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Dear Members,
The AAO has observed an increasing number of optometry clinics in Alberta being delisted from insurer networks, often without clear or consistent explanations. In some cases, these actions have been linked to billing practices or internal insurer policies, creating uncertainty and concern among providers and patients alike.
These developments pose risks to the sustainability of optometric practices and could impact Albertans' access to vision care. The AAO is committed to working collaboratively with stakeholders to better understand these issues, support members in navigating them, and promote transparent, fair processes that protect both professional standards and patient choice.
In response to this issue, we have established the AAO Private Insurance Task Force (the Task Force). To support its mandate and ensure meaningful progress, AAO Council has earmarked a budget of $250,000 for this initiative. This Task Force will work in coordination with related initiatives at the national level, including the CAO’s Working Group on Billing Practices and Fraud Prevention, to ensure consistent messaging, share insights, and complement efforts aimed at supporting optometrists across Canada.
More specifically, the Task Force is a collaborative initiative established to:
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Monitor and Analyze: Track instances and patterns of optometry clinic delisting across Alberta, and review the underlying reasons and impacts.
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Support Members: Develop practical tools, communications, and educational resources to help members understand risk factors and respond to delisting actions.
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Engage Stakeholders: Initiate dialogue with insurers and other relevant parties to clarify delisting criteria and advocate for fair, evidence-based processes.
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Develop Multi-Faceted Strategies: Recommend approaches that may include policy input, education, legal review, public communications, and media relations.
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Report and Recommend: Provide regular updates and strategic recommendations to the AAO Council and members on risks, trends, and opportunities for member advocacy and support.
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Coordinate: Work with the CAO’s Working Group on Billing Practices and Fraud Prevention where applicable, in order to share insights and avoid duplication of efforts.
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Collaborate Across Professions: Engage with other allied health associations to identify shared concerns, align advocacy where appropriate, and strengthen the voice of regulated health providers in system-wide insurance matters.
To view the Task Force Terms of Reference, please click here.
To help members better understand anti-fraud practices to avoid billing errors and prevent fraud and fraud investigation of their practices, the CAO will host a webinar on Monday, October 6 at 7:30 PM ET: Benefits Fraud – What You Need to Know to Protect Your Practice and Your Patients. This webinar will offer a comprehensive overview of the CLHIA Anti-Fraud Programs and tools that are being leveraged by the industry. The webinar will cover their educational campaign for healthcare providers, highlights current trends in benefits fraud, and offer strategies to protect your patients and your practice against fraudulent activities. For more information or to register, please click here.
We will continue to keep you informed with timely updates and resources to support our members.
Thank you for your continued engagement and support.
— Dr. Sophia Leung, AAO President
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