Optometric Management Tip # 45   -   Wednesday, November 27, 2002
Additional tests - but no insurance

Based on a request from a reader - I would like to address how optometrists and technicians present the need for additional medical testing to patients when insurance will not cover the fee.

When medical insurance or Medicare is expected to pay for the fee, and when the practice is willing to directly bill the third party - the additional tests are readily accepted by patients. There is no out-of-pocket cost. But optometrists frequently are in situations where a special procedure is needed - or would at least be helpful - and they must ask the patient to pay for it at the time of service. This could be because the patient is under 65 and does not have Medicare, and his private health insurance may not be open to optometrists or it may be an HMO, which has a closed panel. Or it may just be the practice policy to not bill major medical insurance directly because claims are frequently rejected.

Whatever the reason, here are the main points I think are important:

Best wishes for continued success,

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