Ongoing, direct advocacy by the American Optometric Association (AOA), affiliates, and the network of AOA’s Third Party Center volunteer doctors restored more than $12.1 million in reimbursement payments to thousands of AOA and affiliate members since 2023, says the association in a press release. According to the AOA, the Third Party Center Committee, chaired by Steven Eiss, OD, worked tirelessly to ensure that time-intensive records requests, inappropriate denials, Medicare Risk Adjustment audits, and downcoding delays were adequately compensated or halted, with a total of over more than $4.6 million restored during the last 6 months. Even with this win, AOA President Jacquie M. Bowen, OD, says there is more to do, and implores doctors of optometry to report plan abuses immediately, no matter how large.
“We are committed to doing all we can to support our member practices, help them thrive, and break down any barriers to care,” Dr. Bowen says. “Uncompensated and undercompensated care doesn’t just hurt optometrists’ financial sustainability. It drives up the cost of care and lowers accessibility for those who need it most.”
Along with time-intensive records requests, the AOA says several other actions can create undue financial burdens on providers. Specifically, fielding unfair or automated denials by health payers costs $43.84 to fight a single denied claim. Although 97% of claims are eventually paid, providers spend $19.7 billion annually for the administrative labor to make that happen, the AOA explains.
Downcoding that delays or reduces payments, contract renewal issues, and credentialing issues diverts staff resources from patient care, says the AOA. In September 2025, the AOA won a huge victory with the halt of Aetna’s downcoding program—reaching an agreement with the payer, ending autodowncoding of 92xxx EMR codes. This change alone represents thousands in savings for impacted optometrists, the AOA says. Providers who were previously downcoded by Aetna can still file appeals with AOA’s backing and administrative support, partnering with providers to demand compensation for administrative labor for these requests, notes the association.
The AOA says a victory like this is evidence of the value of the Third Party Center. Instead of expecting doctors to shoulder this undue financial burden, the AOA acts as an extra administrative staff member to fight claim denials, inaccurate network directories, or a host of other issues that arise. Often, it only takes 1 doctor’s report to uncover a problem that affects doctors statewide, or even nationwide, such as new codes and system updates that can lead to claim denials across the industry, the association points out.
The AOA says that the Third Party Center Committee is ready to investigate and advocate on doctors behalf. Connect with the Third Party Center Committee at stopplanabuses@aoa.org. OM