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DIFFERENTIATE INSURANCE

DISTINGUISH MEDICAL FROM MANAGED CARE “SAVINGS PLANS,” AND DISCUSS FEES

MARK HINTON

Q: WHAT IS THE BEST WAY FOR STAFF TO EXPLAIN TO PATIENTS THE DIFFERENCE BETWEEN THEIR OPTICAL AND MEDICAL INSURANCE WHEN EACH ARE SEPARATE ENTITIES?

A: Some plans include both refractive benefits and medical eye care, which can confuse patients who have a vision savings plan that is separate from their medical coverage. To avoid confusion for these patients, have staff say, “Two types of health insurance contribute to your eye health services and products: (1) your vision savings plans and (2) your medical insurance plan. Your vision savings plan covers routine vision wellness exams and includes the purchase of eyewear and contact lenses. Your medical insurance plan covers the diagnosis and management of medical eye issues, such as dry eye disease, glaucoma and macular disease. As a result, it may be necessary for us to submit and bill some services to your vision savings plan and some services to your medical insurance plan, as required by your plan carriers. We will follow a procedure called ‘coordination of benefits’ to do this properly and to maximize your best advantage and reduced contribution by you. Where some fees for services and products are not paid by your vision savings plan or medical insurance plan, you will be responsible for them, including deductible, copayments and non-provider services, as specified by your plan contracts. Please provide both your vision plan authorization card and your medical insurance card and identification, for your benefit, to our team member so we may make copies. Does this all make sense?”

Apples and oranges are both fruit, but two different entities. Your patients can view medical insurance and vision plans the same way.

Q: WHAT METHOD DO YOU RECOMMEND TO PRESENT FEES FOR OPTICAL VS. MEDICAL COVERAGE TO PATIENTS?

A: Change typical “money-focused” words to attractive “buying” words. For example, instead of you or your staff members saying, “your allowance,” which infers limits, say, “your carrier’s contribution,” which infers the patient doesn’t have to pay much. Similarly, instead of you or your staff saying, “Let’s see what’s covered,” which, again, infers limits, say, “You have extraordinary benefits, and I’ll help you maximize them for your advantage.” “Benefits” infers “advantages”. Other “money-focused” phrases to avoid: “Your out-of-pocket cost is,” and “According to your insurance, you get up to…”

In addition to changing “money-focused” words to attractive “buying” words, make sure patients always hear what the retail cost of the service or product would have been before the savings: “Cheryl, your vision savings plan is fabulous for you! Your lenses would have been $834 but after your vision savings plan, your contribution is only $351.” OM

Questions are based on reader responses to an Optometric Management online survey, which closed on Dec. 20.

MR. HINTON is CEO and president of eYeFacilitate. Email him at mark@eyefacilitate.com, or to comment on this article, visit tinyurl.com/OMcomment.