To VT or Not to VT? – Falling On The Sword – Part 1

Operating an office which accepts third party assignment (medical insurance) can be a bit challenging. On the one hand, there’s the patients who find us simply because we accept their insurance, and on the other, there’s the folks who leave because their insurance didn’t participate in the manner they would have liked. In the middle somewhere, a few of them choose to play the game.

In our town, there are five or six offices offering Vision Therapy in varying degrees. Some offer it only for people with a specific diagnosis, some offer it as an adjunct to their primary care clinic, and some operate as a referral center where Vision Therapy is their bread and butter. Our office is the latter. We are very lucky in that all of our “VT neighbors” are excellent! The niche we have found, created, or maybe just bumped in to, is we are the only office in our area to accept insurance assignment. Because of this many patients contact us, having just had a full workup somewhere else, interested in better understanding how their insurance will interact with VT services. In essence, they have already been “sold” on Vision Therapy, we just need to find a time slot which works for them and play hardball with their third party coverage. Sounds easy, right?

Yeah, not so much.

A lot of times during our consultations, we will have lengthy discussions with parents about how powerful Vision Therapy is and how much potential there is in a patient, because that’s what’s important! Their kids are struggling in school, in sports and maybe even in life and we can help! We want to help! There’s proof we can help! The doctor is on board, the parents are on board, the patient (if it’s a child) gets on board and we’re all ready to roll!  Right before we walk out of the room, mom or dad will ask “does my insurance cover this?”, and that’s where the mistake is made. We just opened the door to our insurance company deciding what’s best for our child, didn’t we?

Now, I’m a single parent who works hard to make ends meet, and sometimes there’s just not enough money to go around, so I get the question. I really do. But consider this:

If the answer is “yes”, then life is good. This rarely happens.

If the answer is “no”, then the cards are on the table.

If the answer is “well, we have to submit the codes from your exam because your future visit coverage is based upon the diagnosis, and your insurance company cannot decide if this is a covered benefit until then”. Ummm….Houston, we have a problem. We are now going to let the insurance company decide both the importance of our services and the effective needs of the patient. This is troubling for many reasons. More to come on that thought…

A few weeks back, by way of a survey, I posed a question. It was:

What is the single most important factor in your decision to enroll your child in Vision Therapy?

Here are the results:

Quality of Life (My Child is Smart and Deserves Better) – 67% (28 votes)

Effectiveness (Assurance It Will Work) – 29% (12 votes)

Research (Prove It!) – 2% (1 vote)

My Answer Is Not Listed – 2% (1 vote)

Cost (Managing the Out Of Pocket Committment) – 0% (0 votes)

Insurance (Understanding My Coverage) – 0% (0 votes)

 

Ponder this for a moment…and stay tuned…

 

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Posted on June 19, 2017, in From My Perspective.... Bookmark the permalink. 2 Comments.

  1. A difficulty subject, Robert, and thank you for addressing “The Elephant in the Room”. I’ll be anxiously awaiting Part 2. We made the decision a long time ago not to work for third parties by being a par provider, and to keep the relationship primarily between us and the patient. Our “niche” is working hard to be an advocate for the patient to be reimbursed to the extent they’re entitled out of network. We believe the plusses outweigh the minuses from many angles, all the way around.

    Liked by 1 person

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