Insurance Discrimination Against Optometrists

on September 10th, 2007 | Filed under Comics, Optoblog

Your claim was rejected because you are an optometrist.  We only pay out to ophthalmologists.  So, you can put a price on an ophthalmologist, but an optometrist is priceless?

In Utah, the major health insurance company is called SelectHeath, a.k.a. IHC, Intermountain Health Care, SelectMed, and SelectCare. What’s funny is that they allow optometrists on their panel in remote areas and even in populated areas like St. George where there are an abundance of OMDs; however, in the most populated “I-15 Corridor” and even in Cache Valley way up north, they only allow our “EyeMD” friends. The notable exception is the Brigham City/Tremonton area.

IHC recently rebranded themselves “SelectHealth, simply there” and claim in their commercials that they are providing quicker access to care, but if they don’t allow optometrists to be paneled then they are actually slowing access to care. Currently in my area, several OMD offices are booked weeks in advance- some doctors have up to a 2 month wait. Word on the street is that the Brigham City area panel was opened for optometry because of all the employees of ATK (rocket engines) in that area. They had to open up the panel for O.D.s so there would be enough eyecare providers for their ATK beneficiaries.I talked to someone in the know. A manufacterer of car air bags had a large number of employees on IHC, yet none of the eye doctors in the area were on the IHC panel, including the OMD. They opted to let an O.D. be panelled (presumably because the OMD was doing surgeries at a non-IHC hospital). Then they later allowed the OMD to be panelled if he agreed to take the IHC surgical patients to the nearest IHC hospital.

But what is the deal with restricting O.D. enrollment? They would pay me the same as an OMD for a routine eye exam, so it doesn’t make fiscal sense…actually, it does when you think that patients get fed up with the long wait to get in with an OMD, so they just pay out of pocket to be seen by an optometrist. IHC doesn’t have to reimburse anything because they went out of network to a non-participating provider. (And the only reason the O.D. isn’t participating is because IHC won’t panel him/her.)

Anyway, I tell patients about the situation all the time, and invariably they say something like, “Oh, it’s all political.” Exactly. They get it. They realize their health plan is flawed. I wish more patients would make a stink to the IHC administrators, but I’ll bet they don’t because they’re used to SelectHealth not being there for them despite what its commercials claim.

If SelectHealth really wanted their beneficiaries to have quicker access to care, they would allow any optometrist to be paneled anywhere.

When will Utah get an Any-Willing-Provider law? This type of discrimination should be illegal.

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  1. […] recently talked about a local HMO/Insurance Plan, IHC-SelectHealth, that discriminates against optometry. A lawsuit was […]