Optometric Management Tip # 469   -   Wednesday, February 16, 2011
Increasing Your Profitability with Vision Plans, Part 2

Let's continue with our analysis of vision plans and develop a plan to make changes to your practice operations that will maximize profitability. In this issue, I'll focus on determining which third party to bill: vision plans or medical insurance.

Routine vision or medical eye care?
Many ECPs strictly define the scope of vision plans to only pertain to routine vision care or what is sometimes called a well-vision exam. If an examination reveals any abnormalities of a medical nature, then it is deemed to be outside the services covered by vision plans and the fees would then be billed to the patient's medical insurance. This approach seems smart and indeed some ODs report good success with it, but it can present problems. I advise extreme caution because patients have a bigger stake in this process than you may realize and it is possible to lose the patient and his family over it.

The difficulty is where to draw the line. An ECP can find a medical diagnosis on the vast majority of patients, which could effectively mean that nearly all exams could be billed to medical insurance, which may pay higher fees. It is easy to see that glaucoma patients are receiving medical eye care and require additional exams and special diagnostic tests that are not covered by vision plans. And the healthy 20 year old, two diopter myope would easily qualify for vision plan coverage. But what about the people in between the extremes? Consider an asymptomatic patient who mostly just needs an update on his glasses Rx to return to 20/20 vision, but has very mild signs of allergies or very slight nuclear sclerosis. Deciding when to call a case medical vs. vision can be difficult.

Why medical is not always better
Here are some factors that make aggressive conversion to medical insurance not in your best interest.

The patient has a stake
My advice is to consider the patient's preference when it comes to billing. If you asked the patient if he would rather have today's visit billed to his vision plan or medical insurance, what would he say? Obviously, if additional office visits and diagnostic testing is needed, that is always billed to medical insurance.

Next week...

Best wishes for continued success,

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