill in terms of increasing consumer choice.

“It is obvious that folks who can provide some of the services but not all of the services that are needed by patients who have eye problems are a legitimate part of the service community,” Cardinale said. He said that if optometrists choose not to make eyeglass lenses or sell frames, they shouldn’t be prevented from signing contracts for medical insurance. Without having insurance contracts for medical care, these optometrists would be too expensive and would no longer be a choice for patients, Cardinale suggested.

But insurers suggested that the bill isn’t about those optometrists who just want to offer medical services and not regular eye exams. Instead, some optometrists may prefer to be outside of the insurer’s vision-plan networks so that they could receive more money for these non-medical vision services than the reimbursements offered by insurers.

For example, Cigna estimates that vision-care premiums would rise nearly 45 percent for patients of those optometrists who don’t accept vision-care insurance and only accept insurance for medical care. In addition, the average annual out-of-pocket costs for patients would increase from less than $7 to nearly $80, since fewer patients would benefit from insurer-negotiated discounts.

Cigna lobbyist Patrick Gillespie raised the possibility that optometrists would engage in the same reliance on out-of-network business practices that have raised concerns of legislators with some hospitals and medical practices.

“We don’t want to see that transferred from certain hospital settings to the vision-care setting,” Gillespie said of out-of-network pricing, saying that consumers who believe their insurance will cover the cost of buying glasses could be hit with “surprise bills.”

Gillespie said that insurers would support an amendment to the legislation that would allow doctors of optometry that truly do not offer any non-medical vision care to contract with insurers for only medical care, the same way they do with ophthalmologists, who have doctor of medicine or doctor of osteopathy degrees. But the sponsors didn’t agree to the proposed amendment.

The Senate passed the bill 34-0 yesterday, after the Assembly passed it 74-0 last month. The bill had bipartisan sponsors in both houses, with Sen. Nicholas P. Scutari (D-Middlesex, Somerset, and Union) joining Cardinale in the Senate, while Assemblymen Daniel R. Benson (D-Mercer and Middlesex) and David P. Rible (R-Monmouth and Ocean) sponsored it in the Assembly.