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Bill focuses on vision care practices

Special to the Legal News

Published: September 27, 2017

Members of the House Insurance Committee are mulling a bill that would eliminate the seemingly arbitrary limitations health insurers impose on vision care services for Ohio consumers.

Lawmakers in the Ohio House of Representatives recently heard testimony in support of the measure - House Bill 156 - as the bill advanced in committee.

Dr. Beckie Brown, president of Ohio Optometric Association, characterized the bill as patient centered and non-intrusive of the patient-optometrist relationship.

HB 156 "addresses several disturbing tactics in vision insurance that are limiting my patients' treatment options," she told committee members.

Many insurance contracts now dictate that certain designated vision care material suppliers or manufacturers be utilized for the purchase of vision products, Brown offered as an example.

"Many times, these mandated suppliers produce products that do not meet the quality standards my patients deserve," she said. "Additionally, these suppliers are sometimes not as timely in producing eyewear, which can lead to a delay in patient treatment.

"These tactics remove treatment decisions from the hands of patients and their eye doctors."

The bill also would promote greater transparency for patients in the purchase of eyewear and other related products - both insurers and providers would be required to notify patients of any business interest the provider or insurer has with a supplier of materials prior to a patient making a purchasing decision.

Association Executive Director Keith Kerns was on hand to discuss "non-covered services" of vision care plans.

"The House and this committee dealt with a similar issue within dentistry in recent years," Kerns said. "Non-covered service provisions are particularly onerous on providers who operate an optical dispensary.

"The most common vision service that is not covered under an enrollee's benefit plan is the purchase of a second pair of prescriptive eye glasses.

He said placing an artificial price limitation on that second pair of glasses, effectively removes the optometrist from the marketplace for the sale of the eyewear because, oftentimes, the optometrist is required to provide the product at a rate lower than the cost of obtaining the product initially.

"Patients may then be forced to leave the provider they trust and seek vision materials from another retailer who may not have the same limitations placed on it by an insurer," Kerns continued. "This other retailer could be down the street in the form of a major retailer or an online supplier located out-of-state."

Another provision of HB 156 would preserve a vision care provider's ability to contract with insurance plans that coincide with the provider's business model and practice philosophy, presumably to prevent insurers from requiring vision care providers participate in a secondary discount plan as a precondition of joining an insurer's provider panel.

Kerns noted that 19 other states, including Texas, New York, Florida, Kentucky, North Carolina and Virginia, have passed similar legislation to with no known negative implications to patients, the vision insurance marketplace or the cost of care.

"The (association) does not undertake legislative initiatives lightly," he said. "However, in this instance, the tactics being implemented in the vision insurance marketplace are significant and legislative action is the profession's only option for relief.

"Antitrust restrictions eliminate vision care providers' means to bargain or negotiate with insurers resulting in 'take-it-or-leave-it' standardized contracts containing unfair provisions such as those addressed in this bill."

In addition to imposing disclosure requirements on health insurers and vision care providers regarding non-covered and out-of-network vision care services and materials, HB 156 makes violations of these provisions an unfair and deceptive act in the business of insurance.

Under continuing law, committing an unfair and deceptive practice in the business of insurance is subject to any or all of the following sanctions:

-Suspension or revocation of the person's license to engage in the business of insurance;

-Prohibition on an insurance company or insurance agency employing the person or permitting the person to serve the company or agency in any capacity for a period of time;

-Return of any payments received by the person as a result of the violation;

-Fees for attorneys and other costs of any investigation into the violations committed by the person.

Sponsored solely by Rep. Kirk Schuring, R-Canton, the bill had not been scheduled for further hearing as of publication.

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