Keeping an Eye on Vision Care, was the focus of a July 6, 2021 lunchtime webinar hosted by the Canadian Optometrists Association (CAO) in collaboration with The Benefits and Private Healthcare Associate program from Connex Health. Dr. Aaron Patel, an Edmonton optometrist, and chair of the CAO Insurance Working Group, spoke to an audience of over 70 benefits advisors and insurance company representatives at the lunchtime session, providing insights into key strategies to modernize vision care and reduce fraud and abuse.
Vision care fraud is infrequent compared to some other employee health benefits like orthotics and paramedical services, but it does exist. Dr. Patel provided examples that included patients who obtain prescription sunglasses without a legitimate prescription, and plan members who share their contact lens benefit with family members not covered by the plan. Online optician services that may not always require an up-to-date prescription for frames and lenses are also of concern. Insurers take fraud and abuse very seriously. Optometrists can be removed from an insurers list of eligible providers, even if their staff or an optician with whom they share office space are the perpetrators.
Reducing fraud and abuse are a priority for the CAO, who believes that modernizing vision care benefits is one of the most effective prevention strategies. A modern plan design is based on medical need, including separate frame and lens maximums, and an additional allowance for those who require more than a single focus lens. The CAO also recommends providing coverage for additional monitoring, management and treatment of serious eye conditions that can lead to vision loss.
Download the CAO’s Best Practices Guidebook or contact Ibrahim Daibes, Director Policy and Research at the CAO at firstname.lastname@example.org for a one-on-one discussion on how to ensure benefit plans provide best value vision care.