Optometric Management Tip # 167   -   Wednesday, March 30, 2005
Dropping Managed Care Plans, Part 4
Communicating with patients


Letís suppose you decide to bite the bullet and drop a managed vision care plan that your practice has been participating with for some time. You realize that you may see a decrease in patient visits because some of these patients will choose to go elsewhere, but you also know that this group of patients is the least profitable group you have. It may be possible to reduce your staff costs, since there will be less work filing claims. You may actually be able to see fewer patients and not see much change in your net income at all. You may even be able to fill those empty appointment slots with a more profitable group of patients, or use the free time to focus on practice development and staff training. In this way, your net income may actually grow, even though you dropped an insurance plan.

Patient form letters

I often hear doctors who have dropped managed care plans discussing the form letter they sent to all patients to notify them that the plan is no longer accepted by their office and provide all the reasons why this change was necessary. Why ODs do this remains a mystery to me. It seems to me that this is the fastest way to ensure these patients will look elsewhere for a provider. It is almost like telling them they need to find a new doctor. And patients donít care about the injustices you have to deal with in managed care; itís boring stuff to them.

I believe we have an ethical responsibility to inform patients if we no longer accept an insurance plan, but I opt for telling them one by one, verbally. It happens automatically when the patient calls to schedule his next appointment, because my staff always obtains all insurance information over the phone and reviews our office policy about fees and payment. This is an office policy that I think is extremely important for efficient practice management, but many practices just donít do it.

Get it over the phone!

Our standard practice is to ask every patient who calls for an appointment if they intend to use a vision or health insurance plan with their visit. If the answer is yes, we ask the name of the plan, and we then inform the patient if that plan is accepted by our practice, or not. If not, we always quote the exam fee (even if the caller doesnít ask), and we let them know that the fee is due at the time of the visit. We also let the patient know that they may file their own claim with the insurance company and that weíll provide the paperwork they need for that.

If the caller has an insurance plan that we accept, we always verify benefits before the day of the exam. If we find that benefits are not available, we call the patient back and let him know that he can still keep the appointment, but the fee is due at the time of the exam.

It may seem like a little work to train staff to do this, and to require that the information be obtained over the phone for every appointment Ė but itís all worth it because of the increased cash flow, reduced accounts receivable, and reduced stress in the office since we no longer have confrontations at the front desk. Trust me, this in one policy your staff will embrace once they try it. Patients actually appreciate the information; most know there will be a cost for their services and materials and they want to know how and when payment is expected. We never have a situation when we ask for payment without having told the patient about it in advance. We also never transfer fees to an insurance company without having the benefits pre-approved. Imagine, never having a situation where you are battling with an insurance company for payment after services have been rendered! It can be done; just ask the patient to pay it.

Given the above procedure, informing patients about plan participation is automatic. We may add or drop plans from time to time, just as we raise fees on occasion, and no formal notification is required.


Best wishes for continued success,

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