h1

Third-party advocacy plays pivotal role in gaining coverage for OD medical eye care for Chrysler workers

April 27, 2012

Fiat 500s and redesigned Dodge Darts aren’t the only news at Chrysler Group, LLC. All active and most retired employees of the nation’s third-largest automaker now have insurance coverage for medical eye care services provided by optometrists.

The Chrysler Group, LLC, Health Care Benefits Program, which provides major medical coverage for all of the automaker’s salaried and hourly workers, began accepting claims from optometric practices for eye care services on March 1, according to Blue Cross/ Blue Shield of Michigan, the company’s benefit plan administrator.

Until now, Chrysler employees could see optometrists only for vision care.
Most Chrysler United Auto Workers (UAW) retirees have had coverage for optometric medical eye care since April 1, 2011, through the UAW Voluntary Employees’ Beneficiary Association (VEBA), a joint self-funded retirement trust established in 2007 for former employees of the nation’s big three automakers (see AOA News, April 2011). More than 720,000 auto industry UAW retirees and their families covered by the UAW VEBA program can access their optometrists for medical eye care.

With the recent actions by Chrysler and the UAW trust, more than 29 million Americans have gained access to eye care in optometric practices as the result of a two-decade AOA Advocacy Group program to encourage coverage by managed care and employer-based health plans.

“This is a huge victory for optometry’s patients,” said Peter M. Agnone, Jr., O.D., a member of the AOA Third Party Center Executive Committee and the Michigan Optometric Association Third Party Committee, who played a key role in talks with Chrysler and Blue Cross officials as well as in last year’s UAW VEBA decision.

The Chrysler major medical plan will now honor claims from optometrists for any eye health services within their scope of practice, including:

  • Evaluation and management services
  • Diagnosis and treatment of selected medical conditions, including infections and glaucoma, and
  • Management of post-operative cataract extraction patients who have been referred to the optometrist by an ophthalmologist.

“On behalf of the AOA and the MOA and the profession of optometry, I applaud the insight of Chrysler Corporation for making this important policy change for their active and retired workers. Improved eye health care, better access, and reduced costs make this policy change an important addition for the Chrysler workers and their families,” Dr. Agnone said.

March’s change in the Chrysler health plan came following years of talks with company and Blue Cross/Blue Shield officials, Dr. Agnone said.

Optometrists who see employees of the various Chrysler facilities around the nation can begin billing the health plan immediately.

However, Blue Cross/ Blue Shield administrators say it will take approximately 60 to 90 days to load necessary billing codes and information on local optometrists into their computer system.

Claims received before the Blue Cross computers are ready will be held and processed as soon as the system is able, Dr. Agnone said.

Additional information is to appear in Blue Cross/ Blue Shield’s Record newsletter by May or June.

Optometrists who have questions on billing the health plan may wish to contact benefit managers at local Chrysler facilities at that time.

Attitude change

“Access to medical plans is the key to the future for optometry,” Dr. Agnone said. “It is important for optometrists around the nation to pursue coverage for the medical eye care services provided in their practices under insurance programs.”

“The American Optometric Association and the state affiliates like the Michigan Optometric Association are the only organizations out there knocking on doors like Chrysler and the UAW and advocating for change that allows access for patients to see their optometrists for medical eye care. No one, and I mean no one else, is doing this for the profession,” Dr. Agnone said.

While virtually all health plan officials acknowledge that coverage of eye care services by optometrists will increase patient access to care, many fear the increased access will lead to increased utilization of services and overall increases in plan costs, Dr. Agnone acknowledged.

Employer-based plans such as Chrysler’s – that are organized under the federal Employee Retirement Income Security Act (ERISA) and exempt from state patient access and mandated benefits laws – have traditionally been among the most resistant to covering medical services provided by optometrists.

However, recent years have seen a change in the attitudes of public and private health plan administrators, with Chrysler being a good example, Dr. Agnone said.

Though now enjoying a sales resurgence, Chrysler, which restructured under bankruptcy in 2009 with the help of a much-publicized federal bailout, remains highly cost- and efficiency-conscious, according to Dr. Agnone.

“They are out to save money. I showed them how optometry can do that by providing accessible, cost-effective, quality eye care,” he said.

The availability of medical eye care in optometric practices helps to avoid costly emergency visits. It also prevents costly referrals to ophthalmologists when a condition is diagnosed in the course of a routine optometric eye exam, Dr. Agnone said.

Such referrals result in not only a charge to the insurance plan for a second office visit, but a visit billed at a higher “new patient” rate, Dr. Agnone noted. Dr. Agnone summarized the benefits of optometric eye care in an AOA Third Party Committee White Paper he wrote and provided to Chrysler, Blue Cross and UAW executives. Based on such efficiencies, Medicare, state Medicaid plans, and numerous HMOs now cover medical care by optometrists, Dr. Agnone noted.

That trend is increasingly evident to the administrators of employer-based plans.

“Medicare is the gold standard,” Dr. Agnone said. “Once they understand that Medicare covers medical services by optometrists, they begin to consider why they should.”

Also important is the increasing acceptance of optometric eye care among Blue Cross/Blue Shield organizations over recent years, Dr. Agnone said.

The nation’s 38 Blue Cross/Blue Shield companies administer thousands of public and private health plans, he noted. Both the Chrysler and UAW trust plans are administered by Blue Cross/ Blue Shield of Michigan.

The AOA Third Party Center encourages AOA members to pursue coverage of optometric medical eye care by employer-based health plans in their practice areas.

AOA members can obtain copies of Dr. Agnone’s white paper and other resources from the center by contacting staff person Lendy Pridgen at 703-837-1013 or LPridgen@aoa.org.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: