Optometric Management Tip # 544   -   Wednesday, August 08, 2012
How Does Your Staff Handle These Challenging Situations?

I thought I would present some examples of real world issues that face many eye care practices every day. Some of these cases present ethical dilemmas or other sticky situations. Consider using these vignettes at a staff meeting to get feedback on how your staff handles them. Provide some guidance on ways to improve patient communication and prevent unpleasant confrontations. I'll share my thoughts briefly on each issue, but just use that as a starting point for your preferred management.

You answer the phone and the caller asks "How much is an eye exam?"
The key is to train your staff to ask a question back to the caller. We want to have a conversation so the caller sees how friendly and caring you are. Ask about insurance plans first, which speaks to the real issue of the cost of an exam. It may be free or just a co-pay! I recommend that you actually quote the fee eventually because we don't want to dodge a direct question, but also comment on how thorough the exam is and what kind of tests are performed. Next, ask if the caller is having any problems with his vision. Listen, show concern and comment about how good the doctor is. It is important to have enough staff so these calls are not rushed.

A patient is checking out at the front desk and questions the contact lens evaluation fee; he does not want to pay for it.
I believe in being proactive and telling patients about these services and fees over the phone when they schedule the appointment even if they don't ask! I find that patients don't really mind the contact lens evaluation fee, but they hate to be surprised by it. Train staff to look up the established patient's record while talking to them and see if he wears contacts without asking. You will have to ask new patients. Explain that contact lens patients require additional testing that other patients do not need. Most staff members don't mind this procedure once they get used to it because it prevents complaints at the front desk. For general questions about contact lens fees just say that a new fitting and lenses start at $XXX, but the fee varies based on the type of lens and complexity of the fitting.

A patient has both a vision plan and medical insurance and your office accepts both. The doctor found a medical problem and bills the medical plan, but the patient wants to bill the vision plan.
Don't lose the patient and family over billing aggressively to medical. The patient does have a financial stake in this decision. Most doctors see patients for the first exam under the vision plan and bill medical for subsequent visits and tests. Don't schedule subsequent visits if they are not really needed. One new strategy I've heard is to bill the medical insurance if you have a medical diagnosis but waive any co-pay or deductible and waive the refraction fee unless it is covered. In other words, remove any cost to the patient so they don't care which plan you bill. Of course, you only do this if the medical insurance payment is higher than the vision plan and it may not always be! Also, be aware that your contract may not allow you to waive patient fees, this is especially true with Medicare.

A patient calls to check on a contact lens order from two weeks ago and you look it up and find it was never ordered. What should you tell the patient?
We never lie to a patient, but we don't have to tell them everything. The first thing to do is apologize for the delay and then give a firm statement about when the lenses will be in. For example: "I'm so sorry but your contacts are not in yet. I spoke to the lab and they said they will be shipped tomorrow and I'm having them sent overnight express at no charge to you."

The office manager notices a staff member made an error earlier in the day on the fee calculation for a vision plan patient or realizes the patient was not eligible for a particular benefit, i.e. frames, exam.
The technician who made the error calls the patient right away and sincerely apologizes, but explains that an error was made in the calculation and the correct amount is ____ and the balance will be___. Apologize again and thank the patient for understanding. Turn the call over to the office manager if the patient does not agree. At that point, is a judgment call on how to handle it, but if materials have not been made yet, you should be able to collect the correct fees. Mistakes happen. The patient can check with the vision plan support line if necessary.

A patient wants to buy more contact lenses but the Rx has recently expired.
Be helpful and give a grace period. Optometrists can sometimes be extremely tough on these situations without good reason. An important factor is that the patient must actually schedule the needed re-exam on the spot. If he does that, we will sell him one box for each eye or give him a trial pair to hold over.

A patient supposedly does not know a basic office policy, like he is picking up new glasses and he says he did not know he had to pay the balance due.
I like for my office to take the blame in a situation like this, even though we know we communicated the policy very well. It saves embarrassment for the patient. I would actually want our optician to apologize for our office not making the policy clearer. Then we would say that we will be happy to hold the glasses until the patient can return with the payment. We will not release the glasses, but we are very nice about it! I've seen many patients in this situation produce a credit card and pay the balance.

Notice that some of these tough situations are made easier by the staff member saying I'm sorry. Yet, in my experience, it is extremely rare for eye care staff or doctors to ever speak those words. When something goes wrong, an is apology really what any of us want to hear and when we get that response, everything is much better.
Best wishes for continued success,

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