As much as I detest health care insurance, some providers are better than others. Then again, some are much worse than others—far worse.

A few years back, a vision care provider with a glib OD front man started coming to our state association meetings. He seemed sincere enough, so his reassurances about how much his company respected and wanted to work with optometry sold us. The plan covered state of Arizona employees, which sounded good to us, as we built a then brand-new practice.

So we initiated the credentialing process. When we requested a fee schedule, we were told that it was confidential and only provided to participating providers. Although warning bells rang in the distance, the explanation seemed sufficiently plausible to get past my typical New Yorker state of finely tuned BS detector.

We soon found out that the plan was not what we were told. Reimbursements were paltry, and dilated exams had to be justified, coded separately and were payable for state employees only. In this day and age that’s hard to believe, isn’t it? By the time we realized what we had stepped into, we had unpaid claims accumulating.

Although we hated to lose patients, we sent our notice of withdrawal from the plan and waited to be taken off the provider list. Today, well over a year later, more than a thousand dollars in legitimate claims remain unpaid, despite numerous calls and repeated empty promises. This past weekend, out to dinner with OD friends, we discovered that we’re not alone. A quick check of other local practices shows that this may be endemic. 

We will be filing a complaint with our state insurance commissioner, and now that I am sufficiently irritated, perhaps I’ll take it further. However, regardless of how this turns out, an important lesson was learned: If an insurer isn’t up front from the beginning, the relationship isn’t likely to have a happy ending.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com