By Yoongie Min, OD (from Review of Optometric Business,


Patients usually are in the dark about their vision insurance coverage--but that creates an opportunity for your office to do a big favor for them and you. Letting patients know that they have eyecare and/or eyewear benefits eases the cost to them and can increase your revenues for services and optical sales.

The majority of your patients most likely have a vision benefit that they can use toward their annual comprehensive examination. Many have vision plans that offset the cost of both the exam as well as the purchase of related products like contact lenses and eyeglasses. Unfortunately, too many patients--even those with generous benefits that cover much of the expense of exam and products--are unaware of what their vision benefit entitles them to. You can increase the chances of these patients purchasing contact lenses and eyewear from you if your office takes the time to educate them on the details of their plan.

Ask About Insurance When Making Appointments
When a new patient calls us for an appointment, the first thing our receptionist does is ask if they have a vision plan. With people frequently switching jobs and employers frequently switching managed care providers, we also verify vision plan information with existing patients when they call. I recommend having your staff get to thoroughly know the most common insurance plans in your geographic area. In the Columbus, Ohio, area where I practice, we have a high concentration of the two most common vision plans--VSP and EyeMed. For that reason, my staff knows those plans well enough to easily point out to patients what that coverage will mean to the cost of their exam and to any product they think they will end up purchasing. We also are often able to tell patients entirely in the dark about their vision benefit what their plan is as soon as we find out who their employer is.

Avoid Blindsiding the Patient
It is important to let the patient know before they come for their appointment that they are not covered--if your staff learns that is the case. For example, they may not have been with their employer long enough to qualify for the benefit. Also, vision plans often make patients wait a full year between purchases. Your practice has nothing to gain by luring a patient to your office and having them go through an exam knowing all along that unbeknownst to them they are not covered by a vision plan. In addition to lessening your chances of getting paid, you will engender bad feelings with that patient who may not return to your office and may tell others of his unfavorable experience. You want to give these uncovered patients a heads-up before they get to your office to avoid sticker shock when you quote them a private pay price for the exam and product.

Print Out Insurance Information and Attach to Chart
It is not enough to just have the insurance information on file. It is important for that information to be attached to the patient's chart. That way everybody on our staff who sees the patient can answer general questions that might come up about benefits. I leave explaining the finer points of vision plans to my optical staff, but I do make a point while the patient is in the exam chair of pointing out if their insurance will help them pay for a new pair of eyeglasses or an annual supply of contact lenses.

Have Optical Unravel Finer Points
Your staff should be well trained in helping patients maximize their vision benefit because those benefits often are difficult for patients to understand. Some patients have dual vision plans but depending on the timing of their visit, they may not have the full exam, eyewear or contact lenses coverage. Sometimes it will be necessary to bill certain things to one plan and other items to the second plan. Medical eye conditions and problems should be billed to the patient's major medical insurance, but many times patients are confused and want to use their "vision"plan. That must be explained and differentiated to the patient.

Effective Insurance Communication = Returning Patients
Many eye doctors believe that patient loyalty trumps insurance coverage, but often that is not true. For a while we did not accept EyeMed and found that many patients did not return to our office even though they expressed happiness with our service to them. Once we began accepting EyeMed many of those patients returned. Similarly, if you help patients maximize use of their vision benefit you will increase the chances they will return to your office. By doing so you are creating extra value for patients by making it easy for them to pay for your services and products rather than creating another chore for them. That will give you an edge over competitors.

ROB Talk-the-Talk
Make Insurance Communication Part of Optical Hand-Off


It is important that the doctor set the stage for the discussion of vision benefits and eyeglasses purchases in the exam room. Here is an example of how I aid the hand-off to the optical with a conversation in the exam room:

Doctor: "Jane, I see in your chart that your vision benefit will help you pay for a new pair of eyeglasses this year or will  help you buy an annual supply of contact lenses."

Jane: "Wow, that's great! I'm glad you pointed that out. I had no idea. How much of the cost will my plan take care of if I buy that pair of cat's eye glasses I was looking at before I came in for my exam?"

Doctor: "Our optical staff will help you sort through exactly what your benefit entitles you to in purchasing eyewear and contact lenses after we complete the exam. Don't worry--we'll help you take full advantage of your vision benefit."


Related ROB Articles

Pricing Frames Profitably in a Managed Care Environment
How to Coordinate Medical and Vision Plan Billing
Four Key Steps to Accurate Coding & Billing


Yoongie Min, OD, is the owner of Northwest Vision Center, with locations in Columbus and Chillicothe, Ohio. To contact him: [email protected].