Pediatric Ophthalmology & Strabismus, Inc. has been caring for the community for over 50 years.  Our specialty is focused on the care of children and other vulnerable members of our society such as individuals with special needs, rare disorders, the IDA community, and anyone who suffers from double vision.  We currently have about 30,000 patients under our care.

As most medical facilities do, we participate with private insurance companies and state-funded insurance companies so that we can serve as much of the population as possible.  Because we primarily care for children, the majority of our services are standardized using Pennsylvania Medicaid reimbursement rates.  Even commercial insurance policies will determine their rates as a percentage of those Medicaid rates. 

Medicaid (children care) is funded and managed at a State level, so it varies between each State; as opposed to Medicare (adult care) which is managed at a Federal level and is the same across the entire country.  When it comes to Medicaid rates, Pennsylvania is ranked #50 out of 50, at the very bottom in the entire country.  And the difference between us and #49 is large.

That is why this region is suffering a crisis.  It contributes to the lack of all types of Pediatric Physicians.  If you wonder why there are so few Pediatricians, Pediatric Cardiologists, Pediatric Neurologists, Pediatric Dentists, and so on, this is a huge factor as to why that is.  It will only get worse.  PA is not attracting any young newly graduating physicians.  As your current doctors continue to move out of state or retire, there is nobody to take their place and provide you with care.  Many States do not have this same problem, because those States are doing a better job at keeping reimbursement rates competitive and fair.

For over 20 years, dating back to the early 2000's, we at Pediatric Ophthalmology & Strabismus Inc. have predicted this problem and brought it to the attention of State Leaders and Insurance company representatives: Medicaid and pediatric healthcare is being left behind while the rest of the medical field continues to receive attention financially.  That is, our reimbursement rates were frozen and unchanged while adult medicine and other fields were getting periodic increases to keep up with rising costs of healthcare.

Today in 2024, our exam rates for pediatric care are the same as they were in 2007.  However, our expenses today are exponentially higher than they were two decades ago.  In one final attempt to save our company, we contacted our insurance payors and State Leaders warning them that we would be forced into closing our business if exam rates were not brought up to the same amounts as adult exam rates.  (We were asking for Medicaid:Medicare parity/equivalence).  We warned that the Southwestern PA region was at risk of a healthcare crisis as thousands of patients would have difficulty finding care for their needs.  There are only a handful of Strabismologists/Pediatric Ophthalmologists in the entire State, let alone the Southwest region.

Unfortunately, our requests for parity were declined at a State level.  Similarly, insurance companies were not willing to increase their rates unless the rates were increased at the State level.  So, we are stuck with a glaring problem that we had foreseen 20+ years ago, and no solution to fix it.

As a result, we closed our Washington, PA on August 23rd, 2024.  Even though our appointments were always full, and our office was at maximum capacity with business, the exam rates that are set for us are not enough to cover our expenses.  We estimate that 8,000 patients were affected by this closure.  By closing one office and consolidating down to two, we hope to reduce our expenses enough to keep our business open.

We have no plans to leave any insurance networks as a result of this, even though changing our business to cash only would allow us to choose our own prices.  One of our beliefs is that patients should always come first, and everyone in our community deserves to receive care.  It is never the patients' fault that their insurance company does not pay enough to keep the doctors' office open.

Patients who are able to commute to our Cranberry Twp. or Murrysville offices can continue their care with our specialists.  We look forward to seeing you!

Please join our petition asking insurance companies and State Leaders to raise our exam billing rates to a fair and sustainable amount.  Consider that if this issue is not addressed and fixed, nearly 30,000 families will find themselves driving across state lines to find care.