Vision plans have roots in a time when many optometrists primarily provided refractive eye care and were largely unable to participate in medical plan panels. Optometric practice has changed considerably with expansion of scope and services. That said, for many optometrists, vision plans remain a valuable pipeline to refractive patients. While I can’t tell you which vision plans to accept in your practice, I can give you criteria to employ in making this decision: patient demographics, plan benefits, and reimbursement. Let me explain.

Patient demographics
Knowing your patient population helps you to un-derstand how a plan will impact your bottom line.

For example, if your practice is saturated with medical cases or private pay patients, the bar will be set very high for you to become a provider of any vision plan.  
However, if your practice relies heavily on refractive care and the sale of eyewear and contact lenses, becoming a provider for one or more vision plans may be very attractive. After all, as briefly mentioned above, they can drive in the very patients you seek to attract and retain.

Plan benefits
Another important factor in the decision-making process of whether to become a provider for one or more vision plans is what you will gain by accepting a plan or what you will lose, should you choose not to participate in a plan. 

There are vision plans that have value-added benefits for the provider, such as discounted frames or lenses and even incentives for the practice by offering added reimbursements or discounts for working more closely with the plan, essentially rewarding you for your partnership with them. 

On the other hand, vision plan contracts impact your reimbursement for professional services and your ability to profit from the sales of eyeglasses or contact lenses and even other services, such as contact lens fittings or preventive diagnostic imaging. They are designed to build “value” for the patient by offering these services at deep discounts.

Reimbursement
It is also important to compare reimbursement among the vision plans offered and to consider the impact that the totality of the contract has on the bottom line of your practice or what changes you may have to make to ensure profitability. I have spoken with many colleagues who redesign their practices around the vision plans they become providers for.

For example, when a contract with a payer mandates deep discounts, optometrists often must raise their base charge to accommodate for this, while other ODs limit the number of slots per day or week for these plans to ensure that they have a balance in availability for lower vs. higher-reimbursing vision plans or procedures.

To assess reimbursement, every practice decision- maker must develop a bright line. That bright line represents a benchmark that is the target reimbursement for every appointment type. Consider every plan that is offered to you, be that a vision or medical plan, and analyze the impact that each aspect of the plan will have on your practice’s bottom line. Compare this to your bright line. If that reimbursement is above your bright line, it’s likely a great vision or medical plan to provide for. If it is below, you must consider whether becoming a provider will have a negative impact on your bottom line.

Profession evolution
Thanks to scope-of-practice expansion, the optometry practices of 2024 offer a broad range of services, in addition to refractive care. So, while becoming a provider for a vision plan can still benefit patients and a practice, it’s also important to remember that optometrists now have other methods of attracting and retaining patients to sustain and grow their practices.

STEPHEN M. MONTAQUILA, OD, FAAO practices at and is the owner of West Bay Eye Associates, in Warwick, RI. He is a member of the American Optometric Association and the Rhode Island Optometric Association, is a Diplomate of the American Board of Optometry, and is a Fellow in the American Academy of Optometry. Additionally, he lectures nationally on topics related to eye health, contact lenses, and health care delivery reform. Disclosures: He serves as senior strategic advisor for Radius XR, and as a consultant to Glaukos.