“I just want to see patients and not worry about what vision coverage or medical insurance they have.”
Many doctors have expressed this desire to focus on their patients and not be concerned about the financial side of things.
However, if those same doctors would also like to thrive in their private practice, they will need to skillfully communicate with their patients about vision and medical insurance to accurately code and bill each visit.
Successfully transitioning from all-vision exams to ones that include appropriate medical billing requires clearly communicating this to your patients. If a patient is told ahead of time that the exam is medical, he or she will not be surprised when it is billed as such and is applied to the deductible.
Under the old model, an eye exam included refraction and a detailed review of all medical eye problems. Because today’s model reimburses separately for vision and medical, the single comprehensive exam is no longer acceptable. Insurance companies used to reimburse exams at the amount they now pay for a medical evaluation and refraction with vision benefits combined.
Most patients have vision benefits because it is attached to their medical. To resolve this, the medical insurance industry will need to take on the comprehensive yearly exam and then add a medical eye equipment rider for glasses and contacts.
Until then, doctors and staff will need to use examples below to communicate effectively to their patients.
No previous medical eye problems
Beginning the exam – “Today you are in for your vision and eye wellness evaluation.” Then at the beginning of the slit lamp exam, “I am going to do an evaluation of the health of your eyes. If any concerns are noted we will follow up with a medical eye encounter to look further into the concerns.” The vision benefit would be the primary in this case.
Previous medical eye problem
Beginning the exam – “Your insurance indicates that you have coverage for a vision and eye wellness evaluation and medical eye insurance. Since you have both vision needs in glasses and contact lenses and medical eye concerns, we will do the vision assessment today with wellness check and you will return in 6 months to evaluate further the (diagnosis).”
Many optometry offices have already made this change. However, some optometrists are continuing to give their services away for a simple refraction reimbursement. Billing for both vision and medical is not unethical. Actually, it is doing the right thing by closely following the guidelines of vision benefits and medical insurance. Ironically, many patients appreciate you taking the time to assess their eye problems with more testing and educational dialog during additional visits.
