12/30/2017 IMPORTANT UPDATE: This blog from August 2017 concerning EyeMed’s Tricare Network has been updated with more recent information. Please refer to our new post: https://optometricbilling.com/tricare-eyemed.
As of January 1, 2018, Tricare will merge their North and South regions into one new East region. Humana Military will administer the East region, but they have SUBCONTRACTED ALL VISION SERVICES TO EYEMED FOR BOTH MEDICAL AND ROUTINE. Therefore, optometrists in the new East region will need to be contracted with EyeMed to continue to see Tricare patients. Providers should have received an email from EyeMed to update their contracts with the new Tricare amendment. (12/30/17 Please go to https://optometricbilling.com/tricare-eyemed for more current information)
TAKEAWAY:
There are larger implications for optometrists, however, than just needing to complete a new EyeMed contract. The change in how Tricare plans to administer vision care signals dangerous ground for our profession. In the past, Tricare treated optometrists as any other medical professional and reimbursed providers at 100% of the CHAMPUS maximum allowable charge. Now, vision care reimbursements will be reduced by 30%. Not only will optometrists be paid less for their services, but the fact that optometrists have been pushed out of the Tricare system and are now forced to deal with an outside routine vision payer signals an alarming change in the way Tricare views our profession.
We’ve seen outsourcing of vision care to routine commercial payers happen before with many state Medicaids, and the results nearly always mean a significant drop in reimbursements, even for medical services. There are still a lot of unknowns, but every optometrist and state optometric association should be on high alert: Is this the beginning of a system-wide move that reduces insurance reimbursements to optometrists? If we are willing to accept less for our medical services now, how long will it take for commercial third-party payers like Blue Cross to notice and follow? When state Medicaids started subcontracting medical vision services out to routine payers, they found little resistance. Now Tricare is following suit, expanding to the national level the encroachment on our reimbursements and ultimately demeaning our status as healthcare providers.
Even greater than the issue of money is the move to pigeonhole optometrists into the realm of “routine.” As a profession we need to recognize the danger of payers outsourcing medical vision care to routine carriers lest we lose the parity we’ve fought so hard to gain. Optometrists remain the primary eye care providers in this country, daily seeing patients to assess and treat their medical eye problems. The medical care we provide ensures our patients’ visual heath. Our early interventions often avert more chronic or long-term issues. We counsel patients on diseases such as diabetes and hypertension and discuss lifestyle choices such as smoking and nutrition. We analyze patient and family histories, evaluate medications for adverse ocular effects, and can identify systemic diseases through their ocular manifestations. We prescribe medications to treat eye diseases, and we refer our patients to appropriate specialists when they’re in need of additional care. In every sense we are primary providers on the front lines of our patients’ healthcare. We play a critical role in our patients’ lives far beyond our skills in refracting and writing glasses prescriptions. We must be ready to fight any move by insurance payers to discriminate against our role in healthcare, including attempts to subjugate us to lesser reimbursements or relegate our profession to the jurisdiction of routine vision payers.
We should all be alarmed at Tricare’s new policy on vision care.
