patient communications

Sometimes, the Best Thing to Say Is Nothing

Should you notify patients that you no longer accept their managed vision care or insurance plan? Here’s a better solution.

JAY PETERSMA, O.D., JOHNSTON, IOWA

As a result of your practice’s regular financial analysis, you discover that it is no longer in your practice’s best interest to remain a panel member for “Plan X.” Maybe the managed vision or insurance plan is no longer as profitable as it once was or it now causes an administrative burden. Or, maybe claims aren’t paid in a manner that now works with your practice’s current business model. The reason doesn’t matter. You’ve decided, “We’re out.”

The worst thing

So, what is the first thing you should do? Notify all patients in that plan that you are no longer a panel member, right? Wrong. That would be the worst thing you could do. The first thing you do is… absolutely nothing.

Here’s why. Let’s say you notify all your patients in Plan X that you are no longer a provider:

Dear Mrs. Jones,

I am writing to inform you that we are no longer a provider for Plan X, your vision plan. However, please understand that we value you as a patient and look forward to continuing our care for you and your family …

You have just told the patient subliminally, no matter how well you word it, to go somewhere else.

Aside from the message you send to the patient, there are other factors to consider: For instance, by the time many of the “managed care” patients are due to come back to the office, their employer may have changed to another plan to which you belong. In such cases, these patients would have never known the difference — unless you told them. And, maybe you are on the panel for their new managed care plan. Or, maybe they changed jobs and vision plans, or have no coverage anyway. In these cases, they changed their status, not you. Why ruffle feathers?

A change in plans

Another possibility is that many of the patients who have managed care plans may have moved to different plans with their same employer but can’t recall the name of their new plan. We all frequently see that with our patients. But if these patients received a notice from you, their doctor, informing them that you don’t accept the old plan, it surely must mean you don’t accept their new plan (even if this is not the case). Again, they interpret the message as, “We can’t see you anymore.”

We’ve all heard patients use those exact words, haven’t we? It puts the idea in their mind that they need to go somewhere else. You can talk all you want in writing about your out-of-network status, how much you enjoy having them as part of your practice family, how you’ll still file claims for them, etc.

But you know what? Without a one-on-one dialogue, the patients only hear that you’re out … It’s time to find a new doctor, they conclude.

Manage case by case

How do you manage patient communications when you exit a plan? The best way is on a case-by-case basis that begins when your patients call for appointments. When asking about medical or vision coverage during the appointment process, don’t allow your scheduler to say, “Oh, I’m sorry, we no longer take Plan X,” but rather, consider a script that begins with the following:

“We are now an out-of-network provider for Plan X, so it works a little differently now. Let me explain… ”

By beginning at this point with this script, you can address any patient concerns up front, and provide patients with a clear answer as to how the payment process will work in moving forward. Assure the patient that other than the change in billing/payment, it’s business as usual.

When patients leave

One big benefit of this approach is that you learn right then and there whether the patient plans to stay with your practice. This also helps to clean up your recall system. The savings in staff time, production and postage costs you realize by not sending a prepared mailing to patients who no longer plan to visit your practice is a nice little benefit as well.

When patients decide to leave your practice, do not make excuses for the practice’s change in the plans you accept. Make sure the scheduler thanks them for their patronage and says your practice looks forward to serving them, should the opportunity arise.

Need to know basis

Keep the fact that you’ve left “Plan X” on a need-to-know basis. You’ll be amazed how many patients never need to know. OM

Dr. Petersma is in private practice. He is a past president of the Iowa Optometric Association and was selected their 2013 “OD of the Year.” Contact Dr. Petersma at eyeguy@dwx.com. To comment on this article, e-mail optometricmanagement@gmail.com.