Tips for Discussing and Dispensing Specialty Lenses

Making specialty contact lenses a part of your practice can allow you to change many of your patients’ lives in a matter of seconds. For patients with irregular corneas or severe ocular surface disease, simply applying a specialty lens can instantly improve their quality of life.

There are challenges, however. Choosing among lens options and dealing with insurance coverage and fee structures can be confusing and frustrating for everyone involved. Here are a few tips to help make the process a little smoother for you and your patients.

MAKE TIME

One of the first lessons I learned when I started my specialty contact lens practice was the importance of a consultation visit. Initially, there was a hurry to get the fitting started and help the patient as quickly as possible. Diagnostic lenses would often be applied during the patient’s first visit. This overeager approach, however, resulted in run-overs on appointment times, rushed patient education, and unnecessary lens remakes and follow-ups. Once we instituted an initial consultation visit, many of these issues disappeared.

Our consultation visit includes taking an extended patient history, acquiring a composite corneal topography, conducting a thorough refraction, and performing an anterior segment health evaluation. Based on the information we collect, we then discuss lens options with the patient. The consultation visit ensures that there is ample time to develop a treatment plan and make sure everyone is on the same page before beginning the fitting process.

For most patients, we bill the initial consultation as a medical office visit (CPT code 99213 or 99202). More often than not, we are evaluating a medical condition (keratoconus, corneal graft, etc.) and determining the best lens option to address it. For those rare cases in which a patient doesn’t have a medical condition but still requires a specialty lens, we charge a consultation fee, which is later applied to the lens fitting fee if the patient decides to proceed after the consultation.

EDUCATE, DON’T SELL

During any transaction, the recipient is always more satisfied if he or she understands the value of the good or service. The job of eye care providers is not to sell the idea of specialty contact lenses, but to help our patients realize their value, and then to empower patients to choose which type of lens is right for them. In our consultation process, all lens options are presented, and recommendations are made based on each patient’s particular needs.

During all of our consultations, we discuss three lens options: soft lenses (often custom), corneal gas permeable lenses (including hybrid materials), and scleral lenses. The pros and cons of each design are addressed in relation to the patient’s unique situation.

For example, even if a patient is not a strong candidate for soft lenses, we always discuss the design and explain that, due to the patient’s amount of corneal irregularity, the vision quality with a soft material on his or her eye would likely be no better than that with spectacle lenses.

Providing an in-depth explanation of each option helps patients understand why a more complicated or expensive lens design may be necessary to help them meet their goals. Once all lens options have been discussed, both parties can come to an agreement on which lens is right for the patient. At the end of the consultation visit, the patient should understand the value of his or her choice, feel as though he or she contributed to the decision, and commit to the treatment process.

DISCUSS FEES NOW, AVOID CONFUSION LATER

There is no consensus on the merits of doctors discussing fees directly with patients. Some believe that it causes undue influence on treatment decisions and that quality of care can be compromised; others believe it’s unethical not to mention fees. Both are reasonable arguments.

In the case of specialty lenses, when insurance coverage of services and materials is far from guaranteed, discussing fees is essential. Fees shouldn’t necessarily be the first thing mentioned, but they should be communicated at some point so that the patient has an understanding of his or her responsibilities in terms of payment.

In our practice, all patients sign an agreement before starting the lens fitting process. It outlines the length of the fitting period (90 days), the terms of the fitting, and the cost, which is categorized by lens type. Each patient receives a paper copy of the agreement for his or her records.

Additionally, we write down the ICD 10, CPT, and V codes for each lens option discussed during the consultation so the patient can contact his or her insurance company before the fitting process in order to determine coverage. We also provide patients with a letter of medical necessity (if the lenses are truly medically necessary) so that they have another piece of documentation to help get their services covered. Patients are far more likely to accept out-of-pocket costs if they know that we did everything we could on our end to help them obtain insurance coverage.

GET FITTING

In the complicated world of specialty contact lens fitting, the key is to discuss all the specifics and show the patient the value of the service at the beginning of the process. Once clear expectations are set, your only job is to fit the lenses. The more pain-free and easy you make lens fitting for your patients, the happier they will be, and the more likely to refer others to your practice.