Article Date: 11/1/2011

Creating Policies for the Contact Lens Practice
LENS POLICIES

Creating Policies for the Contact Lens Practice

Consistent policies and procedures lessen confusion for patients and staff members.

By Roxanna T. Potter, OD, FAAO

Maintaining profitability from contact lens fitting is becoming increasingly difficult with the emergence of commercial lens sales and limited insurance reimbursement. Practitioners are wise not to focus entirely on sales from lens materials but rather to charge appropriately for fitting services and expertise. In many practice settings, however, problems inevitably arise when patients become confused and complain about additional fees and procedures. From anger over unexpected refitting fees to confusion about why certain contact lens charges are not covered by their insurance at the time of examination, patients are often understandably upset by standard office contact lens policies simply because they were not aware of them.

Written guidelines outlining office contact lens policies provide staff with a simple and reliable resource to address patients' questions and complaints. While these problems may not be common, they are often addressed differently with each patient and can lead to confusion, frustration and an overall lack of confidence in the practice from the patient's viewpoint. Staff members tire of being unsure of how to handle each situation, and doctors become frustrated with the lack of understanding of standard fitting costs and procedures.

Why Patients Become Frustrated

Patients' discontent with charges resulting from any part of their contact lens experience often is not from the amount of the disputed charge but from the feeling that they have been treated unfairly. Any time a patient is asked to pay an additional fee that he is not expecting, a situation is created that instantaneously diminishes the level of trust between patients and the practice. Patients will disagree with charges amounting to just a few dollars if they feel they were not justified.

To avoid this, be sure each member of your staff can consistently explain the office fee structure so that patients will know about all potential charges before any fitting procedure takes place. It's not difficult to imagine the frustration a patient might feel when told to expect one fee by one staff member and then be charged something different by another. This gives the impression that the office is making up fees to take advantage of patients by tricking them or that the staff is disorganized, leaving patients wondering if they paid the correct amount. Having detailed policies improves patients' satisfaction, not only by limiting confusion and anger over unexpected fees, but also by improving consistency in how the staff responds, as well.

Clearly Outlined Fee Policies

Many business advisors argue that good customer service is the only policy necessary, following the “customer is always right” approach. Although you may occasionally need to waive a fee or extend a warranty to keep a patient happy, these accommodations will become less frequent when you have clear policies that patients and staff members can easily understand. While every office will handle these situations in their own way, it is important to have a consistent approach to each type of problem commonly encountered within a practice. This avoids having patients feel cheated or deceived. Even if you do decide to waive a policy to preserve your relationship with a patient, the patient will then be aware of the policy and will appreciate your effort to accommodate him.

Some doctors are reluctant to establish firm fees believing that patients will lose interest in trying new lenses or designs, but the opposite is often true. Modern consumers are accustomed to seeing merchandise with clear prices, and they know to look for fine print, watch for deceptive sales techniques and fight for what they believe is fair. Nothing is more reassuring to this type of customer than clearly defined expectations and fees. Something this simple may make them more comfortable trying something new, and having a structured outline of what they can expect from the practice builds trust.

Electronic Health Records Templates

If yours is a paperless or nearly paperless office, particularly one that has transitioned to electronic health records (EHRs), you will likely prefer to avoid printing hard copies of policies and should look into other methods of information access. One option is to create templates within the EHR software, which can be customized during a patient's visit and printed at any time. You can also save an electronic copy of your policy manual on a shared server so that it can be printed from any computer in your office.

Another option is to post your practice's policies on your website. Be aware, however, that lengthy, detailed policies take up valuable space online, and potential patients may perceive them as unwelcoming. If you use your site primarily as a marketing tool, you could post your policy statements as a downloadable Adobe PDF file on the same page where your office forms are located. This way, your patients can locate them readily, but potential new patients won't have a negative first impression of the practice. I recommend PDF files instead of Microsoft Word documents because PDFs are more difficult to alter prior to printing when opened from the website.

Contact Lens Policies

Soft lens fitting procedures and policies vary so widely among practices, it's easy to understand why patients are often surprised by fees or billing procedures. Patients who are new to contact lenses are the easiest to educate about proper lens care and follow-up, so don't take this opportunity for granted. Outline office policies for initial fitting and also for expectations and costs. A good way to do this is to create a folder of information that all new wearers take home. Many offices already provide information on lens application, removal, care and compliance, and a new-wearer folder could include this information plus details about policies and fees, and any other desired information. Practices can use this as a marketing tool, as well; include a coupon for savings on back-up eyeglasses, a brochure on specialty technologies and information on any referral rewards or special office events.

Problems arising from new wearers are rare if office policies are explained early and properly. The sample form, “Contact Lens Fees: What You Should Know,” found below shows a sample policy for new and established soft contact lens wearers. This example is somewhat generic, so that it could apply to any lens wearer; specific fees for each fitting level could be included or given separately on a “quote” sheet. Some details, including expiration date, may vary depending on state laws and your preferences.

Contact Lens Evaluation

One of the most common problems encountered with established lens wearers is their unwillingness to pay extra for a contact lens evaluation. Some offices bundle this fee with the examination fee, while others automatically bill it to applicable insurance without fully explaining the patient's insurance benefit options. It's important to discuss the added level of detail and time required to care for contact lenses from the doctor's and the patient's perspective.

Charging a separate fee indicates that more effort is required to maintain a good wearing experience and helps demonstrate the training level and education required to prescribe contact lenses. It may lead to some initial confusion, but if all practices charge a separate fee for contact lens evaluation, patients may be more appreciative of their care and feel less like they are unjustifiably charged extra at other offices.

Also, giving patients the option to use or not use their insurance benefits for fitting or evaluation fees helps avoid problems later. For example, if patients try to use benefits for eyeglasses during the same benefit cycle but have a policy that applies to contact lenses or eyeglasses, they may be upset that they were not warned about this. Likewise, if a patient expects to have a certain amount available to buy contact lenses but finds that amount has been decreased by the evaluation or fitting fee, he will be unhappy.

Refit Fees

Another issue we sometimes encounter with experienced wearers is their dislike of refitting fees. Many patients think that in order to try anything new, they just simply need to be handed free trials and sent home without any further examination or cost. Again, teaching patients to appreciate the expertise behind fitting is worth the time, and any significant change in lens type should be appropriately billed. A tiered approach is often the most fair. A mild power adjustment without a change in material may not require a refitting fee, while a refit to a multifocal from single vision deserves a significant refitting fee and, at minimum, one follow-up visit. Of course, required follow-up is at the discretion of the doctor; however, it is recommended that if the prescription is not finalized at the end of the visit, a follow-up visit or phone call is scheduled. Via phone or e-mail, a staff member can often finalize a prescription and offer to place an order, or if the patient is having problems, the staff member can schedule a follow-up. This type of follow-up, which should be noted in the patient's chart, provides opportunities not only for material sales but for additional education on compliance and the benefits of purchasing an annual supply of lenses.

Both evaluation fees and refitting fees may be uniform for all lenses or different based on the lens modality. A single fee is easiest but may not cover the chair time necessary to work with more difficult fittings. A simple way to differentiate fees is to call them basic (sphere or toric), intermediate (multifocal or hybrid) and advanced (keratoconic, scleral, etc.) Personally, I believe tiered fees are more important for fitting purposes than for an annual evaluation, and lens type is not as important as the patient who is being fit. For example, a happy, compliant multi-focal wearer who doesn't require any changes from year to year should not necessarily be charged a high evaluation fee. Similarly, a patient with mild keratoconus may succeed with a GP sphere but, obviously, is a more complicated case than the lens would indicate. Rather than sorting patients into categories based on lens types, it might be preferable for you to use your clinical judgment to decide how much time and what level of fitting a patient may require.

Annual Evaluation Fees

My office charges a uniform annual contact lens evaluation fee, however, if we recommend any significant change, we apply a tiered refitting fee as needed. This rarely deters a patient from trying new lenses or modalities, and it helps prevent patients from requesting frivolous changes against our recommendations. Conversely, some find it easier to charge a tiered annual fee and do not have refitting fees; this concept works by predicting the amount of time and labor that may be needed to address problems with a given modality over future years. This cost is simply averaged and spread out, assuming that years without refitting will make up for significant changes at other times. The downside to this is that a patient who requires no changes may be unhappy with a higher annual fee. The least effective alternative is charging separately for each follow-up visit. This is dangerous because patients who are having problems may not return to avoid more charges.

No discussion on educating patients about office policy would be complete without mentioning non-compliance and expired prescriptions. All practices have had patients try to order lenses using an expired prescription. I'm sure we know of patients who over-wear their lenses to avoid regular examinations or lens purchases, and patients who abuse diagnostic lenses or engage in other frustrating behaviors. While encouraging compliance is a never-ending effort, having a readily available, clearly written policy provides support for staff fielding difficult phone calls and prevents patients from claiming ignorance.

For nondisposable lenses a few additional points are often helpful. For example, a policy that covers lost or broken lenses helps patients understand who is responsible for replacement costs. During the fitting process, it's important to define the length of the fitting period covered under the initial fitting fee, the number of allowed remakes/redesigns if the lenses are under warranty and the importance of promptly returning trial lenses that will not be used. Refund or return policies are crucial, regardless of who discontinues the fitting process. Also, outline shipping and handling costs, along with any nonrefundable fitting fees. To ensure compliance, some offices have patients sign the policy, as well. An example of this is the “Custom Contact Lens Fitting Policy” found below. Even though there appear to be more “rules” for specialty lenses, I've found that patients and doctors tend to have more respect for these lenses and the associated fitting processes.

Conclusion

Clearly defined and comprehensive policies on all the financial aspects of contact lens fitting, dispensing and sales will provide consistent, professional answers to most patients' complaints and questions. Patients will appreciate knowing their responsibilities in advance and having answers to common questions available at home. CLS

Contact Lens Fees: What You Should Know
Contact lenses are medical devices that can cause serious consequences, such as infection, inflammation, permanent damage and loss of vision if not fit and taken care of properly. Examining a contact lens patient takes additional time and expertise. For that reason, there are separate, additional charges for contact lens examinations that patients without contact lenses do not pay.

Contact Lens Fitting
In addition to your regular eye examination, there is a fitting fee associated with trying new contact lenses. There are thousands of types of lenses, and the doctor will need to take special measurements and determine which lens type will work for you. Your initial design fee will cover ocular surface evaluation, diagnostic lenses, lab or shipping fees, fitting analysis and any follow-up visits necessary to obtain a satisfactory fit. If you have never worn contact lenses before, your fitting will include a class in which new wearers receive instruction on application and removal of the lenses and proper care and cleaning techniques. The fee may also depend on what type of lenses you wear; for example, bifocal contact lenses are more difficult to fit and take longer to adjust and fine-tune than standard contact lenses. The fit is finalized after you and the doctor agree the fit has been successful, or if either of you determines that contact lenses are not an acceptable option for your eyes. Your initial fitting fee includes up to ____days of follow-up; any additional visits required to finalize your fit are subject to a per-visit fee. Once finalized, any future lens changes in brand or type will be considered a refit and may be subject to new fees.

Contact Lens Supply
After you have been fit with an appropriate lens, you will have the option of buying a supply of lenses that will last up to 1 full year. You will have to replace your lenses as directed, which can range anywhere from daily, to every 2 weeks, monthly, quarterly or yearly, depending on the kind of lens worn. Buying a year's supply of contact lenses at one time is beneficial because discounts or rebates may be available, and because you will have the convenience of having new lenses on hand when you need to replace them, so that you are not tempted to wear old, dirty or damaged lenses.

Annual Contact Lens Evaluation
Once finalized, per ____ state regulations, your contact lens prescription will be valid for up to 1 year. This means you can purchase enough lenses to last for 12 months and no more. After 12 months, the prescription expires. If you want to continue to wear contact lenses, you must return for a comprehensive eye examination and contact lens evaluation. The doctor will verify that your eyes are responding well to contact lens wear, check the ocular surface for any damage and make sure the lenses are still fitting properly and are the correct prescription for your eyes. The cost for this evaluation is ____. This type of examination is necessary if you wish to continue wearing contact lenses. The doctor will not renew expired prescriptions without first making sure that your eyes are healthy enough to wear lenses. To avoid any inconvenience, make sure your annual examination is scheduled on time so that you do not run out of lenses before you are seen. If you wear contact lenses, this examination must be done annually, even if your insurance only allows for a 2-year examination interval.
If, for some reason, you require additional time or visits because there has been a change in the type of lenses you wear, there may be additional refitting fees. These cover any extra trials, examination time and follow-up appointments that may be necessary to finalize a refit into another type of contact lens.

Custom Contact Lens Fitting Policy
You have been dispensed a pair of custom-made contact lenses. These lenses were provided by an outside lab and come with a limited return policy. You are allowed ____ adjusted remakes (new lenses changed or improved based on the doctor's assessment of the previous lenses) within _____ days. All previous lenses must be returned before we can dispense each new remake.
If you break a lens during the fitting period, we will replace it free of charge if you have remakes remaining and if the broken pieces are returned. If no remakes remain or if the ____ day trial period has elapsed, you will be responsible for the cost of replacing broken lenses. Some materials have warranties that allow for breakage replacements but this is not guaranteed. In any case, you must return the broken pieces of the lens to get the warranty replacement. Lost lenses are not covered under warranty or remake, and you are responsible for the cost of replacing a lost lens. Available remakes will not replace lost lenses.
If, for any reason, you or the doctor decide to discontinue the lens-fitting process or choose not to wear the contact lenses, any lenses given must be returned within _____ days of the initial dispensing date. If you return the
lenses in the allotted time, the cost of the lenses minus any shipping charges incurred will be refunded. The contact lens fitting fee that encompasses any office visits and training classes during the fitting is nonrefundable.
By signing below you have agreed to the above policy. If you have any questions, please do not hesitate to contact us at any time.
Name: _________________________________ Date: ________________

Dr. Potter owns a private practice in Sylvania, Ohio. She enjoys fitting, writing and lecturing on specialty contact lenses. She can be reached at rpotter@personaleyecare.com.


Contact Lens Spectrum, Issue: November 2011