Optometric Management Tip # 296   -   Wednesday, September 26, 2007
Contact Lens Fees Are Not Always Simple

Eye care practitioners frequently ask how to handle the sticky situations that can arise with contact lens fees. Is it always smart to charge a refitting fee if you want patients to try new lenses? When should a refitting fee apply and how do you explain it to the patient? Should follow-up visits be included in a refitting or itemized separately? If you didn't charge a fitting fee, how do you handle patient complaints and ensuing office visits that arise right after prescribing a new lens? What should you charge if you evaluate diagnostic lenses in the office on a new fitting, but you or the patient decides to not go through with the order? Is it a good practice to charge a fee only to adjust it out if anyone complains? How do we respond to patients who don't understand the need for contact lens professional fees?

Clearly, there are many scenarios that can occur and the fee issues can be challenging. I think the best way to analyze this topic is by presenting individual case reports and I'll do that over the next few weeks. It behooves us to have a clear understanding of contact lens services and fees so we can train staff members and communicate well with our patients.

Definitions

Before we jump into managing some of the real world situations stated above, we should review some of the terms that are often used in contact lens services. If I've learned anything about eye care practice it's that there are many, many different office policies and procedures in use for contact lenses. Accordingly, communication can be confusing and it's easy to misunderstand another practitioner's fees.

For example, a contact lens exam may include a general eye exam plus any additional testing needed to fit contact lenses, all for one fee. It may include patient education and training and follow-up visits or those could be an additional cost. Or, it may include all office visits for a year. On the other hand, a contact lens exam may be structured as an additional service from a comprehensive eye exam with a separate fee charged and itemized on the bill.

There are many definitions for the terms contact lens fitting and refitting, although some doctors don't like the term "fitting" and may call it contact lens prescription and management or various other descriptions. And what is a contact lens evaluation? Are exams, fittings and evaluations all the same thing? Should there be different levels of complexity in CL fittings with different fees? How do contact lens service agreements fit into this?

A system to consider

There is no right or wrong to how contact lens services are packaged or organized and the terms really don't matter as long as people understand what we are talking about, but I'll share with you my preferred system for contact lenses. Here are some definitions that I use for CL services.

• Contact Lens Evaluation.
  The evaluation of the fit and Rx of an existing pair of contact lenses on an established wearer, usually performed at the time of an annual eye exam. This evaluation includes additional tests that are not always done in a routine eye exam, such as slit lamp evaluation of the lens on the eye, over-refraction, keratometry and corneal topography. This service carries a separate fee from the eye exam fee and it's itemized on the patient's statement. I do not have different levels of complexity for a CL evaluation because by definition it is only performed on successful cases that do not need a fitting change. If a fitting change is needed, then the CL evaluation is replaced by a different service: a contact lens fitting. CL fittings have various levels of complexity and fees that increase accordingly. A CL evaluation leads to the renewal of the contact lens prescription and I include power changes as part of that process, not as a refitting. It's important for practitioners who accept vision plans to charge a separate CL evaluation fee because vision plans generally consider this a non- covered service and will allow the practitioner to charge the patient privately for it. It has become a widely accepted standard procedure in eye care in the United States.
• Contact Lens Fitting
  I have four levels of contact lens fittings based on the complexity of lens design and each level has a different fee. I don't differentiate among patients new to contact lens wear and those who have worn them in the past but discontinued. A CL fitting includes dispensing, training and follow-up visits for two months.
  • Basic fit - Spherical soft or gas permeable lenses on a daily wear basis. While the fitting period is defined as two months, I usually will only need one follow-up visit. The two month period just gives us some reference for the follow-up care, but if we are actively pursuing a successful fit, we will continue to work beyond that period.
  • Advanced fit - Includes extended wear, toric and presbyopic lenses, including monovision.
  • Keratoconus or post-surgical fit - This service includes six months of follow-up care.
  • Orthokeratology or Corneal Refractive Therapy
• Refitting
  I use the term refitting whenever I make significant changes in lens design or lens brand for a current contact lens wearer. I will typically reduce the usual fitting fee because the patient does not need training and I can use the past and current experience to help me with the fit. These cases are handled on a case by case basis but the refitting fee will often be 50% to 75% of the full fitting fee for that type of lens, but if the case is very challenging there may be no reduction in the fitting fee. Follow-up visits are included.

A comprehensive eye exam by a doctor in my practice is always required before a contact lens fitting (within six months). The eye exam has a separate fee. Contact lens materials are always charged separately.

I have much more to come on this topic... stay tuned. Feel free to share with me any issues or ask any questions that have been challenging in your contact lens practice.


Best wishes for continued success,

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