A new law in Texas prevents managed care plans—including medical and vision plans—from controlling fees on an optometrist’s products and services not covered by the plan.
“Over the past several years, our member doctors have complained that new benefit plan designs had the tendency to have steeper and steeper discounts required of the optometrist on non-covered services and products,” says Thomas A. Lucas, Jr., OD, legislative chair of the Texas Optometric Association (TOA). “In many cases, the optometrist was required to accept the terms of the new benefit design in order to become credentialed or stay credentialed with the company for their traditional benefit plan designs.”
But, standardized discount mandates don’t make much sense for small businesses, such as optometry practices, because consumers have abundant options for their needs at all ranges of quality and price, Dr. Lucas says. After failing to convince the insurance companies on this point, the TOA took the legislative route, and the legislature agreed.
The bill, SB 632, was signed into law by Gov. Rick Perry in mid-June. Specifically, it says that an insurance contract cannot limit the fees that an optometrist charges for non-covered products or services. It also says a contract cannot require discounts on non-covered products or services.
Now, optometrists in Texas “will be able to set their prices on goods and services at rates that make sense for their business and reflect local market conditions,” says Dr. Lucas, who advanced the legislation.
Comparable laws are already in effect in Kentucky and Maryland, he says. And, optometric leaders in other states have shown interest in supporting such bills. “I encourage each state association to consider working with their state legislatures to pass similar legislation,” Dr. Lucas says.
The law goes into effect on September 1, but it applies only to contracts entered into or renewed on or after January 1, 2014.