AUTHORIZATIONS, INSURANCE CYCLES AND THE OLD SWITCHEROO

ALTHOUGH MANAGED care drives patients to our practices, it also provides us with some quandaries — many of which are related to customer service.

“WHO DOES THE CANCELING?”

How can we provide one or more products to a new consumer when the prescribing doctor’s practice pulled authorizations for the consumer’s exam and materials, but the consumer just used the exam benefit?

“Do you call the insurance plan yourself and cancel the material authorization? Or, do you call the prescribing doctor’s office, and have them cancel the authorization?” asked one ODs on Facebook member.

This post received two likes and 14 comments. Examples:

• “Always have [the] patient call the other office to release benefits. Vision plans will release authorizations without checking with the office to see if services have been rendered.”
• “The insurance company will ask you to verify that it did not use the benefits elsewhere, then they will cancel the authorization on their end.”

“WHEN DO I SEE HIM AGAIN?”

One “ODs on Facebook” member posted that a consumer, who saw her eight months prior for a comprehensive eye exam and new glasses, requested contact lenses. The poster asked, “How long do I let him go before performing another eye exam to get him contact lenses?”

This post received 30 comments. Examples of comments:

• “90 days, then new exam.”
• “[Perform] and charge to re-refract and evaluate anterior segment health. You have to have the most current prescription and assess that the cornea is healthy in order to (in good conscience) fit a contact lens [on the patient]. Then proceed with the contact lens fitting/evaluation. So, you charge a fee for refraction/cornea check and then the contact lens evaluation. (Personally, I will do this if it’s more than six months from the patient’s last eye exam. Before six months, I don’t charge. If [this occurred] at 11 months, I would schedule the patient when his insurance kicks in at 12 months.)

“DO YOU RE-SUBMIT?”

Posted by another member of “ODs on Facebook:” a consumer returned a few days after purchasing eyewear using his medical insurance to use his vision plan instead. The poster said cancelling and re-submitting takes a lot of time and, thus, asked, “Do you say, ‘tough luck’? Submit it yourself? Charge a fee to the patient? Suck it up, and keep doing it?”

This post received one like and 22 comments. Examples of comments:

• “. . . Within reason, you do what you can for the patient. Regardless of the fact that insurance coverage issues are the responsibility of the patient, the fact is they [patients] will expect you to help them, if possible, and, unfortunately, they don’t understand or care that it’s a time suck. . .”
• “We pre-check most benefits. We tell patients that if they don’t give us their cards 48 hours in advance, we cannot guarantee benefits, so they are responsible for the full amount.” OM

DR. GLAZIER is founder of Shady Grove Eye and Vision Care, a five-doctor medical-model practice in the Rockville, Md. suburbs of Washington DC. He is an author, inventor, industry consultant and frequent lecturer on ocular disease and Internet marketing. He can be reached at aglazier@youreyesite.com. Be sure to follow him on Twitter @EyeInfo or PM him on Facebook.