Uninsured pt's using bad vision plans to get full-service care!

[ilanh]

Here's a problem that has worsened over the last few years:

We've always taken some of the very poor vision plans out there as a service to our existing patients. For example, if we have a medicare or PPO patient and they happen to have Spectera, Davis, Eyemed etc we will accept the vision plan. This is really done as a service to the patient because some of these plans pay exam fees of $30 (outrageous!). So if the patient is postop cataract surgery and their PPO does not cover glasses, they can use their "vision plan" to get a refraction and perhaps some glasses.

This approach, however, is beginning to backfire on us: I've been noticing over the last year or two patients who have either no medical insurance or have HMO are showing up with these vision plans and trying to get a full-service eye exam, second opinion or advanced consultation. I first started to notice this after the economy began to worsen. Occasionally these are patients who we used to see when they had proper medical insurance. They are now showing up with macular degeneration, cataracts, glaucoma etc and trying to use their $30 plans to get follow-up care, second opinions etc.

We will need to limit those poor plans to existing patients and refuse them in every other case if possible. Or simply drop them altogether if it proves easier. How can a vision plan expect to pay an O.D or M.D $30 for a complete exam????????? Any other OD's or M.D's noticing this trend?

[chip anderson]

Do you ever do less than "full service eye exams?"

[MikeAurelius]

So, in other words, you want to get rid of an entire class of patients just because you are soooo greedy that you don't want to help out some folks who can't afford decent vision.

Wow. Simply, wow.

Priceless.

[mdeimler]

Or he may be having a hard time generating real revenue while being cut away...we need to make SOME money to actually provide service to our patients.

[NeaOptikiSA]

Both sides have a point, but i think that the high quality of service brings the high scores!!! in the long run!

[Happylady]

A standard exam with a refraction and dilation is not the same exam that would be done on a patient with serious eye issues such as macular degeneration and glaucoma. These kinds of exam should cost more if you are actually treating these issues.

[AustinEyewear]

So, in other words, you want to get rid of an entire class of patients just because you are soooo greedy that you don't want to help out some folks who can't afford decent vision.

Wow. Simply, wow.

Priceless.

OOooooo, I don't think soooooo girl. If you can afford $150 month on hair and nails, you can afford a few bucks for a good eye exam.

http://salonpolished.net/users/edito...326&fn=pricing

[MikeAurelius]

OOooooo, I don't think soooooo girl. If you can afford $150 month on hair and nails, you can afford a few bucks for a good eye exam.

http://salonpolished.net/users/edito...326&fn=pricing

girl?? Since when? I shaved my face this morning, plus the 3rd leg definately makes me male.

[MikeAurelius]

Ok, here's my point: if the insurance doesn't cover those kind of exams, then why are you examining them in the first place? Shouldn't there be a discussion UP FRONT beforehand that the insurance the patient has DOES NOT cover an advanced exam?

It's all about communication, folks! If you let them get in the chair, finish the exam, and only then find out they don't have the insurance to cover, then the problem is in your office staff, not the patient. Don't blame the patient for trying to "work the system", blame your office staff for allowing it to happen in the first place.

[AustinEyewear]

Ok, here's my point: if the insurance doesn't cover those kind of exams, then why are you examining them in the first place? Shouldn't there be a discussion UP FRONT beforehand that the insurance the patient has DOES NOT cover an advanced exam?

It's all about communication, folks! If you let them get in the chair, finish the exam, and only then find out they don't have the insurance to cover, then the problem is in your office staff, not the patient. Don't blame the patient for trying to "work the system", blame your office staff for allowing it to happen in the first place.

Agreed!

My point was there are too many people who think medical care should be free, even if they have the means to pay for it. What, A CO-PAY!!! You have to be kidding!!!! The nerve of some doctors!!! I wish Ferrari's were free too.

[MikeAurelius]

Agreed!

My point was there are too many people who think medical care should be free, even if they have the means to pay for it. What, A CO-PAY!!! You have to be kidding!!!! The nerve of some doctors!!! I wish Ferrari's were free too.

Everywhere I go for medical exams of any kind, if there is a co-pay required, it is collected when I check in. If I don't pay the co-pay, I don't see the doctor. Also, all my insurance cards state quite plainly that co-pays may be required for certain exams, and every time I get a new card in the mail, there is a booklet attached with the required co-pays. Now, yes, I understand that not everyone takes the time to read over that booklet...however, a sign posted on the office wall near reception can go a long way towards softening the patient response to a request for co-payment at the time of the exam.

COMMUNICATE!!!!!!!!

[AustinEyewear]

Everywhere I go for medical exams of any kind, if there is a co-pay required, it is collected when I check in. If I don't pay the co-pay, I don't see the doctor. Also, all my insurance cards state quite plainly that co-pays may be required for certain exams, and every time I get a new card in the mail, there is a booklet attached with the required co-pays. Now, yes, I understand that not everyone takes the time to read over that booklet...however, a sign posted on the office wall near reception can go a long way towards softening the patient response to a request for co-payment at the time of the exam.

COMMUNICATE!!!!!!!!

Thats not my point. They know they have a co-pay. They don't like it. They don't want to pay it. They don't think of the savings, they only think of the co-pay. They don't respect their fortunate situation. Not everyone, but enough to ruin your day once in a while.

[GokhanSF]

Thats not my point. They know they have a co-pay. They don't like it. They don't want to pay it. They don't think of the savings, they only think of the co-pay. They don't respect their fortunate situation. Not everyone, but enough to ruin your day once in a while.

IF they don't want to pay show them the door. Simple and easy.

[MikeAurelius]

Thats not my point. They know they have a co-pay. They don't like it. They don't want to pay it. They don't think of the savings, they only think of the co-pay. They don't respect their fortunate situation. Not everyone, but enough to ruin your day once in a while.

As I said above, a sign that says: "All co-pays must be paid at time of registration, otherwise your appointment must be rescheduled". Simple, non-confrontational.

[mdeimler]

As I said above, a sign that says: "All co-pays must be paid at time of registration, otherwise your appointment must be rescheduled". Simple, non-confrontational.

That's a good idea. That's how my PCP office is and I think it works very well.

[Chris Ryser]

Overall Health Insurance Coverage

• For calendar year 2010:
  
  • 55.3% of the population was covered by employer-sponsored insurance
  • 14.5% of the population was covered by Medicare and 15.9% was covered by Medicaid — with some individuals covered by both programs
  • 16.3% of the population was uninsured for the entire year
  
  
• http://aspe.hhs.gov/health/reports/2...s2011/ib.shtml
• 
  

That would be about some 53,790,million without health insurance that is a horrible amount of people that can not afford to get treatment.

Why not set a goal to treat a certain amount for free, bill them for which they will not pay, write it off and get a tax credit for it.

[becc971]

we will ONLY bill the eyemeds davis and VSPS for comp eyes, anything medical (i.e. glaucoma, cataracts etc) goes to their medical insurance, if they don't have medical insurance then its self pay and tough cookies. We always explain to patients that this is the ONLY thing that will be covered by these outside insurances. The reimbursement is not great, but it does fill the chairs. our comp eyes are ONLY: dialation, refraction, and general eye health. anything extra they have to come back and have another visit.

MOST insurances (including medical) will pay for glasses post cataract glasses though, or at least a portion of it. the reimbursement isnt huge or anything, but we make them pay the overage too. We give them enough to cover a basic frame and a CR-39 FT-28, if they want anything over and above that they have to pay for it.

unfortunately a lot of it is about red tape with insurance, but unless you're willing to lose your shirt you can't try to bill them for any advanced medical care. we will make people come back on two different days if they come for a comp eye and we discover glaucoma, etc, because that's the way the insurance cookie crumbles.

[GokhanSF]

[/LIST][/LIST]





That would be about some 53,790,million without health insurance that is a horrible amount of people that can not afford to get treatment.

Why not set a goal to treat a certain amount for free, bill them for which they will not pay, write it off and get a tax credit for it.

In San Francisco there is an optical community that gets together couple times a year to perform free eye exams and provide free Rx eyewear for homeless.

+1000 Chris

[OHPNTZ]

The problem lies in the "vision" insurances . They are marketed to hr and patients, and the line is blurred. I have argued this regarding vsp's marketing tactics on this site before. Look at the name EyeMED...what does the "med" conjure up when heard? What is "med" about it???

Where i am we have witnessed many 70 yr olds showing up with davis, eyemed, etc.

[AustinEyewear]

The problem lies in the "vision" insurances . They are marketed to hr and patients, and the line is blurred. I have argued this regarding vsp's marketing tactics on this site before. Look at the name EyeMED...what does the "med" conjure up when heard? What is "med" about it???

Where i am we have witnessed many 70 yr olds showing up with davis, eyemed, etc.

Very true - which is the original posters point anyway. I'm really kind of shocked that someone would have vision ins, but not health ins. I guess their eye issues supersede other health problems so they try the vision insurance route thinking it will save them $

[EyeCare Rich]

we will ONLY bill the eyemeds davis and VSPS for comp eyes, anything medical (i.e. glaucoma, cataracts etc) goes to their medical insurance, if they don't have medical insurance then its self pay and tough cookies. We always explain to patients that this is the ONLY thing that will be covered by these outside insurances. The reimbursement is not great, but it does fill the chairs. our comp eyes are ONLY: dialation, refraction, and general eye health. anything extra they have to come back and have another visit.

MOST insurances (including medical) will pay for glasses post cataract glasses though, or at least a portion of it. the reimbursement isnt huge or anything, but we make them pay the overage too. We give them enough to cover a basic frame and a CR-39 FT-28, if they want anything over and above that they have to pay for it.

unfortunately a lot of it is about red tape with insurance, but unless you're willing to lose your shirt you can't try to bill them for any advanced medical care. we will make people come back on two different days if they come for a comp eye and we discover glaucoma, etc, because that's the way the insurance cookie crumbles.

Well said becc971. This should all be covered and clarified by your biller in your office. If you don't have one, get one! Somebody in the office needs to know the ins and outs of billing/coding for insurance. Mike is right on with the insight of communication. It has to start with the person doing the billing and trickle down to the person making the appointments so that the whole office is on the same page, as to communicate consistently and correctly with the patients.

Best of luck Ilanh.

[opty4062]

It seems increasing in our office that people just don't know/care what insurance they have, what it covers or what they are expected to pay. Trying to explain the difference between routine vision coverage a la VSP and major medical for the f/b hanging out of their eye only gets us, excuse the pun, a blank stare. "I called my HR and they said my vision co-pay is $15". Yes but Mr Smith you have bacterial conjunctivitis, which is a medical condition and your Blue Cross specialist co-pay is $50. Keep in mind this doesn't happen just at the desk, but also on the phone for scheduling. Lately we have had several patients come in with medical complaints who say, "oh and I'm gonna need my contact lens rx renewed while I'm here..." despite being told at scheduling and reception that medical complaints should be resolved before routine exams to ensure accuracy of refractions. Some people are definitely just watching their bottom line, trying to multi-task at the appointment but some, as always are trying to sneak something by. It's frustrating, at the least, infuriating at the worst, depending on the pt. :)

[fjpod]

Ilan,
...as we were discussing in another thread...you have to separate a refraction and eye health check (vision exam) from a comprehensive exam as defined by medical insurance (92004) Sure, a lot of the components are the same, but the intended outcome of a vision exam is a spectacle Rx if at all possible or necessary, while the expected outcome of a 92004 is anything but glasses.

Admittedly, the general public doesn't understand these subtle differences...and I have mostly given up trying to explain it to them. To them, an eye exam is an eye exam is an eye exam. When we take case histories, patients love to heap on symptoms as if the more they state, the better the exam they will get... "yeah I have blurry vision all the time, and my eyes are so dry, and I get floaters and flashy things with terrible headaches, and my uncle went blind from glaucoma, and here is a list of the 17 medications I take..." If it's a vision exam, I say, " here is your spectacle Rx", (assuming no extenuating circumstances such as expected fluctuation of refractive error from diabetes) now you must come back to investigate your other issues".

[shannon]

Admittedly, the general public doesn't understand these subtle differences...and I have mostly given up trying to explain it to them. To them, an eye exam is an eye exam is an eye exam. When we take case histories, patients love to heap on symptoms as if the more they state, the better the exam they will get... "yeah I have blurry vision all the time, and my eyes are so dry, and I get floaters and flashy things with terrible headaches, and my uncle went blind from glaucoma, and here is a list of the 17 medications I take..." If it's a vision exam, I say, " here is your spectacle Rx", (assuming no extenuating circumstances such as expected fluctuation of refractive error from diabetes) now you must come back to investigate your other issues".

Slightly off subject, but I am not sure I am understanding what you are meaning (forgive me, it's early in the morning for me )....are you saying that you are not wanting the extensive history when performing a routine exam? We need to be aware of a diabetic, but do we not need to be aware of most other health issues and medications? Example: A lupus patient who takes plaquenil? Just curious as to whether I am reading correctly or reading things in where I shouldn't be, I'm good at that!!! Sorry, again about being off topic.

[OHPNTZ]

Slightly off subject, but I am not sure I am understanding what you are meaning (forgive me, it's early in the morning for me )....are you saying that you are not wanting the extensive history when performing a routine exam? We need to be aware of a diabetic, but do we not need to be aware of most other health issues and medications? Example: A lupus patient who takes plaquenil? Just curious as to whether I am reading correctly or reading things in where I shouldn't be, I'm good at that!!! Sorry, again about being off topic.

Yes you need the history, but if the patient shows up with their eyemed card, it does not cover a macula evaluation with baseline oct testing and report.

I think as an eyecare community, "vision insurance" needs to be addressed as "eye glasses allowance" or some other name...