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As the eye care professions increasingly rely on billing third party insurance
for goods and services, staff members can gradually lose their skills in
presenting and collecting fees directly from patients. Office policies can
evolve over time to reflect an approach that feels easier to staff. It’s
important to review your payment policy occasionally and make changes if it is
lax. I have found that changes can be implemented immediately that will benefit
the cash flow of the practice and cause no ill effects with patients at all.
Design your policy
Some practitioners require payment in full before an optical or contact lens
order is placed. I think that’s great and I applaud it, but I still feel that
the tried and true 50% down payment at the time of the order with the balance
due on delivery is acceptable. It makes things a bit easier for the patient’s
bank account and does not really cost the practice much. In practice, if we
simply state the total charges at the first visit, many patients simply pay the
entire amount anyway.
My practice policy is as follows: all professional services must be paid for at
the time of the visit, unless an approved insurance plan with pre-verified
benefits exists. All optical materials must have at least a 50% deposit before
any materials are ordered. If the 50% is not available, the order will be held
until the deposit is paid, and then the order will be started.
No credit offered
I see many practices that have much more lenient policies than those above and I
advise them to change. I see no reason to allow optical materials to leave the
office if they are not paid for. And if you don’t get at least 50% down, a
patient may never return to pick up eyeglasses or contacts, and the practice
would incur the cost of the materials. Besides that, posting the down payments
improves cash flow significantly.
In my view, the only credit program that needs to be offered is the acceptance
of major credit cards. Every practice should do that. Today, nearly every adult
in every part of the country can obtain a major credit card or debit card and if
he can’t arrange that, then he is a bad credit risk that your practice should
avoid financing anyway. In today’s marketplace, consumers are very used to such
policies and your practice is not presenting any hardship by implementing it.
Changing a lenient policy
The payment policy should be very simple, and the whole office should
immediately adopt it and enforce it. While we care strongly about patients’
wants and needs, billing and collecting is an area where the needs of the
business must come first and no exceptions can be granted. We will be flexible
in exchanging products, remaking materials or even refunding fees if patient
satisfaction was not met, but we can’t make any exception in the area of
charging fees or collecting them.
This may seem like it will be cold or difficult if your practice has offered
payment plans for a long time, but it isn’t. Simply act like it is out of your
hands and there are no decisions to make. It is not personal. If a patient who
has had credit in the past asks about credit, acknowledge that they have always
been a good patient, but the cost of providing credit became too much for the
practice to bear and the policy must be applied to everyone equally. Teach staff
members to not check with the doctor if the policies are challenged, but to
advise the patient that the policy is the same for everyone.
Exceptions and awkward situations?
What do you do about the patient who comes in to pick up glasses, you have them
all adjusted and when you ask for the balance he says he forgot his checkbook
and he’ll drop it in the mail as he walks toward the door. This is often a
high-powered, well-dressed businessman or woman whom the average staff member
would have a difficult time confronting. What should your optician do… ask him
to give the glasses back? Yes. That is exactly what I would do, although I would
ease the situation by apologizing for not explaining the policy better in
advance. In reality, I’d be certain that someone on our staff actually told this
patient that the balance would be due at dispensing, because we are 100% with
that point, but the apology goes a long way to allowing him to save face. And I
want to do that.
By taking the blame for the misunderstanding, and acting like it is perfectly
understandable that the patient might not know, I save him embarrassment and
diffuse defensive anger. We do stick to the policy, however, and we act like
there simply are no exceptions. If he doesn’t have a major credit card, we’ll be
happy to hold the glasses until he can stop back with a check. At this point,
the patient will want to avoid embarrassment and will generally be
understanding. (After all – why would such a high-powered person not have a
credit card with enough room on the credit line to finance the glasses?) By the
way, this type of person is highly likely to be a collection problem if allowed
to leave with the materials, so you must stand up to him.
A similar case is presented when a parent sends a teenager in alone to pick up
materials that have a balance due. It seems likely that the parent is purposely
trying to avoid payment, but we handle the situation the same as the one above.
We apologize profusely as we take back the contacts or glasses and ask the child
to have his parent come in or call us.
Contact lens orders by phone
Ordering contact lenses over the phone can present a unique challenge because
the call is generally from an established patient who has a good payment record
with your office. The Rx is still current; the patient just needs more lenses
and is probably in a bit of a hurry to get them. Do you need to insist on
payment? Well, it is pretty easy to get a credit card number over the phone from
most patients, but in the interest of patient goodwill and competing for sales
of replacement contact lenses, our policy is to only require a down payment if
the lenses are custom ordered and non-returnable.
Patients with vision plans
Of course, any charges that are covered by an insurance plan or vision plan with
confirmed benefits are treated as if they are paid. These fees are transferred
off the patient’s account and onto the third party account. Patients generally
have some amount that is not covered by insurance and we apply our usual payment
policy to that portion. In other words, any co-payments or non-covered services
are due on the day of service and at least 50% of the patient’s portion on
materials is needed to place an order. Balances must be paid in full at
dispensing. Some doctors use the insurance benefit as the down payment on the
total order, but we have seen some major charge-backs on our vision plan
statement for lens options, and if the patient never returns, we would incur
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.