Several discriminatory policies have prevented nearly two in three ODs from joining insurance plans. Photo: Getty Images.
Optometrists have long fought to be seen and treated with the same respect as other medical doctors, especially ophthalmologists. Unfortunately, a recent survey by the American Optometric Association (AOA) Health Policy Institute revealed that discrimination still exists against doctors of optometry, specifically from insurance companies. Sixty percent of OD respondents reported that they have faced denied participation in a health plan’s network.
The AOA distributed the survey to optometrists across the country and received 485 qualified responses from doctors in 47 states and the District of Columbia as well as from 42 state affiliate executive directors. Nearly two-thirds (64%) of respondents reported that health plans required them to credential with a vision plan, a policy that doesn’t translate to ophthalmologists.
The results also suggested locational differences in insurance discrimination. For ODs practicing in metropolitan regions, the AOA wrote in their paper on the survey results that “84% reported denial to a medical plan’s panel, while only 48% of doctors not practicing in a metropolitan statistical area reported a denial to a medical plan panel.”1 The paper also noted that “29 responding affiliates were aware of doctors in their state being denied participation in a health plan network.”
While the rate of vision plan denial among optometrists certainly represents discrimination, it was only half that of health plan denial. “Thirty percent of respondents reported being denied participation in a vision plan network, while twice as many respondents reported being denied participation in a medical or health plan,” the survey authors wrote.
There were several reasons for vision plan participation denial, including the plan’s provider network was full (55%), the plan did not contract with private practice doctors (25%), proximity to other plan providers (18%) and the plan required an in-house optical (18%). For health plan denial, the survey authors wrote, “In contrast to their experience with vision plan denials, doctors of optometry found that only 40% of denials to medical plans was based upon the network of providers being full. Alarmingly, one-third reported that the denial was based upon the health plan’s policy not to incorporate doctors of optometry into the medical provider panel.”
Additionally, an online article by the AOA on the findings also stated, “A third of doctors of optometry reported being paid differently than ophthalmologists for the same procedure by the health plan, a differential accounted for by quality or performance measures only 7% of the time.”2
It’s clear from these survey results that discriminatory policies exist against optometrists throughout the country. What can be done to initiate change?
“Educating the plans and the patients on optometry's scope of practice can often help,” Steven Eiss, OD, chair of the AOA Third Party Center, says in the article. “Many times, it can just be related to ignorance of what optometry can do. Also, the AOA, through the Third Party Center, has dedicated a lot of resources to battle this discrimination. Any time we are informed of a plan that is denying optometry, we make every effort to reach out to those plans to educate them on the value of having optometry as part of their provider panel.”
These discriminatory policies not only affect optometrists but also their patients. They place a barrier between patients receiving accessible and affordable care from their trusted eyecare provider. In order for these laws to change, ODs and their advocates must continue to grow in these efforts to educate and earn the respect of patients, insurers and lawmakers.
1. Survey confirms insurance discrimination remains widespread. American Optometric Association Health Policy Institute. Published September 12, 2022. https://www.aoa.org/AOA/Documents/Advocacy/HPI/hpi_survey_confirms_insurance_discrimination_remains_widespread.pdf. Accessed on September 15, 2022.
2. AOA survey finds discrimination by health and vision plans. American Optometric Association. Published September 15, 2022. https://www.aoa.org/news/advocacy/third-party/aoa-survey-finds-discrimination-by-health-and-vision-plans?sso=y. Accessed on September 15, 2022.