The going out of network checklist
Dropping one or more vision plans is sort of like a chili recipe: Everyone’s got their own ingredients and you have to decide for yourself what you want your chili to taste like and how to get it there.
That being said, there are a few basics: beans, a tomato base, meat or a meat substitute. And the same goes for dropping vision plans. You can spice it up however you want, but make sure you check off the base ingredients first.
Luckily, we’ve been cooking chili with ECPs for a while now. And with that experience, we’ve been able to put together a checklist of everything you’ll need to drop one or more vision plans. If you’re considering going out-of-network, it’s important to ensure you check off these ingredients before you take any concrete steps. This will ensure you and your team are fully prepared for what comes next: Cooking up out-of-network success.
Why you need an out-of-network checklist
When you drop one or more vision plans you’re changing how your practice bills with a segment or all of your patients. That’s essentially like starting a new business. It means you have to look at everything and how it might change when you’re off-panel.
Because if you’re not prepared, then you risk undermining patients’ trust in your brand. After all, you’re dealing with both their health and their money—two very important things. It’s crucial to get the transition right and identify messaging that effectively communicates why you’re doing it. Pulling this off can be the difference between holding on to most of your patients or not.
The going out-of-network checklist:
And now here's everything you need to drop one-or-more vision plans:
✓ Your financial standing and KPIs
One of the first things you should do is build a thorough understanding of the business side: Where do you stand financially and which KPIs should you follow?
Financial metrics and practice KPIs will help you confirm whether dropping one-or-more vision plans is the right decision and chart a path toward doing just that. Without this information it’s easy to accidentally step off course. However, with it you can ensure more control over the outcome of your out-of-network undertaking.
✓ Download your patient data and other information
You’re planning to explain to existing patients the advantages of out-of-network vision plan benefits. You probably don’t want to ask that they resend their vision plan information to you again as if they’re new patients. Luckily, you don’t have to. Make sure you download patient data as well as any other relevant information ahead of time.
That will make out-of-network lookups easier if you’re using Anagram for benefit eligibility checks. Additionally, if you save in-network rates you can compare them against out-of-pocket costs for future cash-pay patients.
✓ Will you switch to a new lab?
If you’re an optical or have an optical dispensary, then the right lab is essential. In fact, the lab partner you’ve been paired with through vision plans may be one of the reason you’re dropping them!
If that’s the case, we assume you’ll be finding a new one. If not though, you should still consider whether it makes sense for you to find a new lab partner. How could a new lab benefit your patients? Or, on the other hand, could you negotiate your rate per job with your current lab?
✓ Letters/emails for parties affected by you dropping the vision plan(s)
You dropping one or vision plans will be a good thing. But you still need to tell stakeholders you're going out-of-network ahead of time. Determine who you have to update. This varies for everyone, but could include:
- Referral Partners
Plan a date to send communications to each group. Make sure you give yourself enough time to get in touch with anyone who is concerned or confused. With plenty of preparation, you should be able to set your team up for success through what could otherwise be a difficult period. Selling out-of-network care starts with giving every stakeholder a good impression of it. This is one of your first opportunities to do that.
✓ Will you change your mix of services/materials offered?
Many vision plans restrict what you can and can’t offer due to their own agreements with their partners. This limited choice hurts patient experience. Without these restrictions, you’re free to offer patients a mix of services and materials that fits their needs, rather than the needs of a vision plan. What changes can you make?
✓ Updated pricing plans
What patients pay will inevitably change when you drop their vision plans. You'll have new flexibility in how you price services and materials. This means you can be transparent and amenable in how you price services or materials.
Discounts are a popular pricing strategy among out-of-network providers. For example, try packaged pricing for materials. Discounts can help you sell pricier out-of-network materials or services to prospects and keep people coming back.
✓ A plan for verifying patients’ out-of-network benefits
There are some things vision plans undoubtedly make easier for you. Checking in-network patients’ benefits is prime among them. When you drop one or more vision plans this will inevitably change. Some of your options include:
- Have patients verify their benefits for you.
- Try to call the vision plan and check the patients’ available benefits.
- Use software such as Anagram to instantly verify benefits.
✓ A plan for you to ensure patients’ claims are filed
Claims are one of the main reasons people avoid out-of-network providers. No one wants to file a claim with their vision plan. There are more enjoyable ways to be spending your time. But with out-of-network providers it’s a fact of life. Like verifying benefits, there are a few options here:
- Ask your patients to file claims themselves
- File paper claims for your patients using a CMS 1500
- File claims using an out-of-network software like Anagram.
✓ A value proposition that takes into account your new status with vision plans
A change in your status with vision plans means a new value offered to patients or customers. Your value proposition, or the value you add over your competitors, changes. In fact, for out-of-network providers, these mission statements often go hand-in-hand with their new out-of-network status.
Are you looking for a path to more transparency because you believe in an honest practice from top to bottom? Would you like to offer a wider line of frames than nearby opticals? Find your value proposition and use it.
✓ A brand new eye care marketing plan
Like we said above, dropping one-or-more vision plans changes (often for the better) the value you offer. And that, in turn, should change your marketing.
What’s your reason for making this change? How does your value proposition evolve or strengthen? Identify this messaging first.
Then develop a plan to communicate that message to your target audience. Without vision plan directories you’ll have to put more effort into finding and connecting with prospective patients. Luckily, there are plenty of simple and powerful tools and channels you can incorporate in an eye care marketing plan to find new, out-of-network patients.
✓ Scripts for existing and prospective patients
Explaining the advantages of out-of-network benefits to someone live on the phone or in-person can be difficult. In-network care is ingrained in people’s minds as the care they should seek. To actively go to an out-of-network ECP naturally seems like the wrong thing to do.
That’s where your patient scripts come in. You and your team know how this will improve quality of care moving forward. How do you effectively communicate that to others?
Write scripts for various situations, practice them, and then use what you learn to edit and update them. Take your time with your staff to perfect these scripts in order to guarantee they work.
✓ An updated or redesigned website
This goes hand-in-hand with your marketing plan but deserves its own mention. Your website messaging is crucial: 90% of people research local services online, according to BrightLocal’s Local Consumer Review Survey. Chances are if someone doesn’t know about your business already, the internet is where he or she will find it.
Make sure your new out-of-network value proposition is loud and clear, above-the-fold on your homepage. What is it that you offer your patients or customers? Let them know right away, and then explain how.
Don’t forget to include payment options. This is going to be important to your patients and can be used to communicate the value of your out-of-network practice.
✓ Buy in from your team
While it’s normal to be a little scared (as one ECP told us, it shows you care!), it’s essential to have buy in from your team.
If anyone on your staff doesn’t believe that this is the best move for business and for the patients, then it’s going to be hard to succeed. Talk through any objections and ensure everyone understands the advantages and is bought in before moving forward.
Setting yourself up for out-of-network success
The more you set yourself up for success ahead of time, the more painless it will be to drop vision plans. That doesn't mean it will be a walk in the park the whole way through. But knowing how to deal with the obstacles that may come up make them easier to overcome. The list above may seem like a lot, but checking off all of it will help you position your eye care business for long term growth out-of-network. It's better to take care of these now than later, when they become problems.
Keep in mind what you're making this change for and your marketing plan, scripts and all the rest will come together. More often than not, that's the patients and the experience and quality of care you're able to offer. Dropping restrictive vision plans will give you the network freedom and flexibility you need to grow as a business while offering the best patient care around.