Hot Topic! How Much Do You Charge For ‘Refraction Only’?

I got some great feedback on my blog of 7/22 (click here to read).   

If you thought there was a clear cut answer to Dr. Nobin’s question, “How much should I charge for a refraction only?” you are in for a surprise.  

Here are some typical responses.  

Jerry,  

Give the patient WHAT THEY WANT. To CYA, mark it on their record that that's all the patient wanted. You should charge appropriately, like between $35 and $50. 

Ken B.  

We won't do a refraction only in my office. There is so much more to achieving the end result.The act of the "refraction" is only a part of getting the Rx. The interaction with the patient, history, VA's etc. All of those and more are needed to get the correct Rx. Those elements are all a part of the office visit needed to get to the end result that the patient wants, to be able to see. 

Richard A. Driscoll, OD

We immediately educate refraction only and IOP glaucoma check only patients, upon their requests for such limited services.   

If  under the care of a specialist, I explain our photo, field documentation and report that I will share electronically with their specialist, even if they just left his office.  

I require history, reviews, etc... so we document everything and render them appropriate services that "even my specialist didn't do"...hmmmmm.   

If the patient is a return from a shared consultation or specific service referral, we will do the refraction, but perform the necessary foundation building for the appropriate visit.

Refraction is usually a non-covered medical service so it is out of pocket. That their medical insurance will help with the office visit is viewed by the patient as a benefit and medical service reinforcement to our office.

Doc Bison  

I read your “refraction only article” after lunch today. It just so happens that I got a haircut at lunch that took 15 minutes and paid $20 for it (which is normal for our small town for a man’s cut).   

So, you see where I am going with this response. I get a haircut about every 2 to 3 weeks, and I think the value of determining the correct prescription for a pair of glasses that might last a patient several years, is certainly worth more than $25 dollars. The clippers she used surely don’t costs close to a phoropter…etc, etc.  I could go on, but I think you see my point.

And I might add that I am very guilty at times of undervaluing my services, and this article reminded me as well of this fault of mine.

Mark Bowen, OD

There is a code for that! 

Refraction has its own cpt code and therefore is a separate billable service. I don't think it is wise to hand out refractions and neglect eye health but I don't see any liability for performing the service a la carte.  

I am skeptical on how much liability we should assign ourselves for a patient's healthcare choices. I assume that we are not liable when a patient does not return for a recall or if they disobey sound advice to lower blood sugar. 

Dr. Hayes, 

I would, in specific instances, agree to see refraction-only patients.  A typical scenario would be immediately after the patient has seen a tertiary care provider, for example, a retinal specialist, and wants to update their eyewear.   

By 'immediately' I mean a couple weeks. If a couple months or more have passed, there is probably a need to do somewhat of an internal examination, depending on the condition and the frequency of care with the other provider. So I would do this on a case-by-case basis.   

Keep in mind that most patients have some sort of vision plan and wouldn't pay much out of pocket anyway. However....the vision plan usually mandates some degree of health evaluation. If the patient refused, they would have to pay. Plain and simple-part of our contract with the vision plan.   

I think an appropriate fee would be in the $50 range. The $25 quoted by the other doctor seems low, especially for a procedure that requires that degree of time involvement and thought, not to mention the office time and overhead consumed.

If religious beliefs are involved and the patient refused any type of health evaluation, I would refrain from seeing the patient and ask them to seek care elsewhere. They are entitled to their religious beliefs, but I am equally entitled to perform at or above the standard of care to the point I am comfortable with the service I am providing.

Related topic - how about eye health exams with refusal of dilation? I am OK with this to a point, but if they refuse a second or third consecutive time, I am leaning toward dismissing them as a patient. However, this only pertains to patients with no known or documented health conditions.....diabetics, etc., must be dilated and cannot refuse, at least in my office.

Lee Newton, OD

Readers of drhayesblog.com are invited to give feedback by email or Click the red 'Click To Discuss' link below to share your thoughts. How would you handle this situation in your practice? 

Regards,  

Jerry Hayes, OD 

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Disclaimer: The information and opinions contained on this site are for discussion purposes only and are NOT intended to serve as legal, accounting or investment advice. ©2010 Jerry Hayes, OD. Not to be reproduced without written permission of the author.