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Members,
I wanted to provide you an update on the delisting of optometric clinics and doctors by insurance firms.
As previously communicated, we have been working very closely with the Canadian Association of Optometrists (CAO) gathering information why these delistings have been taking place. Additionally, we have been talking with other optometric organizations and allied health care groups collecting intel and insights. Between our two organizations we have found out the following:
- Insurance firms have stated they take the delisting process very seriously, but the relationship is with the clinic/doctor. Thus, neither the AAO nor CAO can get specific details on clinic/doctor delistings.
- There is an appeal process through the respective insurance firms but requires diligence to complete.
- The CAO has pressed through the Canadian Life and Health Insurance Association (CLHIA) our dual position that the AAO and CAO would like to see a more transparent and collaborative process with respect to any alleged claims of fraud.
- That our province is not alone in having members delisted. Some delistings of optometrists have occurred in other provinces.
- Other professions, such as dentistry, encounter the same issue across Canada but specific to their circumstances. Together, the AAO and CAO are talking with similarly affected groups at the national and provincial level to see if there are any points of commonality.
Both organizations are trying to find a way to make the process more open and less punitive on the clinics/doctors and still respects the need to reduce mistakes or alleged fraud.
We suspect that longer term educational programs are needed for members to reduce the chances of billing mistakes or alleged fraud and, at the same time, to enlighten the insurance industry on optometric billing practices.
We will continue to update you when new information is provided. Thank you for your support and understanding.
— Dr. Sophia Leung, President
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