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    Patient needs should supersede insurance demands

    Essential patient care too often dictated by what insurance covers

    Almost every eyecare practice has a person, team of people, or outside service whose sole job is to manage problems related to facilitating the relationship between patients and their insurance companies.

    It is unusual to find an eyecare practice that is not dominated by third-party payers. Many articles are written on recording documentation for maximum payments. ODs have attended multiple lectures on proper billing and coding worrying about the dreaded audits.

    ODs should remain educated on the limitations and requirements of the insurance companies, but it is also important to remember the insurance companies don’t control the care of our patients.

    Previously from Dr. Rothschild: The false security of a full schedule

    ODs may often feel like the relationship is between themselves and the insurance companies. We deal with insurance companies every day; most of our patients do not. We understand deductibles; copays; coverages; usual, customary, and reasonable fees (UCR); healthcare financing administration forms (HCFA); write-offs; additional case reserves (ACR); and all the other items related to filing insurance.

    Our patients have learned that they aren’t going to get answers from their insurance companies—so they ask us.

    Combine that with the fact that we still have to do eye exams, fit eyewear, manage referrals with other healthcare providers, coordinate with labs and distributors of our product, market the practice, and keep schedules full.

    It’s easy to see where ODs may take shortcuts sometimes.

    Related: How to prevent no-shows in your practice

    It’s not covered

    For too long, we have avoided conversations with our patients about services that we know aren’t covered by their insurance. Conversations such as:

    • “Glasses covered every two years? We will talk about it next year.”

    • “Two tests not covered on same day? Pick one.”

    • “Non-covered service? Let the patient go without.”

    When we do venture into the non-covered service conversation, we tend to hesitate or sidestep, blaming the insurance company.

    “Sometimes I like to order this test, but because it’s not covered by your insurance, I don’t know what we should do.”

    Believe it or not, many of us wait for the patient to say, “How much is it?”

    Michael Rothschild, OD
    Dr. Rothschild is the CEO of Leadership OD and is an advisory consultant for Revolution EHR.

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