Insurance reimbursements past 12 years

[Ryan_eyeball]

This is how eye exam reimbursements have changed in the past 12 years for me. Every state/city may have different experiences. Also different practices may have been more successful in negotiating rate increases. Vision plans are notorious for not increasing reimbursement unless they are low penetration in an area.

I have not always taken every plan every year but examine payment schedules faxed to me, and some I have accepted for 12 years. Again this is just for eye exams and not materials or ancillary tests. Some ancillary tests have increased but some have decrease reimbursements.

Vision plans
2006-2018 No rate increase (ZERO!)
Eyemed, Davis Vision, Superior Vision, Avesis, Spectera (optumhealth), NVA, and state medicaid program.

2008-2017 VSP 0% increase 2018 saw a 4% increase.

Medical plans
Coventry, Aetna, Tricare 0% increase

Blue Cross Blue Shield 38% increase since 2006 rates (seen two rate increases)

United Health Care 7% negotiated increase.

Medicare is not a "routine" vision carrier per se, but a medically necessary exam with refraction may be performed.


200k+ loans at 4-6% for new students are getting harder to justify the ROI you'll be getting out of optometry. Love the job, but my eye exams were worth more 12 years ago due to inflation.

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[siddom]

Think there r some schools offering lower tuition though

 

[bigred]

Think there r some schools offering lower tuition though

Which school is lower now than it was 12 years ago? I doubt there is even one school now that is as low as the most expensive school was 12 years ago.

The point is reimbursement which is tied to income is not increasing. Interest rates, tuition, and cost of living have all increased substantially. In 2005 student loan rates were below 3%. Optometry school tuition was half the price. And cost of living is up 25% over the last 12 years. All this means a person that graduated in 2006 probably owed less than 100k for undergrad and optometry school at about 2% interest (weighted average). They were able to get a job making 100k and due to the lower cost of living and lower interest rate, optometry was a great investment. Now, it’s better investment than some career paths but not as good as it once was.

 

[Ryan_eyeball]

Which school is lower now than it was 12 years ago? I doubt there is even one school now that is as low as the most expensive school was 12 years ago.

The point is reimbursement which is tied to income is not increasing. Interest rates, tuition, and cost of living have all increased substantially. In 2005 student loan rates were below 3%. Optometry school tuition was half the price. And cost of living is up 25% over the last 12 years. All this means a person that graduated in 2006 probably owed less than 100k for undergrad and optometry school at about 2% interest (weighted average). They were able to get a job making 100k and due to the lower cost of living and lower interest rate, optometry was a great investment. Now, it’s better investment than some career paths but not as good as it once was.

Bigred got the point I was trying to convey to new students. Thankfully I see more patients today than I did 12 years ago but my rate for those managed care exams are not increasing. You can charge more to self paying patients but eventually you'll drive them away if its to high. You can try to increase costs for new CL fits, CL yearly evaluations, or screening procedures. Personally I resist the screening procedures since patients feel nickle and dimed for their visit.

I'm also noticing more major medical plans are eliminating a routine exam under the policy and farming it out to vision care plans instead. If Aetna was paying $105 on a routine eye exam and the next year the vision benefit goes through Eyemed I've been reduced to making $40-$50 an exam. The same with BCBS (my instate one) paying $125 and now going to Eyemed instead for their rates. I thought 0% increase was bad but now having to deal with 50-60% decrease on some patients is tough.

I try to convert as many as possible to medical but high deductible plans are making that more challenging. You have to be a good educator on why the test is important for them to lay down an extra $200-$300 for fields, gonio, fundus photos.

My business expenses only increase every year and if $15 an hour goes national it'll hurt some practices. We are down to just a student loan at 2.25% and I'll just let it ride out now.