To VT Or Not To VT – The Final Act – Part 3

Just so we’re absolutely clear, I don’t think deciding against Vision Therapy for financial reasons makes you a bad person. Quite the contrary, in fact. If you travel far enough in the process to be told Vision Therapy is needed, you honestly have my complete admiration – even if you decide to take a pass.  If you do find yourself, or perhaps your child, needing Vision Therapy and money is the only thing stopping it from happening, my best suggestion is to talk to family members, friends, consider Care Credit, and if none of those options pan out, have a very honest conversation with the doctor.  I certainly cannot speak for all VT docs, but most of the docs I know have hearts of gold and would do all they can to make it work.  Some offices offer scholarships, some offer payment plans, and some offer a reduced rate for a few families per year. Heck, our office, a few years back, had a mom work as our janitor for six months in trade for the services her son received.  There’s always options, you just need to find them and maybe get a little creative.

My beef, and I’m going to call it that, is with the system. I know that. The system, in many ways, has forced its consumers to take the focus off the patient, off the quality of life, and place it smack dab into what is deemed “medically necessary”.  So, I’ll ask again, how can they possibly understand your child’s medical needs?  How can we possibly allow their judgement in the matter to be the final answer?

The survey posted in Part One asked a very simple question, and it was to identify the single most important factor in deciding whether or not to partake in VT.  The overwhelming majority of those who answered was, in one form or another, to improve the quality of their child’s lives. Now granted, it was a small cross section of voters (42 in all) and my blog is almost completely followed by VT supporters, so the results make sense. The people who voted wanted what’s best for their kids, and that trumped all else.

Now for the kicker…

In Part Two I mentioned that our office takes insurance assignment from most of the major providers, and we have a full time staff member assigned as the liaison between those providers and our patients. Well, every six months or so, along with our doctor, as management we review the newest policies and billing procedures to be sure we stay ahead of the many curves they seem to conjure. As a part of this process we review our conversion numbers, meaning we identify the number of people recommended into Vision Therapy and compare to the number of patients who actually enrolled themselves or their child.  So far in 2017, our office has referred 142 patients into Vision Therapy who were interested in billing their insurance, with a touch more than 60% of them deciding to enroll. As for the other 40%, well, you can probably guess why they decided against it. Their coverage was not what they had hoped for.

Here’s the math. Of the 56 patients in question who were referred into VT:

• 51 patients (or families) declined to enroll in VT after their doctor consultation due to issues with their insurance coverage. 39 of those actually enrolled initially after understanding the impact VT could have on their child’s life, but then backed out before starting our program because of what we politely refer to as “insurance complications”. The remaining 13 families understood their insurance before enrolling and never took another step towards improving their child’s vision.
• 3 (of the original 56) declined due to the distance and time commitment
• 1 had a death in family and promptly moved out of state
• 1 was overwhelmed with many other therapies and wants to revisit the VT idea in a year

51 families.

51 families who, sadly, allowed their insurance carriers make the decision as to what was best.

51 families who were told by a doctor they had found the help they (or their child) needed, and had to say no.

51 families whose family member potentially is still struggling in school (most of them were kids) because their insurance told them VT is not a covered benefit, or not medically necessary.

If that isn’t just enough to piss off the pope…

At my last estimation, there are approximately 2100 VT offices around the world, and that’s a rough estimation. There’s probably more. I’m not sure how many take insurance assignment, but even with modest estimates, the number of families falling victim to the game of insurance coverage is staggering. We had 51 patients so far in the first six months of 2017 (and June isn’t over yet), so multiply that out against the number of offices who accept insurance assignment for VT, subtract 10% to cover a margin of error, and the figure is still staggering.

Our friends at VisionHelp, who have been beyond fantastic in sharing their wisdom and experience, wrote a blog post a while back about a patient who was sent over by a strong referral source, who eventually cancelled his visit after learning his insurance would not cover the process. (Tip of the cap to Dr. Leonard Press). The post has always stuck with me for two very simple reasons. First, it shows this to be an industry-wide challenge, which is concerning. Secondly, because Dr. Press makes a point which rings true every time I get frustrated about someone allowing their insurance to dictate their care. The statement was (paraphrased) “It’s time to focus on our relationships with our patients rather than the insurance companies.”

Amen to that.

It may also be time to realize we need a better solution to these “insurance complications” so we can focus on these families and these kids. Dollars to donuts most of them would have enrolled in VT if their insurance was to their liking, and that is beyond disheartening. Instead, their coverage plan made the decision for them, and there’s no way to put a positive spin on that fact.

All parents want the best for their kids. It shouldn’t be this difficult.