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Texas legislators pass insurance statute protecting optometrists
Eye care practitioners in this state will be able to consider medical and vision plans independently starting in January.
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A statute was added to the law regulating the Texas Department of Insurance and the operation of certain insurance programs that protects optometrists from coercion by managed care plans.
As a condition for inclusion into one or more of a plan’s medical panels, the statute states, health insurance companies can no longer legally require an optometrist or ophthalmologist to be included in, or accept terms of payment under, a particular vision panel in which he or she would not otherwise wish to be included.
“Optometrists in Texas will now be able to independently consider medical plans and vision plans that make sense for them to join,” Thomas A. Lucas Jr. OD, communications chair for the Texas Optometric Association Board of Directors, said in an interview with Primary Care Optometry News.
Eye care practitioners will be able to credential and re-credential without the specter of accepting terms of an unwanted vision plan, Dr. Lucas added.
Prior to this legislation, Dr. Lucas explained, vision plans had convinced insurers to institute policies requiring optometrists to join certain vision plans in order to be a part of the medical plan, and optometrists who were already credentialed with certain medical plans were told that in order for them to re-credential, they would have to sign contracts, listing nonnegotiable terms and requirements, with a specific vision plan that the health insurance company had partnered with.
“The arrangement was a win-win for both companies,” Dr. Lucas said, “and a lose-lose for doctors and patients. Optometrists who were managing and treating patients with medical eye conditions were shocked when they were told that they must accept the terms of an unrelated vision wellness plan, and that if they did not capitulate, they would lose their ability to see the medical patient as a contracted provider.”
The statute also states that managed care plans cannot exclude an optometrist as a participating practitioner in the plan due to a lack of medical staff privileges at a hospital or particular hospital, or because services or procedures provided by an optometrist may also be provided by another type of health care practitioner.
Also, patients enrolled in a managed care plan cannot be restricted or discouraged from seeing an optometrist for covered vision or medical eye care services solely on the grounds of the practitioner being an optometrist.
“The Texas Department of Insurance has been monitoring the situation and is already in contact with medical insurers who have current policies that are violating the new statute,” Dr. Lucas said.
The change in law only applies to a contract entered into or renewed on or after Jan. 1, 2012. The legislation specifies that contracts entered into or renewed before this date are grandfathered under the old laws and will continue as such until the contract expires. – by Daniel Morgan
- Thomas A. Lucas Jr., OD, can be reached at 2102 South W.S. Young Drive, Killeen, TX 76543; (254) 690-4733; fax: (254) 690-6728; talucas@gmail.com.