Incentives Explained for Optical Providers

What are Incentives?

Incentives are offers made by healthcare providers to attract patients or encourage the purchase of specific products or services. While incentives may be intended to add value to patients, they can sometimes influence individuals to purchase items or services that are not medically necessary to receive a reward. When this occurs, it is considered abuse of the benefit plan.

Examples of Incentives Include:

• Discounts, rebates or refunds offered after a claim is submitted, that reduce or eliminate a patient’s co-pay
• Retail gift cards, particularly those of significant value
• Free goods/services, such as designer sunglasses, gym memberships or footwear
• Items not shown on receipts—such as a retailer offering a $25 gift card when a member purchases prescription eyewear—which can encourage benefits abuse by incentivizing members to obtain products or services solely to receive the reward