Winning battles for patient access in Maryland

July 19, 2012

The Shore Health System (SHS), a major provider of hospital services along Maryland’s Eastern Mid-Shore and the region’s largest employer, will soon cover medical eye care services provided by optometrists under its Employee Retirement Income Security Act (ERISA)-qualified employee health plan, according to the Maryland Optometric Association (MOA).

“This is of monumental importance to optometric practices on the MarylandShore. The SHS has over 2,000 employees and is preparing to expand into a regional health system as part of the University of Maryland Medical System,” said Alan S. Bishop, O.D., who led the effort to change the health plan’s reimbursement policy. “Obviously, we are very pleased with this development.”

The SHS Benefits Committee voted to include optometrists as providers under its employee health plan last month following a series of discussions to clarify the role of optometrists as providers of primary eye care as well as vision care, according to Greg Bartoo, the administrator for Dr. Bishop’s Easton Eye Care. Bartoo also contributed to the discussions.

The SHS benefits committee acted on a recommendation from its employee health plan’s third-party administrator, Innovative Health Services (IHS). That recommendation was the result of denied case reviews and demonstrating how optometric care has resulting in improved care at a lower cost with the IHS Executive Team, including the company’s medical director.

Critical to the policy change was a letter from the MOA to SHS Benefits Committee Chair Michael Zimmerman outlining the contemporary scope of optometric practice under Maryland law and the educational requirements for optometrists in the state.

Misunderstandings regarding the role optometrists now play as primary eye care providers is still common among many health plan administrators, Bartoo said.

“We found SHS receptive to our presentation,” he added.

AOA Third Party Committee member Peter M Agnone, Jr., O.D., and AOA Third Party Center Director Lendy Pridgen worked with Dr. Bishop to initiate “a very successful dialogue” with the plan administrators, Bartoo said. The AOA also provided information for the letter to the SHS benefits committee.

“This is good example of how practicing optometrists can win coverage for their eye care services under employee benefit programs by working with plan administrators,” Dr. Agnone said. “The AOA Third Party Committee can provide a wealth of advice on arranging and conducting such meetings. The AOA also offers materials specifically designed for presentation to plan administrators.”

As the AOA, MOA and other affiliates at the state level continue to advocate for ODs to be defined as primary care eye care providers, “this is an excellent step in the right direction,” said Jennifer Levy, director of Legislative Affairs at the MOA, who was instrumental in facilitating the productive dialogue among the parties.

Bartoo added, “Obviously, we are very pleased with the development, and we could not have represented the interests of our patients and our optometric colleagues without the coordinated support from the MOA and AOA. There simply is not a more beautiful portrayal of team work in action!”

AOA members interested in pursuing coverage for their eye care services under employee benefit plans should contact Pridgen in the AOA Third Party Center at  TPC@AOA.org.

One comment

  1. A separate technical bill related to the health care overhaul, know by many as the “reconciliation package”, was also approved by the House and forwarded to the Senate for final consideration.

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