Managed Care

The Out-of-Network Medical Solution Increasing Annual Profit 100K

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By Chris Butcher, OD

Oct. 2, 2019

Patients visit optometrists for glasses and contacts, and importantly, to maintain the health of their eyes. Until now, we have had no way to process insurance for patients with out-of-network medical benefits. That has just changed.

Patch, a technology service we have used for two years to process out-of-network vision benefits, is now making it possible to do the same for out-of-network medical insurance.

Patch is 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.

Expanding Access to Care–and Profitability
Medical plans often deny access to optometric practices, so we often end up being out-of-network with many prospective patients’ medicals plans. We won’t even consider taking a patient with an out-of-network plan because it would be too difficult for us to file for reimbursement.

For those reasons, Patch’s new out-of-network medical insurance feature gives us access to many plans we cannot take, or have not been able to add to our list of accepted plans.

I believe we could generate an additional $100,000 in profit per office through better utilization of our out-of-network medical plans.

The ability to enhance access to care while increasing ease of reimbursement will be seen on an everyday basis after we implement the new Patch technology. Here are two examples:

A patient comes in with a red eye. We will be able to properly bill their medical insurance, even if they are out-of-network. Being able to help patients get reimbursed will reduce out-of-pocket fees for the patient and increase the reimbursement for the doctor. Win-Win.

A patient comes in for a regular exam using a vision plan, but has a medically based problem. We will be able to use Patch to bill the out-of-network medical insurance and then bill the vision plan. This minimizes the cost to the patient and allows the doctor to deliver the care needed at the appropriate reimbursement level.

The Boost Patch Gives Us
Initially, we tried to look up patients in the gateway EDI to get basic information about the patient’s plan and deductibles, but most of the time we would end up calling the insurance provider to get the needed information.

This is time consuming, and it’s difficult to get all the information needed. There are usually long wait times to speak to insurance reps, and you have to ask the right questions to get the information needed from them.

Being out of network adds additional complexity due to lack of cooperation from insurance companies and difficult filing processes. This often left us pushing this burden of filing claims to the patients, which meant fewer patients coming to our office.

Our process with out-of-network medical for Patch is a pleasure. We enter the patient information into Patch, and get a response back in less than one minute with all the needed details in an easy-to-understand format. This gives us the ability to file a claim with a few clicks.

Patch makes taking and filing out-of-network medical claims easier than in-network medical claims. Now we don’t have to turn patients away because we are out-of-network with their medical plan.

Little Needed Investment, Big Returns
We are out-of-network for some important vision plans, and Patch has made finding and filing for the benefits 100 times easier, faster and more efficient.

We have easily generated 20 times on the investment with Patch in each of our locations.

Now, with the ability to use this technology to process out-of-network medical benefits, we expect the return on our investment to be even greater.

Improve the Office Experience for Both Staff & Patients
Patch is easy to use, so we can train new staff members within hours. Most importantly, our staff saves significant time by not having to be on the phone with an insurance company. This advantage alone has paid for Patch in staff hours/utilization. Staff is freed up to book appointments or confirm appointments, which generates more income.

While Patch makes it tremendously easier to look up benefits and file claims, most patients feel that using insurance should be easy, and expect us to be able to lookup and file easily. So, most people don’t comment on the ease of using their insurance in our office, but on the high-quality experience with our staff and doctors.

In other words, Patch allows patients to forget about their insurance and focus more on the personal relationships with the people serving them in our offices.

 

>>Click HERE to learn more about Patch>>

 

Chris Butcher, OD, is the co-owner, along with his father Jeff Butcher, OD, of Capstone Eye Care, with several locations in the Tampa, Fla., area. To contact him: cbutcher@capstone.vision

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