Optometric Management Tip # 298   -   Wednesday, October 10, 2007
Contact Lens Services, Part 3

This series on contact lens services and fees seems to have struck a chord with our readers, judging from the number of emails I've received in the past two weeks. I appreciate that interaction very much because it often makes me look at things in a new way. I generally believe that if one person takes the time to write in a question, there are probably many more people who wonder the same thing, so I will reprint some of the questions here in a Q and A format. All of the following are actual questions from readers.

Q. An established CL patient is in for his annual exam and I need to make a change in the lens type... this might be a spherical case which now needs a toric or a daily wear patient who wants to switch to extended wear. I typically charge an exam fee and a contact lens evaluation fee, but in these cases I would like a follow-up visit. Should I charge an additional fee for the contact lens progress exam (CLPE)?

A. Yes, but I would charge the fee in advance and call it a refitting fee rather than charge for the progress exam when it occurs. I agree that you need a follow-up visit in these cases and it could turn out to be more than one visit. In my practice, the evaluation fee is simply replaced by a higher refitting fee. Follow-up visits would be included in this fee. I would tell the patient that I need to see him back in one week (or possibly even sooner than one week for the new EW case) and the appointment would be scheduled before he left the office.

Q. Do you specify the number of follow-up visits that are included in a CL fitting or refitting?

A. I prefer that contact lens fitting and refitting fees include a period of time for follow-ups rather than a specific number of visits. I like that because it may be hard to predict exactly how many follow-up visits are needed. A toric fit may look easy enough at the outset, but it may not remain that way! Furthermore, I like to avoid the situation where a patient does not return for the second progress visit, but a year later starts having a problem and declares that he is now ready for that second visit he was supposed to receive. I typically set the time period for covered follow-up visits at 60 days. In many cases, that will only be one visit if all goes well, the patient is seeing great and corneal health looks great. My protocol for required visits has decreased over the years as lens technology has improved.

I prefer to include follow-up visits as part of a global fitting fee rather than charge them on a per visit basis because the patient may not return for a visit if an additional fee will be incurred. I view the follow-up care as a necessary part of a fitting, so charging a global fee encourages good follow-up care and eliminates the cost factor in the patient's mind.

Q. How does one determine an appropriate contact lens fitting fee?

A. I have four levels of contact lens fitting fees, based on the complexity of the case, the evaluation of diagnostic lenses, additional tests like corneal topography, time for patient training and the typical number of follow-up visits anticipated. I believe we should set fitting fees fairly high. Contact lens practice must be profitable and I believe we should be well compensated for our skill and expertise. Since lens materials prices are somewhat market sensitive (although not as sensitive as many ODs think), I prefer to see most of the profit in the services.

As you determine your fitting fees, consider your usual fee for an intermediate office visit as the appropriate charge for a contact lens progress exam. I see many doctors with global fitting fees that would barely cover one office visit, but that's much too low when you consider that the progress exam is only one small part of the total fitting service. If the usual fee for an office visit is $80, the entire fitting fee can't be only $90.

Q. One aspect of CL fees that I would appreciate your opinion about concerns patients who are new to your practice, but are successful contact lens wearers. Do you charge these patients for a fitting on their first visit to you? Would it matter if they came in for their exam with their old CL Rx, and/or if they were wearing their contact lenses?

A. If a patient is new to us but is a successful wearer and knows their CL Rx (has the boxes or the written Rx) then we just charge a CL evaluation fee (in addition to the exam fee of course), assuming we do not need to change the fit for some reason. If I have to put on trial lenses because I don't know what the CLs are, then it would be considered a fitting and a higher fee would apply. We tell the patient this in advance and we'll help the patient obtain the old CL Rx if necessary to avoid the extra work and fee. It's helpful if they just bring in their boxes or foil wrappers.

Best wishes for continued success,

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