Optometric Management Tip # 8   -   Wednesday, March 13, 2002
Controlling Managed Care

Does your staff find out about each patient's insurance when the appointment is first scheduled? In other words, does the receptionist ask every caller about the name of the vision or medical plan and any appropriate ID numbers over the phone? If your staff does not currently do this - you may find that you can make your office run smoother and reduce accounts receivable. Doing so gives you control over managed care - rather than managed care controlling you.

Here's how we do it: if the patient has a plan that we accept, we inform him or her of this and we get the authorization of benefits before the day of the appointment (except Medicare, which does not need pre-authorization). If the patient has a plan that we do not accept, we tell him so, and we add that we will give him a statement so he can file his own claim for reimbursement. We go on to tell this patient the cost of a comprehensive exam and advise him that amount is due at the time of the visit.

This policy starts with the premise that our practice decides what vision and medical plans we accept, and if we don't accept a plan, we expect to be paid by the patient at the time of the visit. We do not extend credit to patients (but we do accept major credit cards). I think it is only fair to tell people in advance what is expected of them with regard to payment. We never want to embarrass patients or create an awkward situation for our staff at the front desk when patients checkout. Therefore, discussing fees and payments in advance of the visit is a great strategy.

We have been doing this for years and we've learned that patients are actually happy to comply with our payment and insurance policies - if they just know the rules. I used to worry that patients may not schedule the appointment (or keep it) if I disclosed the exam fee, or if I told them that we don't accept their plan. In reality, it hardly ever changes their mind, and if they aren't prepared to pay the fee, I don't want them to come in anyway! We are not shy about talking about fees. They are what they are. No apologies. I don't mean to imply that we are arrogant about fees or services, quite the contrary; we let people know we appreciate their business. But we don't act like the fees are something we shouldn't talk openly about. Patients react well to this approach. They don't sense a red flag that the fees may be too high.
Best wishes for continued success,

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