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SERVICES
In the context of this website, the word ‘services’ has
two applications: ( a ) Services performed for private patients
or Health Plan members by Network Doctors, and ( b ) services
provided by FOPN to the Managed-Care Plans, Professional & Trade
Associations, companies, corporations and government Health Plans
we support. For more information on the services we offer
Health Plans, please continue reading below.
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• 'Services
By Design'
• Commercial Plans
• “Healthy Kids” Plans
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Medicare Plans
•
Medicaid Plans
• Routine
Vision-Care
• Comprehensive
Eye-Care
• Structured
Benefits
• Customer Care
• Provider Relations
• Credentialing
• Comprehensive Eye Exams
• Frame Selections
• Lens Treatments
• Contact Lenses
• Co-Pay Amounts
• Courtesy Discounts
• Local Area Networks
• Automated
Voice-Response Authorizations
• Data Processing
• HEDIS Sampling
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Benefits
Administration & Claims Payment
• Centralized Production/Finishing
Labs
• Quantity-Purchasing Advantages
• Quality Improvement Programs
• Member Satisfaction Surveys
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SERVICE BY DESIGN: Generally speaking, our Vision-Care / Eye-Care services are divided into four categories: (a)
Commercial Plans; (b) ‘Healthy
Kids’ Plans; (c) Medicare Plans; and (d)
Medicaid Plans. All of FOPN’s service agreements can be tailored to meet the specific needs of the contracting organization. That includes individual Managed-Care companies; Professional or Trade Associations; other Not-for-Profit Organizations; independent companies and corporations, and local and state governments. The greatest flexibility in structuring Vision-Care / Eye-Care benefits falls under the
‘Commercial’ heading,. ‘Healthy Kids’, Medicare and
Medicaid plans are usually shaped by the specific government program and its mandated benefits.
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A MATTER OF CHOICE: The first decision Health Plan administrators face in structuring Vision-Care / Eye-Care benefits begins with a choice between:
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Routine Vision-Care Services – Benefits can be structured to include an annual, comprehensive eye examination; eyeglasses and corrective lenses; contact lenses, lens fittings and follow-up visits; and structured spectacle-benefit packages. |
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Comprehensive Eye-Care Services –
In addition to Optometry, benefits can be structured to include
medical conditions affecting the eyes; the care and treatment of Glaucoma, Cataracts, Corneal Abrasions, Eye Infections, Foreign Bodies, etc.; and the prescription of appropriate medications. |
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FEATURES & OPTIONS: All of our Vision-Care / Eye-Care plans and programs feature:
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Structured Benefits –
Some sub-contracted service networks offer their programs to Health Plans with limited or no options. The Florida Optometric Physicians Network currently provides more than 20 different Vision-Care / Eye-Care plans and three separate Options programs. Each contract is tailored to the specific goals of the individual Health Plan and its members’ needs. We work with Plan administrators and Provider Relations staff in structuring appropriate benefits and packages to give members the most benefit for the least cost. In some cases, the Health Plan underwrites all costs for the members’ basic benefit package. In other cases, members may be required to make ‘co-payments’. And in still other cases, Health Plan administrators may arrange for Plan members to receive
“discounted fees for services”, at no cost to the Health Plan itself. |
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Customer-Care –
Whether we’re providing routine Vision-Care or comprehensive Eye-Care, there may be times when a Health-Plan member needs someone in Network headquarters to answer specific questions, address problems or complications, or follow-up and follow-through. Our Customer-Care desk is available by toll-free 800-number, email and mail. |
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Provider Relations –
There may also be times when network Providers need someone inside the Network to act on their behalf, such as to follow-through on special orders, rush jobs, order changes, replacement frames, etc. Our Provider Relations desk offers two-way communication between the Network and Providers. |
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Credentialing –
To make sure prospective Providers are properly qualified, doctors must submit a Credentialing Application as well as copies of their professional license(s) and Board-Certified authority, proof of professional liability insurance and three Letters of Recommendation from colleagues. |
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Comprehensive Eye Exam –
Vision-care and eye-care benefit packages generally include an annual, comprehensive eye examination and evaluation, performed by a licensed, Board-Certified Doctor of Optometry or Doctor of Ophthalmology. A comprehensive eye exam will address 14 key points, including: Personal History; Family History; Medications; Allergies; Visual Acuity; Pupillary Exam; Fields; Motility/CT; Retinoscopy/Subjectv; Biomicroscopy; Tonometry; Fundus Evaluation; Assessment and Treatment Plan. The
‘dilated fundus’ portion of that exam allows the doctor to look inside the patient’s eyes, where many diseases often show themselves first! If the comprehensive eye exam indicates a medical problem, then the affected member can be referred to Ophthalmology or his or her Primary Care Physician for follow-up treatment. |
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Frame Selection –
Vision-care and eye-care programs can include spectacle benefits and/or contact lens benefits. Many of our plans offer glasses at no cost to the member if the member selects a frame from an FOPN basic-frame kit and only needs standard single-vision or bifocal lenses. The standard frame kit includes 24 styles for men, 24 styles for women, 12 styles for boys and 12 styles for girls. We also have an upgraded-frame kit with another 36 styles, and all Network providers keep samples of those 108 frames on hand. If a Health Plan member selects a frame outside of the 72 Network frames, such as a frame from the Provider’s own selection, our programs can be structured to give the member a “frame credit” which will be deducted from the final amount due. |
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Lens Treatments —
Some lens treatments (such as a basic tint) are provided as a standard courtesy when requested by Health Plan members. Other lens treatments, such as scratch-resistant and ultra-violet coatings, may come at a nominal additional cost. Lens treatments may be included in benefits packages or offered as member-co-payment items. |
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Contact Lenses –
If corrective lenses are recommended by a doctor after a patient’s comprehensive eye-exam results, not all Health Plan members may necessarily want eyeglasses. Plan administrators can anticipate those members’ wishes by incorporating optional contact lenses as part of their Plans’ Vision-Care / Eye-Care benefits package. Fitting patients with contact lenses is more involved than fitting eyeglasses, often requiring several follow-up visits. Giving Plan members a choice between glasses and contacts can be a distinct marketing advantage to the individual Health Plan. |
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Co-Pay Amounts –
Some Health Plans may require members to make nominal co-payments as their portion of the overall expense of a specific Health Plan benefit. Variables to be considered when Plan administrators structure their Vision-Care / Eye-Care benefits package include: Whether Health Plan members contribute a co-payment or not; When co-payments are required and for what; and How much the co-payment amounts will be. |
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Courtesy Discounts – Individual, structured Vision-Care / Eye-Care plans and programs generally offer many choices and options to Plan members under the Plan’s broad umbrella. However, some members may be interested in specific choices and options
not included in the Plan. In those cases, FOPN Providers will offer that item, treatment or
service at a 20% discount off the Provider’s
customer & usual pricing. |
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Local Area Networks –
Generally speaking, whether a Plan includes Optometrists only, Ophthalmologists only or a combination of Optometrists and Ophthalmologists, we want to offer a Network Provider within five miles of most members’ homes or place(s) of employment. Rather than give Health Plan administrators just one Provider network to work with, we can provide a Network to meet the specific needs of each individual Health Plan —
City-Wide, County-Wide,
Region-Wide (two or more adjoining counties) or
Statewide. Regional Networks include:
South Florida, Central Florida, Northeast Florida, West-Central Florida and West
Florida. |
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Automated Voice-Response Authorization –
FOPN has a toll-free Automated Voice-Response Authorization system which allows Network Providers to call in to confirm that a member is: (a) Active with a specific Health Plan; (b) entitled to Vision-Care / Eye-Care benefits; (c) what those benefits are; and (d) what benefits remain available for the current calendar year. The Network’s
AVR system gives Providers authorization to examine the member and to provide the appropriate benefits following the eye exam, such as glasses, lenses, lens treatments, etc. |
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Data Processing –
A major part of the administrative function involved in providing Vision-Care / Eye-Care services and support to Health Plans and their members revolves around providing appropriate, timely data to Health Plan administrators and data-entry, utilization, marketing and other departments. We can transmit data to Health Plans daily, weekly or monthly, depending on the Health Plan’s needs. |
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HEDIS Sampling –
From time to time, we are asked to provide data for HEDIS reports on a sampling of Health Plan members, to (a) determine if those members have received an annual eye exam within the last 12 months; (b) if the comprehensive exam included a dilated-fundus exam; and (c), if it didn’t,
why not. |
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Benefits
Administration & Claims Payment – FOPN acts as the bridge between a Health Plan and the Providers who examine and serve that Plan’s members. In that capacity, FOPN maintains accountability for Network authorization, members seen, services provided and products dispensed. The Network also dispenses Provider payments, assures Provider quality improvement and acts on behalf of both members and Providers if disputes arise over service performance, prescription accuracy, refusal of benefits, etc. |
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Centralized Production/Finishing Labs –
IF the Network used just one production or finishing lab for all of the regions of the state, orders for glasses and corrective lenses or contacts may be delayed, especially for Health Plan members at the far end of the state. The same would be true if we used the US Postal Service to send glasses or lenses to Providers for dispensing to members. Instead, we work with centralized production and finishing labs in each region to meet our own standards of service and member satisfaction. We support those labs with two-way, overnight delivery between the individual lab and Providers’ offices.
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Quantity-Purchasing Advantages –
Quantity-purchasing advantages earned by FOPN from frame and lens manufacturers and other vendors and suppliers are passed on to Health Plans and their individual members through lower contracted rates, service fees, co-pay amounts, etc., and, when appropriate, higher courtesy and related discounts. |
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PROGRAM & PLAN OPTIONS: We also offer several important Program & Plan Options, including:
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Quality
Improvement Programs – In addition to the Network’s own,
ongoing quality improvement activities, FOPN can formally conduct
and manage a Quality Improvement and Quality Assurance program
for a Health Plan, and provide reports on a quarterly, semi-annual
or annual basis, as determined in advance by the Health Plan
itself. FOPN’s ‘Quality Improvement Manual’ is more than
100 pages long, covering a wide spectrum of activities and considerations,
from Provider Reviews to Site Inspections to Member Satisfaction
Surveys. For more information, please send an email message
to: FOPN_QI@fopn.org |
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Member Satisfaction Surveys –
Patient satisfaction surveys can be conducted for a designated sampling of Health Plan members, city-wide, region-wide or Network-wide, for a set period of time (two-to-three weeks) one or more times a year. Surveys are distributed to Health Plan members after seeing a Network Provider. Members are asked to complete the two-page questionnaire
anonymously (so responses can be as truthful as possible) and return the completed form in a postage-paid envelope to the Network’s Quality Improvement office. Reports on survey results can be sent to the Health Plan itself and individual Providers, so the Providers can improve the areas of their performance, etc., where member satisfaction may call for attention. |
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For more information on
any or all of the topics above, please contact the
FLORIDA OPTOMETRIC PHYSICIANS NETWORK
at:
FOPN_Info@fopn.org
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