Most modern optometric practices accept both vision and medical insurance. This is great when it gives us opportunities to better serve our patients and gives us flexibility with the services we are able to provide. However, when it causes us to argue with our patients or creates a negative experience because of confusion, this flexibility can become a liability.
Common Scenario:
A patient presents to your practice with verified vision and medical insurance. The patient’s expectation is getting new glasses and contacts. The "chief complaint” is dryness, discomfort, headaches or worries about glaucoma (which runs in the family). Through the course of the exam, it is determined that this visit should be billed medically.
We all recognize the advantage of this for the practice but let’s think about this from the patient’s perspective: The shift results in a higher copay, coinsurance and maybe a deductible. The patient who expected a $10 copay now is expected to pay over $200 for today’s visit. Usually, the higher copay is collected at the visit but the bill for the coinsurance and deductible shows up next month in the mail. They are mad twice.
Blaming the patient for saying the wrong thing: Often, when these misunderstandings occur, the staff points out the chief complaint was “medically-based.” This effectively “blames” the complaining patient for saying the wrong thing during the exam. Forget the anxiety over the “1 or 2” question. Now you are telling the patient that you tricked them into complaining about Dry Eyes so you can make more money.
While it is good to get the most out of third party payers, it is not worth generating mad patients.
The secret is in UP-FRONT communications.
When checking into a hotel, you sign an agreement and initial by the rate, the check-out date and the no smoking policy. This is because most customer disagreements are related to these topics. So, before you get your keys, you verify that you agree to these important points.
If a patient presents to our practice with the intention of using their vision benefit and the medical plan is better, upfront, clear, concise and complete communication about that is essential.
At check-in, distribute a document which outlines the difference between vision and medical coverage - people don’t know.
Once the decision is made to “change” this visit to medical, inform the patient - don’t bombard them at check-out. Explain the decision and answer all of their questions.
Be willing to use two different visits, one for vision and one for medical, when it is close.
The point is: Don’t let your inclination to be right about the insurance create a rift between you and your patient. It is critical to decide how you will handle this “argument”, communicate it well to the entire team and practice routinely.
Leadership OD can help you explore your response and implement a plan to communicate clearly with your patients.