To illustrate the gaps in vision care benefits and the opportunity for change, three patient case studies are presented. Each case represents an actual patient’s treatment plan, demonstrating how plan members often face significant out-of-pocket costs to access clinically necessary vision care services.
The expenses described were not associated with elective or discretionary expenses and rather represent situations where optometric services were required to ensure appropriate vision accommodations in the workplace. Reforms to vision care benefits to reduce potential out-of-pocket costs, particularly for specialty diagnostic services and non-elective interventions, while balancing increases to benefit costs must be explored to alleviate the burden on plan members illustrated by these examples.
Payers and plan sponsors should be encouraged to implement vision care benefits reform to accommodate these, and similar situations where deteriorating eye health requires timely and appropriate interventions and ongoing monitoring and care. Such an approach can ensure plan members remain productive, healthy and safe in the workplace.