Illinois, Georgia pass legislation to address vision plan abuses
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Illinois and Georgia have passed legislation to protect optometrists from vision plan-enforced discounts and interference in the doctor-patient relationship.
The American Optometric Association stated in a notice to members on its website that Illinois passed “precedent-setting legislation” in early August, the same week VSP Vision Care notified the Georgia Optometric Association (GOA) it would comply with SB 27, which passed in May.
On Aug. 4, Illinois Gov. J.B. Pritzker signed the Vision Care Plan Regulation Act, which prohibits plans from requiring providers to set fees for services that are not covered under the plan, requires fees for covered services to be reasonable and clearly outlined, prohibits misrepresentation of vision care benefits and prohibits vision care organizations from restricting an eye care provider’s choice of suppliers. The law also states that terms, fees, discounts or reimbursement rates in a vision care plan can only be changed if both the eye care provider and vision care organization agree in writing.
“SB 764 promotes transparent pricing and out-of-network disclosures,” Illinois Optometric Association President Chelsey Moore, OD, said on the AOA’s website. “It offers access to in-network options, safeguards against misrepresentation and encourages fair practices for better patient care.”
Meanwhile, Georgia passed legislation in May to close a loophole that had allowed vision care organizations to require that clinicians offer discounts on noncovered services. This loophole existed in spite of legislation passed in 2021 that outlined fair trade practices for vision care organizations, the AOA said.
“We want to work with the insurance plans,” GOA President Nacondus Gamble, OD, FAAO, said on the AOA website. “But we don’t have to just take whatever they give us when it doesn’t benefit patients and optometry. This is a clear-cut message to these plans that we’re not going to play ball. I feel like this has set a precedent.
“We already had a law in place here,” Gamble continued. “The ink was barely dry on the document, and it was out of compliance with the spirit of the law. That did not sit well with us, because our goal was to make it uniform across the board. The goal was not to force discounts on the eye care provider.”
Clinicians who participated in the VSP Premier Edge program, which required discounts on noncovered services, may now opt out of such discounts and continue with the program, according to the AOA.
Although these legislative wins indicate a push toward ending vision care abuses, advocacy continues to be crucial throughout the country, AOA State Government Relations Committee Chair Johndra McNeely, OD, said on the AOA’s website.
“Unfortunately, there’s a lawsuit that’s been filed in Texas over their vision plan,” McNeely said. “But, overall, there is so much more awareness now nationwide over the vertical integration of these plans and how they are disrupting the doctor-patient relationship and what’s in the best interest of the patient.”
References:
- Georgia Senate Bill 27. https://legiscan.com/GA/bill/SB27/2023. Accessed Aug. 14, 2023.
- Illinois Senate Bill 764. https://legiscan.com/IL/bill/SB0764/2023. Accessed Aug. 14, 2023.
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