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If you aren’t currently charging an additional fee for annual examinations of contact lens patients, it is worthwhile to
reconsider this approach. In my early years of practice, I didn’t see the need for an additional CL evaluation fee, unless I
changed the design of the lenses. I charged a high fee for the comprehensive eye exam, and a CL fitting fee when I changed the
fit. I reasoned that I performed K-readings and a slit lamp exam on all patients, so it was really not that much more work to
examine a CL wearer than a non-CL wearer. Here are some of the reasons that changed my mind.
For purposes of this article, I’ll define a
CL Evaluation as checking the fit of an existing pair of contact lenses at a
routine eye exam and renewing the contact lens Rx. A CL Fitting is a more complex diagnostic service, which involves changing
an existing CL design or prescribing lenses for the first time. A CL fitting typically would include follow-up visits, where a
CL evaluation would not. A CL fitting would often have 3 or 4 different fee levels, based on complexity and time predicted.
The lowest fitting fee would be for a simple re-fit, and the highest would be for a complex case such as bifocal or
Reasons to charge a separate CL Evaluation fee
Vision insurance plans allow us to charge extra for the CL evaluation during a regular exam. If you accept vision plans,
this is reason enough. Vision plans often limit the fees that can be charged for exams and materials, and these required
discounts are steep. We must charge vision plan patients when we are permitted to do so – even though we must also charge
private patients for that same service.
The prevalence of CL evaluation fees has grown to become the norm in optometry. I would not usually do things just because
everyone else does, but our practices exist in a marketplace, and charging an extra CL evaluation fee is easier to implement
when it’s common practice. Call around and ask for exam fee information in your community and see for yourself.
Topography has become a routine procedure in my practice for all contact lens patients on an annual basis. This
sophisticated test lets me provide the best care by monitoring corneal integrity and the lens-cornea fitting relationship.
I believe in charging for special services like this, and I review the corneal maps with the patient. Topography is a
requirement for CL patients, and that test alone justifies the CL evaluation fee.
We fit disposable lenses and that prescription needs to be renewed each year. There is added responsibility now, compared
with the old days when contacts might continue to be worn for several years.
Profit margins have eroded in CL materials, so the service fee that was formerly built into the lens price must be
replaced with higher professional fees.
We do more tests and evaluate more things on contact lens wearers, even with instruments that we use on all patients.
There is often a regular refraction plus an over-refraction; there is often a slit lamp exam with lenses on and off and with
fluorescein; the case history is more involved and patient education is more extensive.
Communicating with patients about the fee
Colleagues have asked me how to handle the occasional confrontation with patients who don’t want to pay the CL evaluation fee
when they are checking out at the front desk. Of course, all staff should know and be able to articulate what services are
provided for the fee – topography, slit lamp exam, over-refraction and renewal of the CL Rx are appropriate to explain. But
if a patient questioned the CL evaluation fee at my front desk, I would tell my staff that they didn’t do a proper job when
they scheduled the appointment.
I believe in never asking for money unless you’ve told the patient in advance that it would be expected. In the case of exam
services that means the receptionist must find out if the patient wears contact lenses, find out if he has a vision plan that
we accept, then state the exam fee and the CL evaluation fee – even if the patient doesn’t ask about it! If your business
office staff does this 100% of the time, no one will be standing at your front desk unable to pay, and your private pay
accounts receivable will become very small.
What to charge
The amount to charge for the CL evaluation fee is a personal decision, but I would look at it in relation to the comprehensive
eye exam fee. It certainly would be less than that amount. I have found that the CL evaluation fee is often about 25% of the
exam fee. For example, an OD who charges $120 for a comprehensive eye exam would have a CL evaluation fee of $30.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.