Caveat Emptor


Insurance

 

caveat-emptorCaveat Emptor.  Let the Buyer Beware.  In this case it’s the buyer of health insurance, and we’re not even referring to the cautions and red flags of the Affordable Care Act.  We’re talking about patients getting their money’s worth for major medial coverage that should extend to something as basic as vision therapy for convergence insufficiency.  Take a look at the letter above and you’ll see the latest trend that has come to our attention.  Before paying for office based optometric vision therapy, the insurance carrier would like to see evidence that the patient has tried 12 weeks of home therapy.  Where did that idea come from?

As my colleague Dr. Fortenbacher and I have blogged, the most scientific study ever conducted in the field of vision therapy was the CITT study.  This study proved definitively that 12 weeks of home therapy is not significantly better than placebo therapy.  Apparently the insurance company is saying that if home therapy alone can result in a near 40% cure rate by taking advantage of the placebo effect, why not try that first before agreeing to office-based therapy?

Placebo

So consider this:  What would your reaction be if you received a letter from your insurance carrier stating that before reimbursing for medication prescribed, the doctor is to first show evidence that a placebo pill was not effective?

 

4 thoughts on “Caveat Emptor

  1. Dear Lenny,

    I have also encounter this request. It is the medical director(s) of an insurance company attempting to create a new guideline for the implementation of in office based vision therapy. There is no study, which has been done to show the efficacy of twelve weeks of home based vision therapy in the treatment of convergence insufficiency. The only potential valid guideline is the duration of twelve weeks of therapy from the CITT study but there will be individual differences. I assume that all medication protocols will now have a specific time line or insurance will no longer be responsible for covering the drug. The new game in insurance is collecting the premium, increasing the deductible and avoiding payment of any services. The sad reality is that it is getting worse and not better. Hopefully, we can find a solution to this insanity.

    Richard

    PS After twelve weeks of pencil push-ups, it is doubtful that any patient would want to consider another type of vision therapy.
    They would prefer to live with their condition. Medicine has found another unique treatment for convergence insufficiency, which allows them to be in control while the patient suffers in silence.

    • Agreed, Richard. Consumers have gotten what they wished for: the government has now gotten into the health insurance mandate business. How is it working? At some point there will simply be health care savings accounts in which the individual can designate their care dollars for whatever priorities they set in terms of doctor-patient relationship, emergency vs non-emergency, acute vs. chronic, mainstream vs. alternative. etc. It is insanity to abandon the doctor/patient relationship in deference to the doctor being an employee of a third party plan or the government. That is, unless, you didnt want to run a small business called a healthcare practice, and would rather take a fixed, guaranteed paycheck. Hopefully the conversations will continue, and sanity will be restored.

  2. Hi Len,
    We do not accept insurances in our 4-office vision therapy practice; I did participate with all providers years ago, but I know that’s not an option with some docs. I wish I could, but the insurance system continues to oppose us as you illustrate above.
    My wife has been battling Lyme for 4 to 5 years now, has consulted with many doctors, MDs and non-MDs. None accept insurance, a common practice for specialized care.
    Tod

    • We do not accept insurance in our practice either, Tod, other than Medicare for seniors. While many docs are not in a position to be non-par providers, sometimes that is a self-fulfilling prophecy. We are however strong advocates for the patient to be reimbursed to the full extent to which they are entitled. It is in this vein that we write letters of medical necessity, and challenge the system when we see inequities such as “show us you did 12 home VT sessions first” — for which you and i know there is no basis in fact in terms of efficacy.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s