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Keep Coverage in Mind

Patients appreciate your attention to their vision care and insurance plans.

LEAH COLBY, O.D.

I practice in the great state of Minnesota where we are blessed (or cursed, depending on your perspective) to have more than 95% of our patients covered by eyecare insurance. While I admire the practices that have made the leap to “insurance-free,” I’m not sure I’ll ever have the guts to make that leap. With government health care about to become a reality, I’ve decided to share the ways that we’ve embraced our insured patients.

An insurance advocate

Surprise healthcare bills don’t help in the way of building and improving patient relations. At the end of the day, it is ultimately the patient’s responsibility to understand his/her coverage. However, we understand that very few patients comprehend the idiosyncracies of their insurance coverage. So as part of providing legendary customer service, we have employed an insurance advocate to help our patients navigate their eyecare coverage.

Our insurance advocate checks the insurance coverage for routine eye exams of all our insured patients to make sure they understand their coverage prior to their exam. Patients appreciate knowing about co-pays and non-covered services before their exam starts, as they then aren’t on the receiving end of surprise bills.

Informed consent

When it’s time for medically necessary tests, such as OCT, visual fields, photos, etc., that may or may not be covered by the patient’s eyecare insurance, we not only take the time to explain the necessity of the additional tests, so the patient makes informed decisions, we have also created our own version of an insurance “informed consent” form that outlines the additional tests that we must perform.

Specifically, we outline the maximum out-of-pocket expense for each test, and give the patient the key diagnosis and procedure codes so he/she can contact his/her insurance company with any questions regarding coverage.

Preemptive education

Also, we preemptively educate our patients at their check in at the front desk on the possible contact lens-related expenses that are typically not covered by insurance. This has saved us hours in fee explanation during the exam process and in calls from patients who receive surprise bills for fees that weren’t collected at the end of their exams. (Click here for sample copies of forms for special testing and contact lenses.)

Grateful, informed patients

Taking the time to explain and educate your patients about their covered and non-covered services is an opportunity to enhance the patient experience in your office. We have found that patients are grateful for the opportunity to make informed decisions about their eye health care and how their insurance plays a role in delivering it. OM

DR. COLBY OPERATES EYEWEST VISION CLINIC IN ROGERS AND ST. MICHAEL, MINN. SHE WAS NAMED THE “YOUNG OPTOMETRIST OF THE YEAR” BY THE MINNESOTA OPTOMETRIC ASSOCIATION. TO COMMENT ON THIS ARTICLE, E-MAIL OPTOMETRICMANAGEMENT@GMAIL.COM.