 if you went to open access, it's completely up to you. That's the beautiful thing about being an open access provider. You can choose your level of independence from the vision contribution plans. Understand. There's a lot to understand. Insurance companies of all types are known for being rather difficult to work with. And vision insurance is no exception. So the first thing we have to accept is that vision insurance plans are more like vision contribution plans. And honestly, if you take nothing else from what I'm telling you today, please, for the love of all things holy, stop calling them vision plans or vision insurance, right? Call them vision contribution plans and use that term every single time you talk to the patient or you're talking in your office about the plans. It really helps to, I guess, ready the mind of your team and of your patients, really, that the service is contributing towards their eyewear. So vision contribution plans. Okay, going back. Okay, so going back to understanding reimbursements, the plan will contribute towards the patients out of pocket for their eyewear, right? The better way to really understand reimbursements is to completely grasp, I guess, the different roles and functions of the main aspects that control the money distribution between the provider and the patient and the vision plan. So let's start with like the patient copay. Patient copay is what the patient pays out of pocket for that service or item. And this is rather confusing to patients because with other insurance companies, a copay is a single dollar amount. So the patients will go into any other provider to use any other insurance and pay a copay and walk out. And that's it. It's a single dollar amount and they're done. But with the vision contribution plans, the copays are added one on top of the other. If we use copays in the term that the vision contribution plans want us to use copays, they're added one on top of the other, which gives this patient the, I guess, idea of this nickel in dining them. The other thing to understand with the patient copay is that the patient copay is collected when the eyewear is ordered. Okay, when it's ordered. Here's the timeline when it's ordered. That's when we collect it. Now let's talk about charge backs or lab charges. Now this amount has taken out of the provider's check to pay the lab for the cost of the lenses. So this final charge backer or lab charge amount arrives on the remittance explanation of payment weeks after the patient's glasses have not only been ordered, but have been dispensed. And that's when the lab charge back actually comes in at the very, very end of this whole scenario. Now let's talk about material dispense fee. The material dispense fee is the amount that the vision contribution plans has designated the value of the base style of a lens. Sometimes it's called like a lens dispense fee. Now these dispense fees will be smaller for the single vision orders and they will be larger for the multifocal or progressive orders. Now amongst all of the single or smaller to larger differences, there are also different levels of plans that will have different values for this lens material dispense fee. So for example within a vision insurance plan, you will have different plans levels in there and each of those plan levels will value a single vision lens dispense fee at a different amount than you know the other plans that are on there. So it's really confusing. It gets even more confusing when the patient's material copay is larger than the lens dispense fee because the difference is taken out of the provider's check as a charge back or lab charge amount. So for example if the lens dispense fee is only valued at $15 but your patient had a $25 copay, guess who's taking that $10 difference out? So the last thing to really understand when it comes to reimbursements is the service fee or dispense amount. Now this amount is the amount that you should be making from that item. I say item because it could be that material or that AR treatment or a tent or any of the other add-ons that are on there. So the service fee is basically the patient copay minus the charge back and this is what you should have in the end. This is what it should be equal to as the service fee. However issues like incorrect collection of the copay when the patient is there can really cause a pickle. You won't get to your amount in the end or when changes have been made at the lab because of inability to like get a product or availability issues I should say will result in the service fee being inaccurate. Now basically what was entered in your EHR when you collected the patient's copay might be different to what was actually ordered from the lab. So when the charge back comes if that's different you don't make what you're supposed to on your service fee. That's a bummer. Now these issues are further intensified because the unfortunate timeline of when all of this is happening. So when the copay was collected versus when the charge back is actually taken out of the provider's check is weeks after the fact. So it's a real bummer going back to the patient and saying hey patient we were supposed to collect more from you. Doesn't look good right? Well there are actually two misconceptions that drive me absolutely crazy when I hear offices talk about them. The first is that the out of pocket that is collected from the patient is what the practice is actually making what they're actually earning for the job. You will not believe the amount of people on your team that probably think that that's what you end up earning and this is not the case. In fact a majority of what is collected by the practice for the eyewear is taken from the rider in the form of charge backs. Now many offices struggle I will say with understanding how charge backs work on the vision plan or remittance or explanation of payments. The confusion is further intensified with inconsistencies between the different plans. So for example you have all of these different line items that have copays, charge backs and service fees right? All these different ones that you have to try and remember. Well let's take for example Tribex. The Tribex will have a material copay, a charge back and a service fee of what you should be making at the end. Well these amounts are different amongst the different plans that are within that one vision insurance company. Making the ability to master the charge backs and lab charges you know understanding nearly impossible because of the unnecessary complexity of the reconciling right? So most go uh look at what we collected with the out-of-pocket because it's much easier to understand and it's much shinier and much prettier and so a lot of people really have a misconception that the out-of-pocket with the patient has paid is what the practice is earning on the job and that's simply not the case. The other misconception is when I hear independent opticles say you know what it's not that bad being a network because we don't have to pay a lab bill. Bro yeah you do. These charge backs are your lab bill and they're significant and it's not uncommon for an office to run numbers on a particular lens that they maybe just order through the vision contribution plan and their designated lab and take into account what you paid in charge backs. Then an independent optical could call up their independent lab and ask for what your optical would be charged for that exact same lens through the independent lab and then you can go a step further and inquire about a volume discount like if you happened to be sending all of your work there through that independent lab what could you be getting that lens for? You might be impressed it doesn't hurt to ask. It's already well known that we accept a lesser reimbursement for being on a panel with any insurance company vision medical whatever it is right the in-network reimbursement rates are typically about one half to one third for the patient with the vision contribution plans than the revenue that is made from a private pay patients so just depending on what your prices are listed at so the result is that the office must see more of these vision plan patients per day in order to make the necessary revenue to run an effective business. Now this is an unfortunate situation for for the vision plan patients as they are unknowingly having their appointments rushed right in order to make some profit in the office. Now when many independent optical set up their pricing for exams and eyewear they typically set their usual and customary fees knowing that they must inflate their private pay amounts to offset the dramatically low reimbursement rates that they're getting from being in-network with the vision contribution plans so really this makes an unfortunate situation over here for your private pay patients that are being unknowingly penalized for the cost of their eyewear to basically make up for you being shorted in your in-network agreement. Now the great news though is that both of these unfortunate situations can be remedied if the independent practice were able to control their own narrative so without the contractual amounts and mandates of the vision contribution plans offices are able to make more per exam which allows for more quality patient visits because the quantities aren't necessary to be profitable and the other benefit is that the independent offices do not have to charge as much on their eyewear when they are profitable on every pair sold rather than selling most of their eyewear for a fraction of their intended value it's a win all the way around. Open access is an office or provider that is not limited from seeing patients based upon the vision contribution plan that the patient happens to have so open access is a term I learned a long time ago from the founders of anagram and for those unfamiliar with anagram it's a service that allows practices to pull out of network benefits for patients this ultimately allows the practice to service all patients no matter their vision contribution plan and no matter the inner out out of network status of the provider so the opportunities that are found when optical begins to align themselves with an open access mindset are quite liberating the practice will begin to see hope and no longer being controlled by the vision contribution plans and a glimpse of this freedom from the plan mandates and from the rules of what products are utilized and and most importantly from the contractual reimbursements which are amazingly low to put it nicely so when an office is able to migrate towards an open access model they begin to see the the benefits of really controlling the lens choices and the prices from the labs where where they're charging the usual on customary pricing and still having the ability for the patient to utilize their vision contribution plans you know by utilizing their out of network benefits but with anagram you know it's much easier for the patient to be able to utilize that and still have the ability for the patient to utilize their their vision contribution plans you know at an adjusted rate when you have you know a service like like anagram that can help you pull those out of network numbers you can explain that to the patient and they're still able to use their benefit this is where things need to be done properly as communications with your patients is absolutely critical and in order to be brief I guess I'll answer with some key items for success and maybe the main things to avoid so dropping vision plans cold turkey do not recommend there is a process for for real success and I think that that should be done in a in a smart way not just dropping everything so you must teach the appropriate verbiage to the team you need to rehearse all of the objections and the questions that the the patient might have with your team so that they are well prepared with the proper responses and you need to practice practice practice invest in your team's learning invest in numerous team meetings with a lot of brain fruit and a high morale feed them and make them happy and they will learn so I also recommend that you incorporate a refined sales training ongoing education and depth of really understanding the execution of how to properly communicate and sell to your patients I mean this is what we teach at Spexy it's vitally important that your team be equipped with the tools to help your optical succeed in this process and an independent optical all around another thing to avoid do not tell patients you are going out of network patients think that out of network means that they'll no longer be able to come and see you so don't do that start implementing your open access alignment with your vision contribution plans that you're already out of network with is a good idea the most successful practices have utilized anagram for this process do not implement any changes without the entire team being on board with the plan you have to give it time for people to really understand what it is that you're doing if you guys make the call as leadership and then you go all right we're going to start on Monday everyone goes oh my gosh and you're not going to have people that have faith in what it is that you're doing the last thing if and when your office does decide to go deeper into your open access status and independence you'll want to start with the vision contribution plans that have the least influence in your optical and work your way up to the plans that have more influence um uh in your optical will you lose patience well uh potentially many many opticals lose them so but when handled properly the loss is minimal and the profitability is higher on the patients that you do keep uh in addition depending on how many vision plans your office is already out of network with um the open access model will allow for you to see an an increase in patients that you know have not been able to necessarily see you before because they weren't um in network with the plans that you were in network with and if you're able to properly market to these patients before making changes um you know with the more saturated plans it'll really help to offset the patients that you will potentially lose and to be honest most offices um see a dip you know after they started the open access thing once they pull their first um in network uh vision plan they often do see a dip but then that comes back up so something to think about well it's hard to just describe one because they're also different but for some offices open access gives the ability to see patients with you know vision contribution plans that they have never been a network with and this opens the door for opticals to reach for our patients while still maintaining their in-network status with the vision contribution plans um so that that's kind of like the the the smaller edge of it but for most offices open access looks like basically a road to adaptation it allows for the optical to create a mindset of being able to service all patients no matter the vision plan chosen by their employer right and um you know with the use of certain tools you know dropping anagram again but with with the use of you know things like anagram the patient is able to still utilize a majority of their benefits as well so in these offices the focus for the patient revolves around the level of service and of care for the patient and less around the narrative the vision contribution plans have limited providers to the focus for the team is on what is best for the patients and when it comes to eyewear rather than you know what is allowed and the focus for management and leadership is more about the patient experience and less about quantity right there there are some opticals that will implement an adjustment in an even lowering retail pricing of eyewear as the optical becomes more and more independent and makes you know much more profitability per job and funny enough when the price adapts you know even a small amount um is when offices really start to see uh increased returns with the amount of patients that that are coming out if you went to open access it's completely up to you that's the beautiful thing about being an open access provider you can choose your level of independence from the vision contribution plan so if you're one to typically fear change one to take things a little slower on the safer track then the open access principles and training allow for you to slowly adapt your mentality in your team to become less dependent on your in network status and this ultimately can build confidence on the idea of open access before making any dramatic adjustments but if your office is led by you know the forward thinkers the risk takers adopting the open access mindset for these practices allows for them to have a pathway um to the desire that they've been pondering for some time right these are the people who don't have to ask themselves if when it comes to change these are the people who ask themselves how not if they can get to you know real independence from vision contribution plans they ask how they can be freed from them and for these leaders implementing open access and their optical is how they're able to get it done