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A recent tip article on contact lens profitability prompted lots of emails about fees, so I’ll
cover many of the questions in this tip. How we present contact lens professional fees to
patients, such as those for evaluation or refitting, can make a huge difference in how the fee
is perceived. So much so that if you and your staff handle it well, you can raise the fees to
Get the right attitude
First, make sure that you and your staff never adopt an apologetic or defensive posture about the
fee. Remind yourself and your staff that contact lens prescription and management is a very
specialized heath care service that you trained many years to perfect, and that education is
continuous. It deserves a high fee. If you can’t make a very good profit on this service, then
why provide it? There is no need to try to price match low-end providers on services or materials.
We all know they exist, but most eye care professionals are better off keeping their services at a
very high level. You can’t do that and charge low fees. If a patient really wants low prices,
don’t try to stop him. That is his choice and be confident that he will get what he pays for.
When you adopt the high quality/high fee attitude, most patients will sense the higher level of
service and will not want to go to a cheap place.
Tell patients in advance
I’m very big on this point, but many practices think it’s too difficult. It really isn’t. Most
patients don’t mind relatively high fees; they just hate to be surprised by them. They hate
thinking they were taken advantage of; that someone pulled a fast one on them. If you don’t mention
a fee in advance and if the patient did not know to expect it, it will feel that way.
Refitting fees can be presented in person at the exam chair because the patient can decline if they
so choose. The main services provided at that visit are an eye exam and contact lens evaluation.
Those fees need to be mentioned over the phone. That means that the receptionist must ask the caller
if he is a contact lens wearer or look that point up on the practice management system as they speak.
Stating the fees in advance makes them seem quite legitimate and fair. It is very rare that
proactively stating the fee and payment policy will prompt an objection, but if it does, you’re
better off getting that out in the open before the visit. The bonus for staff is that they will
never have to face a confrontation at the front desk after services have been provided.
My definition of a contact lens refit is a significant change in lens brand, material or design from
what the patient is currently wearing. What is “significant” is a professional judgment you’ll have
I believe in structuring your exam and evaluation fee high enough that you can be generous with your
definition of a refit and not increase the fee for minor changes. That way, when you do need to
charge the higher refit fee, it’s easy to explain and justify because you really know in your heart
that there is more work involved.
For example, a patient wearing lens brand A, who is very happy and has no complaints actually has
acuity of 20/30 in the left eye. You find the patient needs an extra -.50 power. This is not
considered a refit in my office and no follow-up care is needed. A CL evaluation fee is charged –
but that would have occurred even if there had been no power change. Just be extremely honest with
yourself about the change and the work involved. I can even see a base curve change or brand change
not being a big deal. I never require follow-up visits if they aren’t really needed.
Presenting the fee
Either the doctor or the contact lens technician should discuss the refit fee and any increase in
lens materials fees as the fitting process is started. The fees should simply be mentioned as the
benefits of the new modality are reviewed. We work on the assumption that the fee is acceptable
until told otherwise; we don’t ask if it is. Placing the emphasis on the features and benefits the
patient will realize with the new lens, and stating the one-time fitting fee and lens cost as a side
note will lead to good results. It’s important to relate the discussion to the patient complaint, if
there was one. If there wasn’t, then the refit should either relate to an objective ocular health
sign the doctor discovered, or relate to the general improved lens technology providing more oxygen,
resistance to dryness resistance, or other benefits.
Here is an example of what your technician might say as she is getting ready to apply new diagnostic
lenses. “These new silicone hydrogel lenses offer great comfort and wettability and should help you
leave your lenses on longer, Mrs. Smith. They are the very latest technology. This requires an extra
fitting examination, which we are doing now, and a one week follow-up visit. The fitting fee is $XX,
which includes the follow-up, and the lenses are $YY per 6-pack. Let’s put on the free trial pair and
see how they feel.”
If the patient balks at the fee, which will be rare, then understand that the complaint or the benefits
are not that important to the patient and accept that. Try to just leave the patient in the same lens
they were wearing or switch to a more economical choice. There is nothing wrong with wanting to save
money; you just need to know what the patient wants. It’s not a rejection.
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.