These are desperate times.

[drk]

And they call for desperate measures.

The set up:
Act I: We are getting really, really low "dispensing fees" from half of our EyeMed plans and VSP, and obscenely low dispensing fees from the other half of the EyeMed plans.

Act II: I have a funny story to share: A lady got her eyes examined here using her VSP No-Choice Plan, and decided to fragment her care and buy frames at Costco (out of pocket or using her frame benefit I don't know and don't care).

It was some nice-enough-looking frame I've never heard of. We said we'd use it, but she'd have to sign a waiver, which she did. So the job went off to VSPOne Columbus (which is a decent enough lab).

Dispensing went well. At one week she called and said her frame was damaged. When she brought it in, a teeny, weeney gold trim "dot/rivet/bead" was missing from her temple. Under magnification, the frame has a divot and something was previously glued in there. We said we'd call the lab to look for it, just to show we care.

No dice, of course, as it is the size of a screw head. We even called Costco. They were adamant that they will not warranty the frame. We even suggested she call her VCP and tell them that their lab messed up her frame, but she's blaming us, and of course Costco is held completely harmless by her.

Our dispensing fee on the job was obscenely low. Certainly too low to indemnify her against her loss even if we were motivated to (we're not). So we expressed sympathy, and she wants to report us to the BBB.

Act III: Nice patient wanting to use her frame...again. Her "favorite frame". Been with her longer than her husband. We gently discourage to no avail. She needs them "tightened" and we try to pre-adjust and SNAP.


Here are the lessons for us:
1. Crap reimbursing VCPs eliminate a lot of margin by which you can "slush fund" these customer satisfaction issues. We simply don't make enough to give "deluxe" service. Hey, they didn't pay for deluxe service, anyway.

2. Private pay patients paying full fare should get the royal treatment.

3. Opticals that don't deal with VCPs ought to make hay with this situation.

4. If you accept VCPs, you are merely one step above commercial opticals.

5. We are instituting (again, for REAL, this time) a frame waiver: If your frame is not a.) from our office or b.) from our office within the warranty period of one year, we are held harmless.

We've also decided to stop messing with "lenses only" orders (and send in every frame) and stop messing with "half pairs" (and do both lenses, regardless), and turn-around time quote is minimum 2 weeks.

In this day and age of "insurance labs", we just can't deliver that kind of service anymore. Maybe you can.

[obxeyeguy]

I really do understand, and not everyone can do what I did as an independent optician, and dropped all insurances. Once Optometry opened the door to VSP in particular, the writing was on the wall. You can't win with them, they dictate everything, and like you said, no royal treatment at the fees you are paid.

As to the hay, I am selling it now. I am making more $$ now then when I took insurance, and I keep about 70% of the insurance patients once they are in front of me.

[Tallboy]

We have thought about taking pictures of patients frames prior to using, because we have had instances where nothing short of that could help dissuade an adamant and angry client.

[ak47]

And they call for desperate measures.

The set up:
Act I: We are getting really, really low "dispensing fees" from half of our EyeMed plans and VSP, and obscenely low dispensing fees from the other half of the EyeMed plans.

Act II: I have a funny story to share: A lady got her eyes examined here using her VSP No-Choice Plan, and decided to fragment her care and buy frames at Costco (out of pocket or using her frame benefit I don't know and don't care).

It was some nice-enough-looking frame I've never heard of. We said we'd use it, but she'd have to sign a waiver, which she did. So the job went off to VSPOne Columbus (which is a decent enough lab).

Dispensing went well. At one week she called and said her frame was damaged. When she brought it in, a teeny, weeney gold trim "dot/rivet/bead" was missing from her temple. Under magnification, the frame has a divot and something was previously glued in there. We said we'd call the lab to look for it, just to show we care.

No dice, of course, as it is the size of a screw head. We even called Costco. They were adamant that they will not warranty the frame. We even suggested she call her VCP and tell them that their lab messed up her frame, but she's blaming us, and of course Costco is held completely harmless by her.

Our dispensing fee on the job was obscenely low. Certainly too low to indemnify her against her loss even if we were motivated to (we're not). So we expressed sympathy, and she wants to report us to the BBB.

Act III: Nice patient wanting to use her frame...again. Her "favorite frame". Been with her longer than her husband. We gently discourage to no avail. She needs them "tightened" and we try to pre-adjust and SNAP.


Here are the lessons for us:
1. Crap reimbursing VCPs eliminate a lot of margin by which you can "slush fund" these customer satisfaction issues. We simply don't make enough to give "deluxe" service. Hey, they didn't pay for deluxe service, anyway.

2. Private pay patients paying full fare should get the royal treatment.

3. Opticals that don't deal with VCPs ought to make hay with this situation.

4. If you accept VCPs, you are merely one step above commercial opticals.

5. We are instituting (again, for REAL, this time) a frame waiver: If your frame is not a.) from our office or b.) from our office within the warranty period of one year, we are held harmless.

We've also decided to stop messing with "lenses only" orders (and send in every frame) and stop messing with "half pairs" (and do both lenses, regardless), and turn-around time quote is minimum 2 weeks.

In this day and age of "insurance labs", we just can't deliver that kind of service anymore. Maybe you can.

Lessons 1 and 2 are almost universally true. Lessons 3, 4, and 5 depend more on the circumstances.

Aside: any frame with beads or rhinestones that retails for under $500 (as well as most of those above that price point) are likely to fall out because most frame manufacturers take no pride in their craft. notable exception: CAVIAR

[drk]

Aside: any frame with beads or rhinestones that retails for under $500 (as well as most of those above that price point) are likely to fall out because most frame manufacturers take no pride in their craft. notable exception: CAVIAR

Then I guess $90 Costco specials don't cut it.

[Uncle Fester]

We have thought about taking pictures of patients frames prior to using, because we have had instances where nothing short of that could help dissuade an adamant and angry client.

Like that will make a difference?

[revein]

We have a set price in addition to the price of the lenses customers have to pay if they want to use their own frames. This discourages most people and they end up buying new frames, which are sometimes cheaper than the working fee. Just say it's up to the customer if they want to take their chances and have their frame adjusted if it isn't from your store or looks like it's about to snap.

[Chris Ryser]

Beads and Rhinestones will also fall out of a frame that you sold for
$ 1,000 or more and have done so for the last 100 years.

[fjpod]

We no longer send a patient's frame, or one of our better frames to a vision plan lab. Period. End of story. When something goes wrong, we get the bad reputation.

[drk]

I like it, Dr. F.

Sadly, at least half of VSP members have to use an "insurance lab" and really, all EyeMeds use an "insurance lab". We have little choice.

[ak47]

I like it, Dr. F.

Sadly, at least half of VSP members have to use an "insurance lab" and really, all EyeMeds use an "insurance lab", really. We have little choice.

Reread your post directly above, Dr. K., and you will find your choice becomes evident.

[drk]

Ok, I don't see it! Help me out.

[ak47]

To be (stuck dealing with insurance) or not to be, that is the question (it is your choice).

[DanLiv]

1. Crap reimbursing VCPs eliminate a lot of margin by which you can "slush fund" these customer satisfaction issues. We simply don't make enough to give "deluxe" service. Hey, they didn't pay for deluxe service, anyway.

2. Private pay patients paying full fare should get the royal treatment.

In this day and age of "insurance labs", we just can't deliver that kind of service anymore. Maybe you can.

You shouldn't give private pay service at insurance prices, and you don't have to. Problem is we give this stuff away when there is no requirement for us to do so. If a patient wants to use their own frame, we do so. If they can't wait 2 weeks and need a 3 day rush, we do so. If they need a free replacement AR warranty (or multiple ones), we do so. Free repairs and adjustments, we do so. All of this is professional service which we build in to our fees, BUT IS NOT COVERED BY INSURANCE PLANS. The fees patients pay with insurance cover materials, lab work, and dispensing. That's it. The reimbursements or dispensing fees are just the bare minimum to mitigate your expenses for providing the most basic service possible. Your primary profit is always going to come from your patient out of pocket [$$$] minus lab bills or chargebacks [$$] plus dispensing fee [$]. The problem is we are charging patients [$$$] while we are giving them (and should be charging them) [$$$$$], and that kind of service is costing us [$$$]. Obviously charging [$$$] minus a cost of [$$$] leave you with only the meager [$] dispensing fee, and that's why it seems to suck because you are providing too much service for what you collect. (I'm employing the [$] characters as stand-ins for relative dollar values, I posted no actual dollar values.)

In cases of insurance all of these service fees should be separated out from the insurance mandated fee schedule and charged to the patient additionally. If you like you may let patients opt out of your additional services to get cheap insurance glasses with no support, or if you prefer you may refuse to sell any glasses without your full optical service. Just because a pair of glasses *can* be 100% covered with their $15 copay only doesn't mean you have to make it for them. You are not obligated to sell insurance patients whatever they want, you are only obligated to price whatever you choose to sell them at contracted rates.

You can add fees for post-dispense adjustment, warranty, express service, repair, hard cases, cleaning cloths, cleaning solution, eyewear troubleshooting, specialty optical consultation, and other miscellaneous services. If you are going to do these things for insurance patients you should absolutely add the fees, and if you are not going to charge them you should be willing to refuse to perform the service. You can charge it at time of purchase as a comprehensive "care package" or whatever you want to call it, or just have a service fee schedule and charge insurance patients piecemeal whenever they come in for service. The reason you are having trouble profiting off insurance patients is because you are voluntarily giving away your service. If you let them walk out with your service without paying for it, you might as well let them lift some frames while they are at it too. Either way you are giving the practice away.

You will have to become very skilled at explaining this to patients. Some (the cheapest ones) will leave and find some other practice that is still giving everything away for free and will leech them instead. But you didn't want them anyway right? If you explain it clearly and confidently the more reasonable patients will see the value of service and understand that insurance is not a blanket free ride.

If you charge insurance patients for your service, then you can accept insurance, patients get their insurance benefit, and you still make enough that you can give them royal treatment just like your private pays. It still won't be the same profit as private pays, but that's what insurance means: you get free patients in exchange for lower profit. But it's up to you to make that merely "lower" profit, not zero profit.

[tx11]

The catch is that most practices are 80% to 90% third party insurance (low reimbursement)..offering crummy to average service to these people will simply make them go elsewhere...and then there were none...

[Paul Smith LDO]

If a patient has a strong desire to bring an outside frame (cheap) for use with their insurance I charge 40.00 SV 60.00 PAL. I know that I will be responsible for multiple adjustments. That should encourage them to buy from you in the future. With VSP, I stay away from their frame division. Waivers are useless IMHO they do nothing when a patient subterfuges the condition and quality of their frame, especially when in the presence of others.

[fjpod]

DanLiv....
First of all, most vision plan contracts mandate that you perform adjustments and minor repairs for a year, and extend warranty replacements, etc. without charge, in their contracts.

Secondly, as someone else said, if the majority of your practice is vision plan patients and you give crummy service to almost all your patients, you will have a crummy reputation.

Thirdly, I don't know if I can agree with the concept of treating patients differently based on their ability to pay. I mean it's ok for wealthier patients to get better frame and lens choices, but the manner and accuracy in which we provide these materials should be the same.

Eyeglasses are not exactly a medical service, they are more of a consumer product, but, for example...in NYS, a doctor working in a hospital ER is not even allowed to know what insurance a patient has, for fear that it might color the doctor's decision making. So, I sorta subscribe to the concept that all patients who walk through my door, deserve the best care.

Some "insurances" make this difficult, but......... you win some, you lose some. Even if all your patients are private pay,.....you win some and you lose some.

[Gizzo]

We do out-network VSP very often. Rare is the client that 'walks'. We sweeten the deal, of course. As for EYEMED, we keep all the work in our labs, as well. There is little assurance of quality in these big mills. I had to drop a fine name up in Portland because it was so easy finding better work at an array of Independents. As for some of the turnips that come through for re-glaze: WAIVER; Failed frame? Sorry, we'll make you a great deal on a frame...

I like it, Dr. F.

Sadly, at least half of VSP members have to use an "insurance lab" and really, all EyeMeds use an "insurance lab", really. We have little choice.

[tx11]

fjpod +1

[DanLiv]

DanLiv....
if the majority of your practice is vision plan patients and you give crummy service to almost all your patients, you will have a crummy reputation.

I don't know if I can agree with the concept of treating patients differently based on their ability to pay. I mean it's ok for wealthier patients to get better frame and lens choices, but the manner and accuracy in which we provide these materials should be the same.

Hmm, I don't give anyone crummy service, even my most bare-bones insurance patients. Don't know what I said that made that seem the case.

I have a huge range of capability in materials and service, with a corresponding huge range in fees. I provide every patient the best of what they opt to purchase. If they don't want my better frames or lenses, or don't want my best services, they have that option. But I don't give products or services away. In fact, I believe giving the same service to an insurance patient who *declines* to pay when the service is offered is a slap in the face to your private pay patients who are paying for the service built in to your fees.

When a patient says they want only what their insurance covers, I explain and offer them a host of desirable materials and services that are not covered by insurance. If they opt for them, fantastic! They receive everything they opted for, and I was compensated enough to provide everything for them without taking a loss. If they decline, they will still get the best I can provide of what they opted for. It is their choice, and when I explain it up front it becomes clear what they do and don't get from their insurance. Everyone is treated equally, offered the same service and materials, and has the same opportunity to get everything they want. If they decline a materiel or service that costs them money, giving it to them anyway doesn't make sense to me. If they want a $500 frame but their insurance only covers $120 and they refuse to pay the extra, you don't just give them the frame anyway. To do so would be poor business, and an unfair disservice to the other patient that did opt to pay extra for what they wanted.

[eryn]

Hmm, I don't give anyone crummy service, even my most bare-bones insurance patients. Don't know what I said that made that seem the case.

I have a huge range of capability in materials and service, with a corresponding huge range in fees. I provide every patient the best of what they opt to purchase. If they don't want my better frames or lenses, or don't want my best services, they have that option. But I don't give products or services away. In fact, I believe giving the same service to an insurance patient who *declines* to pay when the service is offered is a slap in the face to your private pay patients who are paying for the service built in to your fees.

When a patient says they want only what their insurance covers, I explain and offer them a host of desirable materials and services that are not covered by insurance. If they opt for them, fantastic! They receive everything they opted for, and I was compensated enough to provide everything for them without taking a loss. If they decline, they will still get the best I can provide of what they opted for. It is their choice, and when I explain it up front it becomes clear what they do and don't get from their insurance. Everyone is treated equally, offered the same service and materials, and has the same opportunity to get everything they want. If they decline a materiel or service that costs them money, giving it to them anyway doesn't make sense to me. If they want a $500 frame but their insurance only covers $120 and they refuse to pay the extra, you don't just give them the frame anyway. To do so would be poor business, and an unfair disservice to the other patient that did opt to pay extra for what they wanted.

+1000000
Giving everyone the same good attitude/ patient education / choices is excellent customer service.
Providing an actual service without charging seems to be rather unique to opticals. Can't really remember the last time I walked into another type of business and received service (actual work) of any kind for free.

[Paul Smith LDO]

Hmm, I don't give anyone crummy service, even my most bare-bones insurance patients. Don't know what I said that made that seem the case.

I have a huge range of capability in materials and service, with a corresponding huge range in fees. I provide every patient the best of what they opt to purchase. If they don't want my better frames or lenses, or don't want my best services, they have that option. But I don't give products or services away. In fact, I believe giving the same service to an insurance patient who *declines* to pay when the service is offered is a slap in the face to your private pay patients who are paying for the service built in to your fees.

When a patient says they want only what their insurance covers, I explain and offer them a host of desirable materials and services that are not covered by insurance. If they opt for them, fantastic! They receive everything they opted for, and I was compensated enough to provide everything for them without taking a loss. If they decline, they will still get the best I can provide of what they opted for. It is their choice, and when I explain it up front it becomes clear what they do and don't get from their insurance. Everyone is treated equally, offered the same service and materials, and has the same opportunity to get everything they want. If they decline a materiel or service that costs them money, giving it to them anyway doesn't make sense to me. If they want a $500 frame but their insurance only covers $120 and they refuse to pay the extra, you don't just give them the frame anyway. To do so would be poor business, and an unfair disservice to the other patient that did opt to pay extra for what they wanted.

Kudos Dan, this is a perfect example of providing your patients with services within a tier structure. Exemplary care within the VCP system has to be accounted for by the individual requiring said services. No, this does not mean that we are belittling or treating others rudely, it means that if you require the Gold Level one should pay for it.

[drk]

Great discussion.

fjpod vs. Danliv: I think I have a "middle path".

Dan, if you get too crazy (not that you are), it can be considered "fragmentation of care", as Dr. P says. VCPs are on to some such stuff, like (maybe) selling the case, warranty, etc. You can go too far.

Nevertheless, "tiered care" is clearly the wave of the future. There is nothing at all unethical about "basic-better-best". It's really an additional layer of free-market enterprise on top of a collectivized system (and a VCP is a collectivized system, of sorts).

And I agree that "basic care" can be "basic" but not "shoddy". But for crying out loud, by nature, the forces of the market push it to the very brink.

[ak47]

Be careful trying to be everything to everyone.

You can become the doormat to the world.

I'm sure Ohio has many OD offices to choose from.

What type of choice do you WANT your office to become?

[drk]

I'm riding the "managed care" freight train to hell, for now. We'll see what happens, later.

It is a good learning experience, but of course.