Managed Care

How to Convert Vision-Plan Patients Into Self-Pay Patients

By Stacey Nutting, LDO,
and Richard Krzyzak, OD

Jan. 23, 2019

The insurance claims submission process can be cumbersome, and when done incorrectly, can slow reimbursements to your office. One solution is to use a tool that allows you to convert all patients, regardless of insurance plan, into patients who pay in full upfront, and then get reimbursed by their insurance plan.

In 2017, while managing an optical for an ophthalmology practice, we began using Patch, a cloud-based web application that provides a streamlined experience for managing vision insurance benefits for all kinds of eyecare providers, including optometrists, opticians and ophthalmologists. Patch makes it possible to easily submit claims for all patients, regardless of whether your office accepts the patient’s insurance, or whether your practice accepts any insurance at all.

Create “One-Stop-Shop”
The ophthalmology group accepted no managed-care vision plans. I saw Patch as a way to retain patients, and it did. We were able to offer our patients a “one-stop-shop” after their exam, without the need to go to another office for their eyewear. Patch allowed us to easily submit a claim on the patient’s behalf after they paid in full for their eyewear.

Since November of 2018, I have been co-managing the optical at an optometric practice. We immediately added Patch. Our office was recently able to drop a major vision insurance. Now that we are no longer a provider for that plan, we still can offer patients with that plan the option of purchasing with us. We still participate with one vision plan, but are able to use Patch to retain patients that have the other plans in our area.

No Need to Wait to Be Reimbursed
Patch allows us to easily collect full payment for all services and products from patients, and then submit a claim on their behalf, regardless of whether our office is on the patient’s insurance panel. The one caveat is that Patch can only be used for the agreed contract (with the insurance company) reimbursement amount. Patch can only be used for full fees when the patient is seeking out-of-network care, or with private pay.

The patient is not restricted on frame or lens selection, and we are able to extend a self-pay discount to patients who are going out of network. Patients receive their vision-plan reimbursement directly after we have submitted their claim through Patch.

Submitting a claim for patients after their eyewear or contact lens purchases is simple with Patch, and honestly takes just a few minutes. There is no processing as the reimbursement goes directly to the patient, and they have already paid us for their purchases. So, no deciphering insurance checks and charge-backs!

Boost Capture Rate & Profitability
The yearly cost for Patch is about $1,900, which comes to less than $160 a month. If you retained one patient per month you would more than pay for the service.

At the ophthalmology practice were I previously worked, we were able to submit over $60,000 in claims via the Patch platform in less that a year and a half. That works out to approximately $3,300 in revenue per month in self-pay patients who may not have purchased from that office.

User Friendly With Minimal Training Required
Patch is a simple platform to use. We have been able to train staff in one sitting. We did a group webinar, the instructor from Patch walked us through all the features of the platform, and how to submit a claim. The training lasted about a half hour, and even our optometrist followed along. It is something that can be mastered in one day.

After logging into Patch’s web site, the user just fills in the blanks about the insurance claim that is being submitted on behalf of the patient. The form the site provides makes it easy to input the patient’s information, including insurance member number, name and date of birth.

It is essential to have the correct information, such as insurance member ID, for the patient you are trying to look up. Occasionally we will have someone we can’t verify (usually due to the vision plan having incorrect information). If we get stuck, Patch has an easy-to-use customer service chat feature. We let them know the insurance member we are trying to verify benefits for, and the Patch staff will verify the out-of-network benefits for us. Sometimes that can take a few moments, so it’s a best practice to get the vision plan info when the patient is checking in.

I love how we are able to go over with each patient what their out-of-network reimbursement will be, and how Patch shows what they are eligible for in frames, lenses and contact lenses. We are able to show the patient exactly what they are going to be reimbursed, so they can then factor that information into their purchasing decisions.

Most of our staff has been trained to use Patch. All of our opticians and reception staff have access to the platform. We allow the receptionists to verify benefits if the patients present with a vision plan at check-in, and opticians often verify benefits for patients who walk in for eyewear.

Get Paid in Full Upfront While Facilitating Patient Reimbursement
In a perfect optical world we would be able to provide the best products and services to our patients without restriction from a vision plan. Patch can be a solution for cutting ties with vision plans for some offices.

Patch can help offices retain long-term, loyal patients who can’t control the vision plan their employer chooses. I see Patch as way to provide another layer of service that gives value and differentiation in the optical market.

>>Where to Find It: Click HERE for more information>>

 

Stacey Nutting, LDO, co-manages the optical shop at Krzyzak Eyecare & Eyewear Unlimited. To contact her: krzyzakeyewear@gmail.com

 

 

 

Richard Krzyzak, OD, is the owner of Krzyzak Eyecare & Eyewear Unlimited in Liverpool, NY.

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