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 By Neil B. Gailmard, OD, MBA, FAAO, Editor November 27, 2002 - Tip #45 
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Additional tests - but no insurance

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Based on a request from a reader - I would like to address how optometrists and technicians present the need for additional medical testing to patients when insurance will not cover the fee.

When medical insurance or Medicare is expected to pay for the fee, and when the practice is willing to directly bill the third party - the additional tests are readily accepted by patients. There is no out-of-pocket cost. But optometrists frequently are in situations where a special procedure is needed - or would at least be helpful - and they must ask the patient to pay for it at the time of service. This could be because the patient is under 65 and does not have Medicare, and his private health insurance may not be open to optometrists or it may be an HMO, which has a closed panel. Or it may just be the practice policy to not bill major medical insurance directly because claims are frequently rejected.

Whatever the reason, here are the main points I think are important:

  • The doctor should tell the patient what the test is called and why it is needed. The need for the test data is primary and payment is secondary. A common example is the need for a threshold visual field test in a glaucoma patient; we simply must have it.
  • The patient should be informed in advance that there is an additional fee for this procedure and exactly what the fee is and that it is due at the time of the visit. This is just a common courtesy and it should not be stated in a defensive or apologetic way. While doctors should never be uncomfortable discussing fees when asked, this discussion could be delegated to a technician. If the doctor makes a big deal out of the fee, it may appear to be his or her primary interest, which is obviously a poor image.
  • The technician should advise patients that they may be able to file their own claim for reimbursement by attaching a copy of the office receipt. This depends on the plan and patients who are concerned about this should check with their insurance company. We proceed to schedule the appointment for the test - or we may do the test right away on the same day, depending on our schedule and the patient's needs. It is up to the patient to let us know if they want to see another provider - this rarely happens.
  • The fees for the tests ordered by optometrists are often less than $200, so they are not prohibitively expensive for patients to pay out-of-pocket.
  • If additional tests are frequently refused by patients due to lack of insurance coverage, I would try to strengthen the practice's competitive advantages. These are the reason's people want to come to your practice. It is what creates patient loyalty and the more you have, the better. It could be convenient hours, friendly staff, fast service, good reputation and so on.

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.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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