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Last week's column was devoted to the contact lens evaluation, which I define as the additional services provided for contact lens wearers at annual eye exam visits. This week we will focus on contact lens fitting fees and pricing for contact lens products.
Fitting and refitting
It's pretty common in most practices to have a few different contact lens fitting fees based on the complexity of the case. I agree with this approach and the fees in my practice are described as a standard fitting (basic spherical daily wear), advanced fitting (toric, multifocal, extended wear) or medical fitting (keratoconus and post-surgical cases). Each of these levels has a higher fee. Corneal refractive therapy (orthokeratology) represents a fourth category with a higher fee.
In developing a fitting fee, one should consider the number of follow-up visits that are typically included in a case and the likelihood for lens fit changes and other complications that require more chair time. Patient training on lens care and handling must also be considered. While follow-up visits could be itemized separately, I prefer to charge more and include them in the global care of the patient. Including follow-up visits in the fitting fee avoids the problem of a patient not showing up for progress visits because they are not having any problems and wish to avoid an additional fee.
I think it's better to specify a time period in which all follow-up care is covered, rather than a specific number of visits. If you include a certain number of visits and if the patient doesn't utilize them all, there is the possibility of the patient returning a year or more later, with the idea that the visit should be at no charge. I include two months of follow-up care in my fitting period, but that is usually only one visit if all goes well with the fit. More visits are scheduled only if problems occur. The patient is then recalled for annual examinations from that point forward.
The contact lens fitting fee is charged in addition to a comprehensive eye exam fee. A comprehensive exam is required before beginning a CL fitting. Be sure your contact lens fitting fee is high enough to cover all the components of care that are provided. One follow-up visit alone is worth the fee usually charged for an intermediate exam.
I would never include additional follow-up visits that aren't really needed in order to justify a higher fee. Just charge the higher fee anyway and don't waste doctor time or inconvenience the patient.
Refitting an existing wearer was discussed last week to some extent. Eye care practitioners generally agree that some of these cases are simpler than a new fitting. But some aren't. Refittings may be based on professional judgment on a case by case basis. Quite often, a 20% discount off the usual fitting fee for that type of case (basic, advanced or medical) is appropriate.
What kind of follow-up visits are covered?
This issue is more controversial than I expected, but there are a large number of ECPs who differentiate between follow-up visits that are contact lens related and those that are not. The contact lens fitting fee is only meant to cover contact lens related follow-up. If a medical eye problem occurs during the contact lens fitting period, the fees for that care would be billed to the patient's medical insurance or to the patient directly. I understand the theory, but I don't like it because the situation often leads to patient misunderstanding and dissatisfaction.
I can easily see the patient's point of view if he gets a red eye within the first few weeks of being fitted with new contact lenses that he would likely conclude that the red eye was caused by the contacts. Granted, it may not technically be true, and it could be just a coincidence that an infection occurred at this time, but I don't think the average patient is going to buy that. The last thing I want at a time when a new contact lens patient is experiencing difficulty is to create a confrontation and distrust. I would be hard pressed myself to honestly be certain that the contact lenses did not play some role in most external inflammations of the eye. I prefer to set my fitting fee at a high enough level where I can handle most any kind of problem during the global contact lens fitting period (two months).
When should fees be charged?
It has come to my attention that many ECPs write up and enter contact lens fees over time as each case progresses. The advent of free diagnostic lenses played a role in this gradual evolution, because the practitioner can now wait until success is proven before charging for any materials. This approach works, but I prefer to charge all fees up front, all at once for the following reasons:
I want the patient to know the total charges for all exam and fitting services and contact lens materials at the beginning of care. I don't want to surprise them with a second billing for lens products later. Even if explained, patients don't always hear us and they can easily misunderstand.
I don't want to forget to enter some of the charges. By always entering all fees up front, we avoid patients having lenses dispensed that were never charged. Sometimes it appears there is no balance on an account, not because the fees were paid, but because none were entered!
I prefer to show the sale as soon as possible in order to speed up payment and cash flow.
I generally know what type of lens I want to prescribe at the fitting visit. My technician reviews exam, fitting and lens fees at that initial fitting and asks if the patient wishes to order contact lenses from our office and if so, how many boxes are desired. All fees are written up at that time and entered into the patient's account, even if the patient is leaving the office with only a trial pair of lenses. The boxes of lenses are ordered if we don't have them in stock. We do not require payment in full until the supply of lenses is actually delivered, but I prefer to have the total of all fees entered and acknowledged. Most patients just pay the balance in advance. Of course, in the rare event that the first lens design is changed to another type or brand at the follow-up visit, we simply exchange any lens boxes as needed. Generally, the revenue boxes have not been dispensed yet and the new lens supply is ordered. If the lens price category changes with the lens fit change, a credit or debit adjustment is made to the patient's account.
We always release a written copy of the contact lens Rx when the fitting is complete.