Optometric Management Tip # 61   -   Wednesday, March 19, 2003
Getting Insurance Information Over the Phone

A colleague asked if I had any suggestions for verifying patients' eligibility for vision insurance benefits. He brought up the often-faced dilemma of finding out about insurance at the time of the exam (or worse yet, after the exam) and how the doctor's schedule can be destroyed while waiting to confirm eligibility. This might occur because patients fail to mention insurance when they schedule the appointment, or if they give incorrect information over the phone and need to update it in person. I do have a few tips on this topic - and it is an area that I believe our practices should continually work to improve upon.

Since there are so many aspects of managed vision care that we have no control over, we must become absolute experts at controlling what we can. We must do all we can to be efficient and accurate, because profit margins on this part of the practice are so slim. In my practice, this starts with discussing insurance benefits, fees and payment policies over the phone.

This requires detailed staff training. Here is a list of how we handle gathering insurance information over the phone. You might want to use it as a checklist in a meeting with your staff to see if you could improve your procedures.

In my view, patients deserve to know and need to know what our fees will be if we are planning to ask for payment. They may not know enough to ask about fees - or may be happy to avoid the topic - but we are better off taking the initiative. Taking the proactive approach saves time and reduces bad debt.


Best wishes for continued success,

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