Article Date: 2/1/2004

health benefits
How to Escape the "Insurance" Trap
Recognizing the difference between insurance and benefits is a key to successful practice.
BY BRIAN CHOU, O.D., F.A.A.O., San Diego, Calif.

The Practice's Vocabulary

DO SAY (professional) DON'T SAY (unprofessional)
Contact lens prescribing Contact lens fitting
Frame & lens specialist Optician
Progress visit Follow-up visit
Contact lens application Contact lens insertion
Patient Customer
Practice Store
Fees Price
Reception area Waiting room
Complimentary Free
Certificate Coupon
Over-stock frame Discontinued frame
Diagnostic contact lens Trial contact lens
Savings or fee reduction  Discount
Measurement Test
Payment plan Finance
Instrument Machine
Eyewear boutique Dispensary or optical
Vision (eyecare) benefit, policy, or plan Vision insurance


The purpose of insurance is to protect you and your family against financial catastrophe in the event of sickness, crisis or accidents. For example, if you experience a work-ending injury or expensive surgery, or if your house burns down, insurance can relieve your financial burden.

In contrast, replacing broken glasses wouldn't ruin your finances. Nor would replacing a torn lens. So how does vision insurance qualify as insurance? It doesn't. Vision insurance is really a misnomer -- more accurately it's a vision benefit because it deals with health, wellness and improving quality of life.

Medical insurances have diluted the meaning of the word "insurance" by covering nonessential services such as massage and acupuncture. Nowadays, you can even buy so-called "insurance" for your pet and cell phone. I'm not suggesting that pets and cell phones aren't important -- just that losing either won't put you on skid row.

The distinction between "insurance" and "benefits" isn't just semantics. Recognizing the difference and conveying it to your staff and patients is a key to successful private practice.

The private-pay mistake

We all want to see more private-pay patients. They pay our usual and customary fees, and there's no billing headaches or other insurance hoops and hurdles to deal with. But it's easy to create an "insurance" mentality among private-pay patients. Consider how our staffs communicate. Upon making an appointment, receptionists ask, "Do you have vision insurance?" In the dispensary, opticians ask, "Will you be using any vision insurance?" If private-pay patients didn't know about vision insurance before their visit, they'll know they don't have insurance before they leave. They may feel that vision insurance is no different than medical insurance and that the uninsured are down-trodden and underprivileged.

Rather than alienate them, let private-pay patients know that they're welcome in your practice by banishing the use of the term "vision insurance." Instead, tell them about vision benefits. (Think about it: Although it sounds socially acceptable to lack benefits, it sounds embarrassing to lack insurance.)

Get rid of "insurance"

On the flip side, patients learn that their plans don't cover retinal photography, threshold visual fields, the additional costs of anti-reflective coatings and high-index, etc. They respond with an attitude of, "If it's not covered, I don't want it." Patients may leave understanding more about what their plan doesn't cover than of the benefits of retinal photography and high-index lenses.

With these actions, we perpetuate the idea that if something isn't covered by "insurance," it's unnecessary. This can lead your staff into assumptive behavior, such as opticians showing the patient the "insurance" frames first while ignoring the higher quality, more expensive product.

Better care, higher revenue

By shifting to the paradigm of vision benefits, patients are more likely to learn and take advantage of their savings for purchasing supplemental services and desirable frame and lens options. It also increases marginal revenue for your practice.

Patients want to know what they can do with their benefits ­ not what they can't do with their insurances. Give them what they want and you'll also be doing yourself a favor.

Dr. Chou is in group practice at Carmel Mountain Vision Care. A frequent writer on refractive surgery and contact lenses, he completed a fellowship in cornea and external disease at the Jules Stein Eye Institute.


Optometric Management, Issue: February 2004