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We covered the common terminology used in contact lens services last week,
along with some basic definitions, but since definitions and office policies vary
widely, we must try to compare apples to apples when we discuss services or
quote fees. It's the little details and special situations that make contact lens
fees challenging for doctors and staff members, so let's look at some
hypothetical case examples in the coming weeks. How would you handle the
An established, successful, daily wear contact lens patient is in for her annual
exam. You routinely charge a comprehensive eye exam fee plus an additional
contact lens evaluation fee. The patient presents no eye or vision complaints.
No change in the Rx is found and the eyes are healthy. You discuss the benefits
of silicone hydrogel lenses with the patient and offer to let her try the lenses at
no extra charge. You put on a pair of diagnostic lenses; the fit looks fine and
visual acuity is 20/20; the patient is intrigued; you dispense the lenses and tell
her to call and let you know whether she wants her next supply of lenses to be
the new ones or stay with the lenses she was previously using. You can order a
new supply without seeing the patient back again. She calls back in a week,
likes the lenses very much, but thinks the prescription may need to be adjusted a
bit. She wants to come in for a recheck before ordering the full year supply. Do
you charge her a progress exam fee for this next visit?
Points to consider
Back to the original case
- Should you have allowed a change in lens brand or material without a
fitting fee? Many eye care professionals (ECP) would say that charging a
higher refitting fee at the time of the exam would have prevented the
problem in the case above because follow-up visits could be incorporated
into the fee, and I agree. On the other hand, charging a higher fee when
you encourage a perfectly happy patient to try a new type of lens can
place your motives into question.
- It's certainly a refreshing and easy approach to tell a contact lens patient
who is in your chair that even though he's doing fine with his current
lenses, you always want to let him know about the latest and best
technology in contact lenses. Offering a free sample pair of trial lenses,
with no hidden agenda for an increased fee, is a great way to show
patients that you care about their best interest and that your practice is
on the cutting edge of technology.
- It's easy to say that we should charge a higher fitting fee when a new
lens is tried on or dispensed, but what often happens with such a policy is
that doctors often avoid trying new lens designs with perfectly happy
patients because of the very real possibility that the lens won't be
received as well as the old brand. That would put the ECP in an awkward
- If you charge high enough fees for the comprehensive exam and for the
CL evaluation, you can afford to be magnanimous with patients. You can
give away a few things and not worry about it. You can be very generous
with your services. If you cut the profit to the bone, as do many ECPs,
you have to nickel and dime the patient at every turn. The high fee
practice has a competitive advantage because it can offer nice perks to
patients, which results in higher loyalty and referrals than that seen in
- When deciding if a higher refitting fee should be charged, it's smart to
consider how often a follow-up visit or a complaint will occur and that may
vary by the type of case. If that only happens rarely, a higher fee and
required follow-ups may not be necessary. You might consider any
additional time spent as a form of practice marketing.
- Some ECPs would disagree clinically with the approach that no follow up
visits are needed in the case above. I consider that professional judgment
and I would not make a sweeping conclusion either way. It could even be
handled on a case by case basis, but I would not say that a follow-up visit
is always needed just because we change the brand of lens, especially if
we are assuming daily wear lenses.
I would not charge a fee for a follow-up exam to recheck the contact lens power,
based on the way this case was presented in the first place. I would handle this
visit the same way I handle any patient complaint about a new prescription,
whether it be for eyeglasses or contact lenses. We call these visits "Rx Trouble"
or "CL Trouble" visits and there is no charge. If I elected to proceed without a
fitting fee and without requiring follow-up visits at the initial exam, then the risk
is on me if a problem arises. I would do well to monitor the frequency of such
complaint events and if they seldom occur, there is no need to change my
I've heard all the complaints that eye care seems to be the only health care field
that's burdened with not always being paid for our time and the analogies with
primary care physicians, who would still charge for a second visit even if the first
antibiotic didn't work. But the reality is that the two professions are different
and the public's perception and expectation is different. It's in our best interest
to see complaint cases at no charge (within a reasonable time after a new Rx); I
just roll that cost of doing business into my exam fees. Every eye care practice
has patient complaints that warrant a recheck and I let my staff know that I
want to see those patients. It's far more costly (to your reputation) to not see
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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