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Thread: The Zanniness Zone---Billing Medical Insurance -VS- Vision Plan

  1. #1
    Rising Star Lori's Avatar
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    Confused The Zanniness Zone---Billing Medical Insurance -VS- Vision Plan


    Scenario:

    Patients come in for a medical exam, due to the symptoms described and or diagnosis on file. Our receptionist informs them of any copayments and deductibles at check in. They go back have a medical exam with our MD. Before leaving they decide to get specs- most people are clueless about their plans so I search and find that they have a vision plan- tell them it will be billed for glasses but not the exam because we performed a medical exam based on Symptoms and or diagnosis determined by our MD. They order specs with a smile. Our checkout girl again informs them who/what for we are billing, Collects the exam deductible and/or copayment as well as the amount due for the glasses. Patient leaves happy.

    Everything is Honky-dory.

    For awhile.

    But then... Bam!

    Somewhere along the way they learn that the vision plan exam copayment is less than the medical insurance and they want us to rebill- negate the original and demand a refund. (Which we don't.

    We are sometimes called 'stupid' and other things that I won't repeat; which is doubly insulting because we offer top notch customer service, are extremely helpful and friendly to everyone that comes in. You could say we're so kind is almost sickening...

    Has anyone come up with a solution to this problem? I am wondering if it's unique to an ophthalmology practice since we see a lot (50-100 pts a day) of patients that have medical issues and also have optical.
    Last edited by Lori; 05-04-2016 at 11:03 AM.

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    OptiBoard Moron newguyaroundhere's Avatar
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    Was there any procedures/testing done on the patient that would only be able to be billed through his medical plan?
    Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Medicare for all...

    Quote Originally Posted by Lori View Post

    Has anyone come up with a solution to this problem? I am wondering if it's unique to an ophthalmology practice since we see a lot (50-100 pts a day) of patients that have medical issues and also have optical.
    How about a single payer health care system?

    Pick a number ($60) every 2 years, yearly for kids, for basic frames with sv or lined bifocals. Patient pays extra for anything above that.

    No insurance or managed care involved except for basic frame and lenses.

    Let the OD's and MD's lobby err... fight over amount of exam reimbursement.

    How much does Medicare currently pay for routine exam? Depends on the plan right? How about Medicaid? How do they compare to others?

    How about $XX.00 dollars for each routine exam? One (ONE!) website to submit too.
    Last edited by Uncle Fester; 05-04-2016 at 04:03 PM. Reason: tweak...

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    Master OptiBoarder
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    We get that all the time. You can explain 'til the cows come home and they just don't get it. (and yes...this is an ophthalmology practice) The only thing I can say is that they pay their exam copays and refration fees up front before seeing the doctor. It is explained that they can use their benefits for refraction if they want to come back at a later date and have that done with our optometrist. Sometimes they do. Most of the time they don't. In our office, eyeglasses are separate. Billing is done for that when they are completely done with the doctor.

  5. #5
    Master OptiBoarder rbaker's Avatar
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    Patients and eye care providers must learn the difference between medical insurance and vision plans.

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    Right now I can hear the discussion at the front desk.... if you want to use your NVA, you can't have the other medical tests done today and use your medical insurance ..... if you want the medical tests done today and use your medical insurance and still want to use your NVA, you will have to come back on another day to do that... Oh my....

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    Master OptiBoarder DanLiv's Avatar
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    We do both medical and vision exams. When the chief complaint is medical or there is a condition we advise them we need to do medical, however we have a sign in form where they need to elect either medical or vision exam. If they elect medical, we bill medical only for all exams, and they can additionally elect to self-pay for refraction or not depending on their interest in glasses. If they select vision that's cool, but we inform them no medical testing or treatment of their medical condition is done. The vast majority elect medical if we advise them to, but some elect not to and stick with vision only, usually because they are primarily interested in refraction and have high copays or deductibles on their medical. But either way the patient knows and elects ahead of time which insurance and copays are being used, and what procedures are being done. If the patient isn't fully aware and compliant with what's being done, that's where you get the backlash when they do find out. When they elect and sign off ahead of time, they have little argument later.

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    Master OptiBoarder DanLiv's Avatar
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    Quote Originally Posted by mervinek View Post
    Right now I can hear the discussion at the front desk.... if you want to use your NVA, you can't have the other medical tests done today and use your medical insurance ..... if you want the medical tests done today and use your medical insurance and still want to use your NVA, you will have to come back on another day to do that... Oh my....
    Yup absolutely true. That's the hoop patients need to jump through if they want to manipulate their insurance.for as much coverage as possible. Alternatively, if they care about their time and convenience, they may elect either vision or medical insurance and then self-pay for the non-covered exams and get everything conveniently done at once. It's and inconvenience of their insurance, and we will not accept less or perform services for free to help them navigate their insurance. Most patients agree and understand once we explain things to them ahead of time, and almost all the time now once patients get out to the front desk or opticians and we are explaining the billing, they are nodding in agreement because we already agreed upon it all at intake.

  9. #9
    What's up? drk's Avatar
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    KISS.

    "With your eye problems, your health plan is primary and your vision plan is secondary. Their rules, not ours. We can submit copays and deductables to your vision plan secondarily."

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