Cost of Exams out of pocket

[btomford92]

Hello, so I was just wondering what the cost for a full comprehensive exam should be when a patient does not have insurance?

[mervinek]

All offices charge different amounts...are you a patient?

[btomford92]

No I am an optician, we are thinking about changing the price of our exams for self-pay patients and feel that our out of pocket exams are rather low after seeing a national average. So I was curious to see what other offices are charging their patients.

[Chris Ryser]

Hello, so I was just wondering what the cost for a full comprehensive exam should be when a patient does not have insurance?

Just charge them the same amount as you would get from the insurance and everybody could and would be happy.

[jpways]

A way you could determine the price is to figure out total costs per month assuming you did not have any frame stock and sold no frames or lenses, this would be utilities, rent/lease cost/mortgage, real estate taxes, wages, including a wage for the doctor, etc. Figure out how many exams you do for a month and divide that number into your total costs. i.e. if your monthly cost are $8000 and you do 80 exam a month, $100 an exam seems like a reasonable number.
Another thing you can do is (assuming no other optometric offices in your area recognize your voice) call each office in you area and ask them how much they charge for an exam (of course don't do this on a business line). On this I know someone made a website where they called offices and asked their charge for a new patient exam and contact lens fitting and posted those numbers online. I remember looking at the website after I saw an article about it online to check and make sure that our prices were accurate and to see what everyone else in our area charged. But, in the past couple of years I've tried to find that website or the article that mentioned the website and I cannot.
Due to anti trust laws no one is allowed to tell you what they charge as this may lead to price fixing (and for the record none of our charges for an exam are $100 routine or medical).

[drk]

Just call around and survey five chains/big boxes and five private practices.

[Jubilee]

Many offices set their fees around the Medicare Fee Schedule. You can pull up that list online at the Centers for Medicare and Medicaid Services. As for a discount for private pay, a 20% Prompt Pay is not unheard of. However your mileage may vary as some are very wary of discounting fees at all, and it can get tricky. Mrs Smith will get mighty upset having to pay more for her exam because she hasn't met her deductible, than what she could have paid on the date of service..

For this reason, I really recommend to look up the insurance in advance so you can let the patient know what their options are.

[Dr. Bill Stacy]

My advice is to take the local insurance reimbursement maximum for an eye exam, and set your price at least 20% over that figure, which will pretty much guarantee you'll get max reimbursement. If you go lower than that amount, you are guaranteeing you will get lower reimbursements. And do NOT cheat. If you regularly quote prices on the phone, be sure you do not offer automatic discounts to your "regular" price, or the powers that be (who do shop offices anonymously and regularly) will reset your max reimbursement to something lower than what you are offering on the phone. And it will take up to a year to make any changes stick. In my area of Northern California, it's commonly about $150 for a new patient comprehensive, which I know is higher than most of the USA.