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 By Neil B. Gailmard, OD, MBA, FAAO, Editor April 5, 2006 - Tip #220 
 Contact Dr. Gailmard | Subscribe | Archives | Print this issue Visit: optometricmanagement.com 
Bet you can't answer this one:
How much is an eye exam at your office?

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Additional Information

Over the past five years, this seemingly basic and fair question has become so complex in most optometric offices that it is unanswerable. I think this trend is cause for concern because not being able to tell patients in advance what they are expected to pay can create a very negative customer service experience that really hurts practice growth.

Why can't we quote a fee?

It really comes down to insurance billing and coding. Because most ODs set their routine exam fees so low, many health insurance plans, including Medicare, have maximum allowable fees that are higher. In order to "not leave any funds on the table", as the usual parlance goes, many doctors set a lower fee (or a give a large discount) for healthy routine exams compared to those that have a medical diagnosis.

This can be achieved quite legitimately, through the use of S-codes, time-of-service discounts or just down-coding to a lower level of service, but is it desirable? I think we're better off simplifying our fee structures and charging the full fee levels to all patients.

Vision plans, of course, will only pay their deeply discounted fee regardless of what you charge, but I see that as a separate business decision. It either makes sense for a practice to accept a discount vision plan (in exchange for patient volume), or it doesn't.

Why we think it's OK

Many ODs tell their staff to answer the fee question along the lines that the price depends on the nature of the vision problem, the complexity of the case, the level of medical decision-making, or some other similarly evasive response.

This might seem plausible to the OD, but to the patient/consumer something seems odd about it. The patient thinks he just wants an eye exam. He acknowledges that there are a certain number of testing procedures that the doctor feels should be done to properly assess eye health and vision. Granted, if a more complex problem is discovered, it would be understandable that more services are needed and that would cost more. But those additional fees could be quoted as you proceed with more testing or reappointing. Why can't you just do an eye exam?

Why it's not OK

There are several problems that can occur when a practice has multiple exam fees that can't be determined until the doctor begins the exam.
  • The staff can't inform the patient in advance about how much to pay and when to pay it.
  • It sets up the potential for a confrontation at the front desk after services are rendered. The office is better off not seeing patients who are not prepared to pay.
  • Important details, like a contact lens evaluation fee, may not be discussed in advance.
  • Patients may question the integrity of the practice when it's obvious that the same service is billed at a higher amount to insurance companies.
  • It pushes the practice further away from private pay and moves toward the mentality of billing vision or medical plans for all services. It essentially gives up on the concept of private pay.
Should the nature of the complaint really matter?

To my way of thinking, and eye exam is an eye exam. If a patient has not been examined in more than one year, my philosophy is that they need a full exam - a comprehensive exam if you will - no matter what the complaint. No matter if he says he just wants a vision check-up or if he says he has redness of the eyes, I'm going to do the same tests on the first visit.

You may want to have a different fee for new vs. established patients and I certainly recommend a contact lens evaluation fee in addition to the eye exam fee for contact lens wearers, but those factors can easily be determined over the phone when appointments are scheduled.

My advice is to structure your fee system so your staff can openly tell patients about your fees and payment policies. Patients want to know and they deserve to know.

Why not just raise your fees and charge the same to everyone?

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

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