How to discuss insurance coverage with these patients

To provide the best value to each patient, it is not just important to learn what coverage each patient has for their diabetic eye health evaluation but also how to properly communicate this to them. Patients often arrive with little understanding of their insurance coverage; being able to streamline that conversation not only eliminates their stress but more quickly gets us to the business of helping them see.

Below, we review how to accomplish that.

TELL PATIENTS THEIR COVERAGE

Here are two examples of patient communication from my practice:

• EXAMPLE 1: Ms. A calls to make an appointment for her annual diabetic eye health evaluation. She is a new patient and says she only has a vision plan for insurance coverage. When we pull her insurance authorization, we find that her vision plan covers her annual diabetic eye health evaluation in full, as well as wide field retinal imaging for a single copay of $10. When we confirm the appointment, we tell our patient of the insurance coverage and that we will provide the results of the exam to her insurance and her doctor, and provide a copy for her as well. After we perform the needed testing, we find that her level of retinopathy requires her to come back in 3 months for an office visit and OCT. We already know what the copay and coverage will be, so we schedule the appointment and inform the patient.
• EXAMPLE 2: Ms. B calls to make an appointment as a new patient. She informs us she has medical insurance and a vision plan. We are not providers for her vision plan, however we find that her medical plan does have coverage for her office visit with the diagnosis of diabetes even without evidence of retinopathy; however, there is no coverage for wide field retinal imaging without evidence of retinopathy. We let the patient know of the insurance coverage and what her copays will be. When the patient arrives for the visit, she pays the copays for her office visit, refraction, and wide field retinal imaging screening.

CLEAR COMMUNICATION WINS

In my experience, correct and efficient coding relies on clear communication between my team and our patients. A well-informed patient is much more likely to be a happy patient. OM

DR. JASPER practices in West Palm Beach, Fla. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.