Four optometrists in a group practice in Georgia have sued and won against Spectera. The suit was over a change in the provider agreement that required private practice Spectera providers in the state to use Spectera’s labs for supplying member patients with frames, lenses and contact lenses. This change in Spectera’s plan meant that providers would not be allowed to use their own in-house labs or materials.
How it began: Spectera announced in October 2010 that it was “phasing out” its Patriot provider agreement. To continue as Spectera providers, optometrists had to sign a new contract that “would require use of our lab network for the eyeglass orders and formulary contact lenses,” Spectera wrote in an e-mail.
Optometrist Steven Wilson, of Wilson Eye Center in Valdosta, Ga., couldn’t agree to that. “Our personal service is what a private practice has to offer,” he says. “Eyeglasses are not a widget that you’re buying off the rack—there’s a service component to the manufacture of eyeglasses.”
In court documents, Dr. Wilson and other O.D.s in his practice—David Price, Cynthia McMurray and Jodie Summers—pointed out that Spectera states that it offers its members “the personal service of a private practitioner … a family eye doctor.”
But Spectera’s new contract would take the supply and materials out of the private practitioner’s hands, essentially giving the patient no real choice at all—only Spectera’s materials and services, Dr. Wilson says.
This, Dr. Wilson and his colleagues argued, violates the Patient Access to Eye Care Act, which specifically ensures patient access by allowing “each eye care provider on a health benefit plan provider panel… to furnish covered eye care services to covered persons to the extent permitted by such provider’s licensure.”
And their licensure certainly permits them to provide materials and services, Dr. Wilson and his colleagues noted in the lawsuit.
In mid-September, a county superior court judge agreed, and ruled in favor of Drs. Wilson, Price, McMurray and Summers. In his ruling, the judge prohibited Spectera from requiring a provider to agree to a contract that would preclude the provider from “preparing, supplying and selling eyeglass frames and lenses or supplying and selling contact lenses” to patients who are covered by Spectera’s plan.
This ruling applies only to practitioners in Georgia. Dr. Wilson says he knows of no other similar case against Spectera in the nation.
Spectera did not respond to requests for comment as of press time. Georgia law allows 30 days for an appeal, and Dr. Wilson expects that the company will appeal the decision.