Callie Richmond for The Texas Tribune
Dr. Susan Shauger performs a routine eye exam at Lakeline Vision Source in Austin. Proposed legislation would stop health- insurance companies from obligating optometrists to discount some uncovered items. Opponents say that could raise premiums.
A group of Texas optometrists is lobbying the State Legislature for more power to negotiate contracts with health insurance companies, and the measure they are supporting could hit consumers' wallets, some business advocates say.
Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.
Callie Richmond for The Texas Tribune
A Lakeline display. "Optometrists are just getting eaten up by insurance companies," a Texas Optometric Association doctor said.
"The problem is that optometrists are just getting eaten up by insurance companies," said Dr. Thomas A. Lucas Jr., an optometrist and legislative chairman for the Texas Optometric Association. "It's very rare that the small-business optometrist has any say in what's actually in the contract."
Senate Bill 632, by Senator John Carona, Republican of Dallas, would prohibit a common practice among insurers: contractually obligating optometrists to offer discounts on services and products that are not covered by the health plan, like a spare pair of glasses or cosmetic contact lenses that change eye color.
The Senate approved the bill this month, and Representative J. M. Lozano, Republican of Kingsville, has agreed to sponsor the bill in the House.
Kandice Sanaie, a lobbyist for the Texas Association of Business, argued that the restriction would mean that consumers would pay more for uncovered items. It could also raise insurance premiums, she said, if insurers began including uncovered services that were previously discounted in a health plan.
"There's nothing forcing providers to sign contracts with health insurance carriers in the first place," Ms. Sanaie testified last month at a legislative hearing on the bill.
Optometrists who sign contracts with insurance networks, she added, receive client referrals from the insurer.
(The Texas Association of Business is a corporate sponsor of The Texas Tribune.)
"Proposals to prohibit such offerings are anti-consumer, serving only to limit the ability of your constituents to obtain quality vision care at an affordable price," wrote a representative for America's Health Insurance Plans in a letter to Mr. Carona expressing the trade association's opposition to the bill. She added that the bill would reduce the number of employers who are able to provide vision coverage because of the increased costs.
In 2011, Texas approved a similar law — also carried by Mr. Carona and Mr. Lozano — to prevent insurers from requiring discounted prices on uncovered dental services in contracts with dental providers.
From 2011 to 2012, the Texas Optometric Association donated $15,000 to Mr. Carona and $3,000 to Mr. Lozano, according to a Texas Tribune analysis of campaign finance records.
As dental and vision benefits are considered additions to health plans, they typically cover only basic preventive services to keep rates low and are subject to more stringent contract terms with health insurers, Dr. Lucas said. Insurers force doctors to offer discounts on uncovered products and services, he said, to make a health plan more attractive to consumers.
"All of that is borne onto the provider at a significant financial cost," Dr. Lucas said. When discounts are required on uncovered services, he said, optometrists raise rates. "Downstream, that hurts any consumer that is not covered by that policy," he said, "including the uninsured."
baaronson@texastribune.org
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