Optometric Management Tip # 188 - Wednesday, August 24, 2005
The Contact Lens Evaluation Fee
I assume that most practices now charge an additional fee for a general eye exam for a patient who wears contact
lenses. Iím not talking about a contact lens fitting fee, which would occur when a patient is initially fitted
with contacts or refitted with a parameter change, that level of service always demands a professional fee.
What I call a ďcontact lens evaluationĒ may go by various names, but it refers to the additional testing one
might perform at a routine annual eye exam for a contact lens wearer. In some cases, a practice does not charge
an additional CL evaluation fee, but instead charges a higher exam fee for contact lens wearers.
Why charge the fee?
If you are not currently itemizing the evaluation of existing contacts as a separate service with an additional
fee Ė you should consider doing so. Charging a separate contact lens evaluation fee has become a very common
practice in optometry, so those practices that donít do it are becoming the oddities. Not so long ago, many
practices (including mine) simply charged an eye exam fee without regard to contact lenses. The reasoning was
that the comprehensive exam included a slit lamp evaluation and refraction anyway, so no extra fee was appropriate
unless a change in fit was needed. There are three reasons I see for adopting the contact lens evaluation fee
Do patients ever question the evaluation fee?
- As profitability in lens materials has gone down, doctors need to be better compensated for the professional
service they provide
- The evaluation fee has become a commonly accepted practice
- Major vision plans allow the additional fee to be charged as an out-of-pocket expense to the patient (some
require a 15% discount to be extended). These vision plans are so deeply discounted that eye care practices need
to take advantage of every allowable charge possible.
Many practitioners tell me that patients frequently question or complain about the CL evaluation fee when they
are presented with the bill at the front desk. It can be a source of confrontation and stress for staff members.
This can be minimized if you follow a procedure that Iíve recommended many times, which is to fully disclose the
exam fee to the patient when the appointment is made. By having your staff discuss insurance plans, exam fees
and non-covered services over the phone, patients are not surprised when asked for payment in the office.
Telling patients what the fees will be does not drive them away; itís a courtesy that lets them be prepared.
The telephone discussion should include questions about contact lenses, and the contact lens evaluation fee
should be quoted. I believe in always telling my patients in advance if Iím going to expect them to pay something.
Consider making the CL evaluation fee just that and nothing more. Itís easy for patients to comprehend and seems
fair. I believe patients donít like fees that are for services they donít think theyíll need Ė like office visits
for the coming year, interim check-ups they really donít need, solutions they would rather buy at the supermarket,
and future discounts on items they may not buy. I prefer to charge for each service I actually provide, as I
provide it, and not try to lock people in by asking them to prepay for services.
A patient education handout
Even with the best communication techniques, patients will still occasionally question the contact lens evaluation
fee. Having a printed educational handout is a handy tool for your staff to keep at the front desk, in case a
patient asks why the fee is necessary. Consider adapting this one to meet your needs:
== Practice Letterhead ==
Q. Why is there a contact lens evaluation fee in addition to the standard eye exam fee?
A. Contact lens patients require additional testing and monitoring over and above what is done during a routine
eye exam. Contact lenses are medical devices and even though they may feel fine, there are health risks that must
be taken seriously.
In order to renew your contact lens prescription, your doctor performs the following tests on a yearly basis.
These procedures are not part of a standard eye exam.
- Corneal topography Ė a digital color map of the surface of the cornea to monitor shape and curvature, which
may be affected by contact lens wear.
- Slit lamp microscope examination of the contact lens on the eye to check the lens fit.
- Slit lamp microscope examination of the cornea, conjunctiva and eyelid tissues, to check the eye health and
to look for adverse effects from contact lens wear.
- Contact lens refraction to determine the correct contact lens prescription power (contact lens prescriptions
are different than eyeglass prescriptions).
- Review new lens designs and materials that may improve comfort and/or health.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management