By Linda Conlin,
August 22, 2018
Most practices have many patients who seek to use managed care vision insurance for services and products.
The goal is always to deliver the best possible care to our patients, including providing them with the products the doctor has prescribed. I’ve learned the importance of working with patients, so they are able to use their managed care plans to get all of the eyewear the doctor has prescribed to improve their lives.
At practices where I’ve worked, the average managed care purchase out-of-pocket for the patient, before insurance payments, was about $120, while the average non-managed care purchase was about $350.
According to The Vision Council, 66 percent of patients used insurance to purchase eyewear in 2017.
What’s important here is to consider the total of patient co-pays plus insurance payments versus cost of goods. In cases where managed care plans require the use of their frames and their labs, the cost of goods is minimal, so collecting co-pays for add-ons is an important source of revenue.
Another consideration is that some plans have lower reimbursements for materials, but higher reimbursements for the exam. (The reverse is also true.) As in any other facet of the practice, total cost versus total revenue must be carefully considered when joining any managed care panel.
Here are some of the ways frame mix impacts optical sales, and how you can ensure you have the right mix of frames based on the plans that most of your patients use.
Review Requirement of Plans You Accept
Understanding the plans your practice serves, and the percentage of your patients who have those plans, is key to making profitable frame-mix decisions.
Some plans require that you maintain an inventory of their own frames, making it simple. Others offer patients larger discounts on certain brands. Still others offer allowances toward frames. For those plans, patients will expect to see frames that are completely covered by the allowance, so investing in some product in, or close to, the plan’s allowance is best.
Make it Easy for Patients to Find Frames Covered By Their Plan
I have found that it’s helpful to have frames covered by the most popular plans in certain areas of the frame board. Remember, patients frequently don’t understand their plans or their benefits. It can be uncomfortable for the patient and staff when someone who wants, or can afford, only what their plan covers, falls in love with a frame outside of their coverage.
That said, you still want to offer patients frames that will be an upgrade to what their plan covers, as well as appealing to patients who don’t have, or use, managed care.
Keep Staff Aware of Plans You Accept–and Changes to Those Plans
It’s important to have plan benefit information, and authorization when required, before the patient’s appointment to help make the patient’s visit seamless. Some practice management software programs will pull benefit information and authorizations automatically, saving a great deal of time. Otherwise, staff can obtain it directly through the insurance web sites. Staff must be familiar with using those web sites. Print-outs of benefit information are particularly helpful for staff to have ahead of time, especially when a patient has questions.
Gaining experience working with insurances is the best way for staff to become familiar and comfortable with them. New staff should be paired with more experienced staff as they learn the process. In a practice where I worked previously, one staff member was particularly knowledgeable about one of the more complicated insurance plans. We all knew to go to her with questions!
How to Have the Conversation About Plan Coverage
Most plans allow upgrades of some type, while other plans offer discounts or allowances. Plan benefits can be valuable tools for presenting the best products to patients at a great price, and the opticians must utilize those tools. Presentation is key. The conversation should start with something like, “You’ll be able to have the glasses you want at a lower cost.” Staff should never say, “Your plan only covers …”
Refer to up-charges as “co-pays”: “Your co-pay for anti-glare treatment is only …” It’s also helpful to price the glasses at the regular price, then with the plan benefit. That way patients can easily see the savings.
Some patients will want only what is covered by their insurance, but we should still present their options to them, albeit gently. Saying something like, “The doctor has recommended anti-reflective treatment to make you more comfortable driving at night, and you can have that for your glasses for only a co-pay,” lets the patient know that they have a visual need that is at least covered in part by their insurance.
Of course, some patients don’t want to pay anything beyond the basic plan coverage, so it’s wise not to push, but we have an obligation to make sure our patients know all of their plan benefits, and we can explain that obligation to them, too.
Linda Conlin is a licensed optician and managing editor of 20/20 Magazine’s Pro-to-Pro Newsletter. To contact: LindaConlin@OpticalCEU.com