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Assessing Vision Plans

 

Assessing which vision insurance plans to accept is a strategic financial decision for any optometric practice. Accepting the wrong plans can erode your margins and overload your schedule with low-reimbursement patients. The right plans, however, can drive patient volume and profitability.

 

Here is a structured approach to assessing and selecting the right vision insurance plans:

  • Understand Your Market/ Demographic & Employer Analysis

    • What are the major employers in your area? What plans do they offer their employees (e.g., VSP, EyeMed, Spectera, Davis, etc.)?

      • Use tools like Zocdoc, LocalMed, or Pearl Vision Locator

      • Call HR departments of major companies that produce your patients or ask your patients during intake: “What plan do most of your coworkers use?”

    • Check competitors: What insurance do nearby offices accept? Can you offer alternatives?

    • Do you need to accept another plan? Is your schedule already full? 

      • If you want to grow, increase the amount of vision plans. If you want to grow profit, do not add or decrease them. ​

  • Evaluate Reimbursement Rates

    • Request Fee Schedules:

      • Directly contact each vision plan and request their fee schedule.

    • Carefully review:

      • Routine exam reimbursement

      • Contact lens fit reimbursement

      • Spectacle lens reimbursement

      • Frame allowance + discount structure

    • Compare With Your Retail Pricing:

      • Are you making a profit after lab costs and chair time?

      • Are discounts so deep that your frame sales suffer?

      • Does the plan allow for patient balance billing above allowance?

  • Calculate Break-Even Per Plan

    • Here’s a quick framework to assess profitability:

      • Exam reimbursement: $45

      • Contact lens eval reimbursement: $35

      • Average materials revenue (after plan discounts): $150

      • Cost of goods (lenses, lab, frame): $100

      • Staff time (billing, scheduling, dispensing)~$25/hour

    • Do you profit $100+ per patient?

      • If not, it may not be worth it, especially if the volume is low or patient compliance is poor.

  • Assess Administrative Burden

    • Billing complexity: Some plans can be a nightmare with authorizations, material restrictions, and paperwork.

    • Lab restrictions: Some require you to use their labs (lower quality, lower reimbursement, longer wait times).

    • Credentialing time: Some take 6–12 weeks to get approved.

    • Ask your team which plans cause the most headaches. These are plans that you might want to drop. 

  • Analyze Patient Volume Potential

    • Estimate how many new patients a plan could bring in:

      • Ask the insurance rep: “How many members are in my zip code?”

      • Talk to existing patients about which plans they wish you took.

    • Run a report in your EHR on insurance usage by patient. If you are seeing a surge in one plan, that may guide your decision. Also look at the revenue that the plans is bringing in. 

  • Balance a Healthy Mix

    • You want a diverse payer mix:

      • Some high-volume, low-reimbursement plans can fill your schedule. 

      • Others offer lower volume but better margins, which is better for profit. 

    • Aim for a balance: 1–2 high-traffic plans and more higher-margin plans.

  • Negotiate & Upgrade

    • If you are already on a plan:

      • Ask for tier upgrades (e.g., VSP Premier, EyeMed Access Enhanced).

      • See if you qualify for better lab contracts.

      • Push for frame board credit incentives.

      • What other incentives can the plans provide? 

  • Track Plan Profitability Over Time

    • Use your practice management software or EHR to track:

      • ​Average revenue per patient by plan

      • Capture rate

      • No-show/cancellation rates

      • Claim denial rate or delays

      • Lab redo rate

    • Even a popular plan may need to be dropped if margins are shrinking.

    • Look at your plans yearly and always consider dropping your lowest paying plan. ​

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Surviving Low Insurance Reimbursements: Strategies to Keep Profitably Thriving​

If you own an optometric practice, you’ve seen it: reimbursements from insurance providers seem perpetually stagnant, even as your overhead rises.

When I looked at my own bottom line, it became clear—practice survival meant getting strategic about contracts, patient flow and income diversity.

Should You Keep Every Insurance Plan?

Many of us started out accepting as many insurance plans as possible just to get patients in the door. But these one-sided contracts too often work in the insurer’s favor, not yours. Take the time to analyze which panels are worth your effort. If payments haven’t increased in years and paperwork continues to pile up, sometimes the best business move is to say no.

If you want to exit a contract, make sure you do it right—give written notice and keep communication formal. Post accepted insurances on your website and always ask about coverage when scheduling new patients.

Click HERE to view four videos on exiting insurance panels

The Risk of Going Cash Only

Some ODs dream of ditching insurance entirely and going cash-only. In reality, the success of this model depends on your practice’s niche, your community and your tolerance for risk. You might consider not accepting credit cards to avoid fees—though this can deter some patients. And remember: billing and collection will require more effort by you and your staff.

Boosting Revenue: See More, Not Just New

One way I offset low reimbursements is by increasing patient return rates and follow-ups, and maximizing the number of patients seen per day. This usually requires tighter staff scheduling and utilization—using scribes or delegating everything allowed by law to auxiliary staff. When each appointment and every staff member’s minute counts, time management becomes your lifeline.

Find Your Niche and Market It

Specialty services like low vision, contact lenses, children’s vision or geriatric care can help you attract cash-paying patients. If you’re in an economically healthy area, social media marketing can amplify your reach—but this only works if you or a staff member is skilled and active online.

Also, be choosy about which frames and products you carry. Some insurance panels dictate what you must stock and where you must send lab work; greater freedom to make decisions about your optical inventory and lab work may bring costs but also more control and potential for add-on sales

Understand Your Contracts—No Surprises

Insurance companies aren’t your partners—they’re contractors, and most contracts are “take it or leave it.” Be sure you know the specifics about prohibited up-charges, reimbursement on lens options and requirements for both vision and medical services. Often, you can’t “give away” services or products to make patients happy because contracts forbid it.

It’s also important to remember that contracts often change—sometimes with minimal notice—so always read updates and know your opt-out process.

Don’t Put All Your Eggs in One Basket

Relying on a single big payer? You’re at their mercy. Diversification is a must. Some ODs negotiate directly with local employers or school districts. For others, offering more medical eye care—often reimbursed at higher rates—can supplement low-paying vision plans.

Know State-Specific Rules and Stay Legal

Thinking about expanding into new services? Know what’s legal in your state before investing in technology or marketing. Telemedicine, for example, is regulated closely by optometry boards—which may differ from medical boards.

Watch Your Costs Like a Hawk

Low reimbursements squeeze margins, so “chair cost” analysis is more important than ever. If you own your building, explore whether it’s still the best financial move, or consider relocating if lease costs are high. Small changes add up, and every dollar matters.

The Bottom Line: Treat Your Practice Like a Business

At the end of the day, owning a practice means making business decisions—sometimes tough ones. Know your worth, run the numbers before making changes and never accept less than your practice deserves out of habit or fear. The love of your profession should not come at the cost of your financial health.

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