Optometric Management Tip # 135   -   Wednesday, August 18, 2004
The Contact Lens Evaluation Fee

If you arenít currently charging an additional fee for annual examinations of contact lens patients, it is worthwhile to reconsider this approach. In my early years of practice, I didnít see the need for an additional CL evaluation fee, unless I changed the design of the lenses. I charged a high fee for the comprehensive eye exam, and a CL fitting fee when I changed the fit. I reasoned that I performed K-readings and a slit lamp exam on all patients, so it was really not that much more work to examine a CL wearer than a non-CL wearer. Here are some of the reasons that changed my mind.

For purposes of this article, Iíll define a
CL Evaluation as checking the fit of an existing pair of contact lenses at a routine eye exam and renewing the contact lens Rx. A CL Fitting is a more complex diagnostic service, which involves changing an existing CL design or prescribing lenses for the first time. A CL fitting typically would include follow-up visits, where a CL evaluation would not. A CL fitting would often have 3 or 4 different fee levels, based on complexity and time predicted. The lowest fitting fee would be for a simple re-fit, and the highest would be for a complex case such as bifocal or keratoconus.

Reasons to charge a separate CL Evaluation fee Communicating with patients about the fee

Colleagues have asked me how to handle the occasional confrontation with patients who donít want to pay the CL evaluation fee when they are checking out at the front desk. Of course, all staff should know and be able to articulate what services are provided for the fee Ė topography, slit lamp exam, over-refraction and renewal of the CL Rx are appropriate to explain. But if a patient questioned the CL evaluation fee at my front desk, I would tell my staff that they didnít do a proper job when they scheduled the appointment.

I believe in never asking for money unless youíve told the patient in advance that it would be expected. In the case of exam services that means the receptionist must find out if the patient wears contact lenses, find out if he has a vision plan that we accept, then state the exam fee and the CL evaluation fee Ė even if the patient doesnít ask about it! If your business office staff does this 100% of the time, no one will be standing at your front desk unable to pay, and your private pay accounts receivable will become very small.
What to charge

The amount to charge for the CL evaluation fee is a personal decision, but I would look at it in relation to the comprehensive eye exam fee. It certainly would be less than that amount. I have found that the CL evaluation fee is often about 25% of the exam fee. For example, an OD who charges $120 for a comprehensive eye exam would have a CL evaluation fee of $30.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management