As I mentioned in an earlier post, the Pennsylvania House of Representatives Insurance Committee is exploring PA House Bill 2101. If passed, this bill will have BIG implications on retrieving a part of your brand. Yes, this bill has major implications on your practice.
Basically, PA House Bill 2101 would eliminate the ability for plans such as Davis Vision, Spectera and others to insist that you acquire laboratory services and products from them as a condition of obtaining payment for vision services. They operate with a basic monopoly on the product, ostensibly to control quality and service. In a recent article in Vision Monday, it was reported that a Highmark spokesperson said, "We believe this bill is flawed and not in the best interest of consumers and employers."
Well, in my opinion, whenever you put an entity in between the consumer and the provider, you’re aborting what I term "the Law of the Marketplace." In this particular case, providers have had a major portion of their brand (lab services and customer service) stripped away. And when the job from the lab isn’t correct or the delivery takes weeks…who does the patient blame…the provider. Further, as a result of the eroding margins from plans that control the product, providers look for every trick in the book to maximize their reimbursements from medical insurance (read Coding and Billing). That, in turn, drives up the cost of health care.
Reality is that the requirement to buy product from the plan sponsor is in place for one reason and one reason only…profits. If these plans allowed the provider to obtain lab services from whomever the provider desired, the provider would find the best, and most cost effective, resource. Why? Because the provider controls his/her brand and providers that don’t deliver value go out of business. It’s really that simple.
The Law of the Marketplace is a good law and works in the best interest of the consumer.
This is groundbreaking legislation and, perhaps, the beginnings of a pendulum swing away from managed care plans holding your brand hostage.