Why We Don’t Take Insurance: The Shades Optical Advantage
The Conflict of Interest
Opting for exclusivity over being merely the best provides a distinct competitive advantage for Shades Optical. Our decision not to accept insurance directly aligns with our commitment to prioritize the needs and interests of our patients over the demands of insurance companies. This approach allows us to serve you without the constraints and limitations imposed by insurance providers.
Here is the problem. Public health insurance programs are funded by the government and include Medicare and Medicaid. Private health insurance plans are offered by employers or purchased individually and are regulated by the states.
Doctors who accept public health insurance are paid according to fee schedules set by the government, which are usually lower than what they would charge privately. Doctors who accept private health insurance are paid according to the contracts they negotiate with the insurance companies, which may vary depending on the plan, the service, and the provider.
Therefore, some doctors may decide to sign up for all or some of the public and private insurance plans, depending on how much they are willing to accept as reimbursement for their services. Some doctors may also choose to be out-of-network, meaning they do not have contracts with any insurance plans and can charge their own rates, but the patients may have to pay more out-of-pocket.
This means that doctors have to balance the trade-off between accepting lower reimbursement rates from more insurance plans, which may increase their patient volume and reduce their administrative costs, or accepting higher reimbursement rates from fewer or no insurance plans, which may decrease their patient volume and increase their administrative costs. This may also affect the quality and quantity of time they spend with their patients, as well as their satisfaction and income.
At Shades Optical, we choose a different path. Recognizing the constraints insurance reimbursements can place on the patient-care experience, we opt out of the insurance system. We don't let insurance companies dictate the quality of care we provide. This decision is rooted in our commitment to providing personalized, thorough eye care. We believe in taking our time with each patient, really getting to know their needs and concerns without the pressure of insurance limitations.. Shades Optical stands unique in this approach, prioritizing patient care over insurance constraints to ensure every exam is comprehensive and unhurried, a practice we believe sets us apart in the eye care industry.
However, we have devised a system where we can still assist our patients in benefiting from their insurance through a reimbursement model. Essentially, patients pay us directly for our services, and we assist with the necessary paperwork to ensure they can claim a reimbursement from their insurance company. This process means that we are not bound by the rules and restrictions typically associated with direct insurance billing, enabling us to offer personalized, high-quality care.
Not being bound by insurance rules also allows us to allocate a full hour for each patient's appointment, a practice that sets us apart in the industry. Our commitment to prioritizing patient care over insurance mandates is what makes us unique, not just striving to be the best but being the only ones to adopt this approach.
Accepting insurance directly would compel us to adhere strictly to the regulations and limitations set by insurance companies. These often includes predetermined reimbursement rates, which may seem beneficial at first glance but often result in lower quality care. Providers constrained by these rules may rush examinations and limit their time with patients, adversely affecting the quality of care and attention each patient receives.
From Dr. Bill Koppin:
“Frequently, people inquire whether our services come at a higher cost. Our initial response acknowledges that it may indeed appear that way. However, allow me to share my perspective. Over the past 35 years, I’ve encountered countless patients who brought prescriptions for their new glasses. Unfortunately, upon fitting their eyewear, they discover that their vision is less than clear. These patients have been rushed through their exams, and in my opinion, this rush is a direct consequence of insurance mandates. These requirements make it nearly impossible to dedicate sufficient time to each patient, resulting in inaccuracies. Early in my career, I recognized the importance of taking the time to do things right. With over 30 years of experience, we at Shades Optical prioritize accuracy and overall wellness.
Insurance policies create an environment where doctors are constrained to spend only minutes with patients, leading to rushed interactions. One significant issue arising from this is the prevalence of inaccurate and suboptimal prescriptions. However, perhaps the most critical concern is that patients often feel unheard and misunderstood. This sentiment is particularly pronounced when they visit other doctors who accept insurance.
At Shades Optical, we prioritize spending quality time with our patients to ensure they feel heard and understood. After all, who wants to visit a doctor’s office where physicians are compelled to rush through appointments due to low insurance reimbursement?
We recognize that poor outcomes, inaccurate prescriptions, and patients feeling unheard and misunderstood do not align with the value most patients seek. Fortunately, there is a better way. We take the time to listen attentively, addressing individual needs. Additionally, we utilize images to provide a clear understanding of each patient’s status. Our commitment lies in delivering exceptional care and fostering wellness.”
Our decision to operate independently of insurance companies stems from our dedication to your well-being. Unlike the typical insurance-driven model, our focus is on doing what's best for you. We emphasize wellness and preventive care, areas often overlooked by insurance providers. The traditional insurance model tends to impose restrictions on our services, influencing decisions about patient care that may not align with your best interests, particularly in the realm of optical health.
The concept of optical insurance is generally a misleading one; it functions more like a voucher, limiting eye exams to a frequency dictated by the insurer. This is concerning because vision can change more rapidly than the allowed intervals for care. Many of our patients express frustration when their vision changes, yet they hesitate to seek immediate care due to insurance constraints.
We aim to shift this perspective and emphasize that our loyalty lies with you. Our goal is to provide immediate care when needed, without the restrictions imposed by insurance coverage.
Technology and Insurance
When we pursue technological advancements, our aim is to ensure the delivery of superior outcomes for our patients. This commitment means that when a new, improved version of a medical device becomes available, we prioritize its acquisition, ensuring we have the most effective technology in its category. Our decisions are driven by the potential to enhance patient care, not by the prospect of insurance reimbursements.
Contrastingly, the common approach in the medical industry involves purchasing equipment based on the potential for insurance billing. Sales representatives often pitch new technologies by highlighting the additional revenue a practice can generate through insurance for specific diagnoses. This creates a scenario where the decision to invest in new technology is heavily influenced by financial calculations. Practitioners may analyze the number of patients and the frequency of certain diagnoses needed to justify the expense of a machine from an economic standpoint.
However, our philosophy diverges from this model. We focus on the intrinsic value of technology in improving diagnostic accuracy, treatment effectiveness, and overall patient wellness. The primary question for us is not how much extra revenue a piece of equipment can generate, but how much it can contribute to the health and satisfaction of our patients. By prioritizing patient outcomes over financial incentives, we aim to foster a healthcare environment where technological investments are made with the best interests of patients in mind, ensuring the highest standards of care.
Let's break this down:
Insurance and Profit Motive:
When a healthcare provider accepts insurance, there is often a financial incentive to prioritize diagnosis and treatment over prevention.
Insurance reimbursements are typically tied to specific services rendered (such as diagnosing and treating existing conditions).
Providers may be tempted to focus on billable services to maximize revenue, even if it means addressing issues after they have already developed.
Technology and Prevention:
We take a different stance. We prioritize preventive measures over reactive diagnosis.
By not accepting insurance, we free ourselves from the constraints of insurance billing codes and reimbursement rates.
This allows us to invest in advanced technology that aids in early detection and prevention.
Rather than waiting for problems to escalate, we proactively use technology to identify potential issues before they become critical.
Balancing Priorities:
The conflict arises when other providers must choose between financial gains (through insurance billing) and patient well-being (through preventive care).
Our decision to forgo insurance aligns with our commitment to long-term health rather than short-term profits.
We can focus on using technology to prevent vision problems, rather than merely diagnosing them when it might be too late for effective intervention.
Our refusal to accept insurance allows us to prioritize prevention, invest in cutting-edge technology, and provide comprehensive eye care that goes beyond reactive diagnosis. Our commitment to patient health drives this decision, even if it appears costly to new clients.
Ready to experience eye care that truly prioritizes your health and well-being? Shades Optical invites you to book an appointment today. Discover the difference of our personalized, comprehensive approach, free from the constraints of insurance companies. Let us focus on you, not on insurance limitations. Click here to schedule your visit and take the first step towards a clearer, healthier vision journey with Shades Optical.