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Optometrists concerned over health fund letters that left patients ‘confused’

Independent optometry practices have been scrambling to contact thousands of patients in recent weeks after health funds sent letters to policy holders, with many wrongly interpreting them as notification they could no longer access care from their usual optometrist or use optical rebates.

The issue – which prompted Optometry Australia (OA) to intervene to help practices clarify the issue with patients – relates to letters private health insurers Medibank Private and HBF sent to patients of independent practices in recent months.

The letters stated the name of the individual practice and informed patients it would no longer be part of programs such as Members’ Choice (Medibank) or Member Plus (HBF), which provide special optical deals.

The letters go on to state patients could still claim benefits at the practice but may face increased out-of-pocket expenses. It also advises where patients can find practices still offering the programs in question.

OA CEO Ms Lyn Brodie said this resulted in confused patients calling practices concerned they could no longer access care or use their optical rebate at the practice, which wasn’t the case.

Lyn Brodie.

However, health funds told Insight they were satisfied with the letters’ contents and were obliged to send them to policy holders under the Ombudsman’s guidelines.

This was due to VSP Vision Care’s decision to withdraw from its role as a contracting entity between Australian health funds and independent optometrists earlier this year in response to COVID-19.

VSP’s contract ended with HBF on 31 August, all other health funds on 30 September and Medibank on 30 November. This meant independent practices subscribed to VSP were no longer part of arrangements such as the Members’ Choice and Member Plus.

Brodie said the subsequent letters informing people about this change prompted several optometrists to contact the organisation.

OA produced an open letter to help practices clarify the issue with their patients. It pointed out Medibank was limiting some deals on optical appliances to some practice groups only, but patients could continue to access care from their usual optometrist and still use their optical rebate at practices that are Medibank providers – which most are.

Optometry Australia’s open letter that practices used to clarify the situation with patients.

“We have spoken to Medibank Private, and worked with Optometry WA who were communicating with HBF, who are a Western Australian-centred fund. We believe the patient confusion reported by members may be from patients reading part of the letter only,” Brodie said.

Mr Dale Rolfe, director of Rolfe Optometrists (Eyecare Plus), was one of the affected practices. Across his 10-practice network in New South Wales, he’s had more than 100 people come in-store querying whether they could still receive a rebate and has spent considerable time contacting 2,000 patients over the matter.

“Patients don’t understand the difference between me being a Medibank Private provider and a Members’ Choice provider,” he said.

“Three of my practices are isolated regionally and patients were distressed they would need to go more than 100km to another provider. Many even asked which health fund they should change to so they could continue to see me.”

Optometrist Dale Rolfe says his business’ name should not have been included on a letter of a generic nature.

In communications with Medibank, he expressed disappointment in being named in the letter, particularly with the statement that patients may face additional out-of-pocket costs.

“That word ‘may’ isn’t good enough. It infers if the patient sees me then I’m more expensive than another provider and that’s not the case. Medibank’s response was that it’s a generic letter and for some that could be true, but I said the problem is you put my name on it.”

Ms Nicky Kiparissis, who operates Kiddies Eye Care in Geelong, Victoria, was concerned for small practices like hers who did not have the resources to contact each patient.

“If I’ve lost patients, I don’t know about it,” she said.

Nicky Kiparissis, of Kiddies Eye Care in Geelong, Victoria, first became aware of the letter after her neighbour, who is a patient, asked if they could continue to visit her practice.

Health funds respond 

In response, a Medibank spokesperson said it reminded customers they could still attend their preferred optometrist and in most cases would still be able to get 100% back up to annual limits.

“Some optometrists have contacted us directly and we have advised that customers were told they could continue to claim benefits at their practice,” the spokesperson said.

“We want to ensure our communications with our customers are clear, and we are required to advise of VSP’s withdrawal as per the Ombudsman’s guidelines. We have not had much feedback from customers on this issue, and trust they will continue to visit the optometrist of their choice and claim their optical benefits.”

An HBF spokesperson said without an agreement in place with VSP-aligned practices, it could not guarantee the out-of-pocket costs for members.

“Accordingly, HBF determined this would likely result in a detrimental change to affected members’ ancillary benefits. We were obligated to inform members of this likely detrimental change and we did so by letter,” the spokesperson said.

“We have received limited feedback/inquiries from the optical industry and providers in response to our letter. We have taken all reasonable steps to ensure our communication with affected members was clear and the necessary matters were adequately addressed. In the circumstances, we have no concerns with our approach to this matter.”

New administrator emerges

With the withdrawal of VSP, in July EyeQ Optometrists – which has 26 practices – established a new entity called Q Optical Network (QON) to ensure independent optometrists could continue to have agreements with health funds and prevent the loss of patients to other providers.

Chief business development officer Ms Lily Wegrzynowski said health funds wanted to still offer their members the option of a local independent optometrist but didn’t want to manage multiple agreements.

So far more than 100 practices have joined, along with 25 health funds. However, Medibank and HBF were not yet part of the network.

Wegrzynowski said QON created a new provider agreement that differed from the VSP agreement as QON is not a supplier and has no requirements regarding stocking and selling certain products. It made the agreement easy to enter or leave if required, and she said the health fund offer needed to be compelling for health fund patients.

“We went through several different versions of this and we feel our offer is very powerful,” she said.

The administration fee is $50 per month per practice or capped at $200 per month for multi-site practices, with no minimum sign up period.

Wegrzynowski said a QON website has been launched that allows health fund members to see what their fund offers are as well as locate their nearest QON provider.

“Feedback from participating health funds has been extremely positive,” she added.

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