Optometrists Seek Negotiating Power With Insurers

Dr. Susan Shauger performs a routine eye exam on Josh Fish at Lakeline Vision Source. A bill backed by optometrists to give them more negotiating power with health insurers, could force customers to lose discounts on services outside their insurance policy’s coverage.
Dr. Susan Shauger performs a routine eye exam on Josh Fish at Lakeline Vision Source. A bill backed by optometrists to give them more negotiating power with health insurers, could force customers to lose discounts on services outside their insurance policy’s coverage.

A group of Texas optometrists is lobbying the State Legislature for more power to negotiate contracts with health insurance companies, and the measure they are supporting could hit consumers’ wallets, some business advocates say.

“The problem is that optometrists are just getting eaten up by insurance companies,” said Dr. Thomas A. Lucas Jr., an optometrist and legislative chairman for the Texas Optometric Association. “It’s very rare that the small-business optometrist has any say in what’s actually in the contract.”

Senate Bill 632, by Sen. John Carona, R-Dallas, would prohibit a common practice among insurers: contractually obligating optometrists to offer discounts on services and products that are not covered by the health plan, like a spare pair of glasses or cosmetic contact lenses that change eye color.

The Senate approved the bill this month, and state Rep. J.M. Lozano, R-Kingsville, has agreed to sponsor the bill in the House.

Kandice Sanaie, a lobbyist for the Texas Association of Business, argued that the restriction would mean that consumers would pay more for uncovered items. It could also raise insurance premiums, she said, if insurers began including uncovered services that were previously discounted in a health plan.

“There’s nothing forcing providers to sign contracts with health insurance carriers in the first place,” Sanaie testified last month at a legislative hearing on the bill.

Optometrists who sign contracts with insurance networks, she added, receive client referrals from the insurer.

“Proposals to prohibit such offerings are anti-consumer, serving only to limit the ability of your constituents to obtain quality vision care at an affordable price,” a representative for America’s Health Insurance Plans wrote in a letter to Carona expressing the trade association’s opposition to the bill. She added that the bill would reduce the number of employers who are able to provide vision coverage because of the increased costs.

In 2011, Texas approved a similar law — also carried by Carona and Lozano — to prevent insurers from requiring discounted prices on uncovered dental services in contracts with dental providers.

From 2011 to 2012, the Texas Optometric Association donated $15,000 to Carona and $3,000 to Lozano, according to a Texas Tribune analysis of campaign finance records.

As dental and vision benefits are considered additions to health plans, they typically cover only basic preventive services to keep rates low and are subject to more stringent contract terms with health insurers, Lucas said. Insurers force doctors to offer discounts on uncovered products and services, he said, to make a health plan more attractive to consumers.

“All of that is borne onto the provider at a significant financial cost,” Lucas said. When discounts are required on the uncovered services, he said, optometrists raise rates to cover the costs.

“Downstream, that hurts any consumer that is not covered by that policy,” he said, “including the uninsured.”

Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.