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Since last week's tip covered pricing of eyeglass services and products, let's continue that theme with a look at contact lens fees. Show me ten eye care practitioners (ECPs) and I'll show you ten different ways to structure contact lens fees. The names and definitions of services along with the prices can vary greatly. Some ECPs charge separately for every service while others prefer to bundle services and products into a package. Those differences are fine; we certainly don't have to all follow the same fee system and many different approaches can be successful. But many fee systems that I see are priced too low and the practice is missing out on much needed profitability.
The actual fees and prices that are selected will depend on the mode of practice and the price sensitivity of the patient base. If your practice marketing strategy is based on low price, you may have to keep fitting fees and product pricing very low and in line with large corporate retailers. ECPs in private practice have much more flexibility in pricing if they build a reputation for great customer service, advanced technology and a high level of clinical expertise. In that situation, I think ECPs can take control of fees and contact lens practice can return to one of the most lucrative specialties we can offer.
Contact Lens Evaluation Fee
Charging a professional fee, in addition to a basic eye exam fee to cover the additional procedures needed to evaluate an existing contact lens fit, has become extremely common. This fee applies when no change is needed to the contact lens prescription, but the prescription is renewed for one year (typically). Here are a few considerations:
The CL evaluation fee is sometimes replaced by what some ECPs call a contact lens exam, which is an annual eye exam for a contact lens wearer that includes a CL evaluation. It's really just a matter of either charging one higher exam fee or charging the usual exam fee plus a CL evaluation fee. I don't really like the term eyeglass exam, which often becomes the lower priced alternative to a contact lens exam. It feels like we are measuring someone for a pair of shoes. I prefer to itemize the exam fee and the CL evaluation as two separate services.
The CL evaluation service typically covers the slit lamp evaluation of the lens fit on the cornea, corneal health assessment, some measurement of corneal curvature, an over-refraction with the lens in place and any other tests deemed necessary. Many ECPs include corneal topography in the CL evaluation fee and the procedure is performed as a pretest on all contact lens patients by a technician. I use this approach and the corneal images are displayed on the computer monitor in the exam room. Including corneal topography in the CL evaluation justifies a higher fee for the service.
Some ECPs have a few different fee levels for the CL evaluation, depending on the complexity of the case. I prefer to have just one CL evaluation fee since it's only used when all is well with the patient and with the existing fit. One fee is simpler for staff to quote in advance and to explain. If there is a problem with the CL evaluation and a change in lens fit is required, then we no longer have an evaluation but the case changes to a refitting and there are now different fee levels based on complexity. Evaluating a perfectly fitting toric lens is no more difficult than evaluating a perfectly fitting spherical lens.
I do not consider minor adjustments in contact lens prescriptions as a refit. A power change, for example, would still be charged as a simple evaluation. No follow-up is needed. One of the best things about charging high professional fees to begin with is that you can be generous with your policies and build patient good will. ECPs who operate with low profit margins may feel they are forced to nickel and dime their patients.
The CL evaluation fee should be incorporated into the fee system for most ECPs because it's allowed by vision plans and it's a non-covered service. Since most vision plans require significant discounts of the usual fees, ECPs need to take full advantage of legitimate ways to charge the patient for some services.
Contact lens evaluation fees can be a source of patient misunderstanding and dissatisfaction if not handled well. I strongly recommend that the fee be quoted in advance over the phone. My staff quickly brings up the patient's file on the office computer system while speaking to the patient by phone. If the caller is a new patient, the receptionist asks if he currently wears contacts. Once it's known that the patient wears contacts, the fee for the CL evaluation is quoted in addition to the exam fee. If there are any questions about what is included in a CL evaluation or why it's needed, the staff handles it then. The fee is hardly ever questioned in my practice when presented in advance. This is strongly preferred to a confrontation at the front desk after the exam.