Hi Jerry,
I wanted to ask your opinion on the practice of allowing patients to come in for a ‘refraction only’ without an eye health exam.
Last week I had a patient who refused any part of an eye exam due to her religious beliefs. Our normal full exam fee is $100, but, we only charged her a refraction fee of $25.
I did have her sign a waiver we made up stating that the eye health exam was not performed at her request.
We also get an occasional request for refraction with patients who are seeing a retinal specialist for their eye health exams on a regular basis.
We still have patients who sometimes complain about paying $25, so I hesitate to raise it a whole lot more all at once. My colleague charges $108 for his exam and $50 for the refraction.
After my recent experience, I am considering not seeing patients for ‘refraction only’ without an exam.
It hardly seems worth my time to see a patient for a refraction only visit given our current fee structure. What is your opinion on refraction fees?
Thanks!
Ranell Nobin, OD (name changed)
Dear Dr. Nobin,
There are really two questions here. What should an OD charge for ‘refraction only’?
And, are you putting yourself at risk to provide less than standard of care, even at the patient’s request?
I don’t give legal advice on my blog, but I think the bigger issue is less what to charge and more how to protect yourself from a liability standpoint.
I want to hear from our readers:
A) Do you accept ‘refraction only’ patients at a reduced fee and have them sign a waiver that an eye health exam was not performed at the patients request?
B) If so, how much do you charge for ‘refraction only’ services?
C) Or, do you make it your policy that everyone has to get an eye health exam and refuse to see ‘refraction only’ patients?
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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Refraction only
What does VSP allow for a refraction charge when the visit is for a medical reason? I do not know.
That should likely be the minimum fee for everyone IMO. Currently we charge $25 and that is too low, but we are not sure where to move to.
We have not been billing refractions to VSP when there is a medical dx ie diabetes, but we are going to start because VSP will cover the refraction. We do not want to bill below the VSP allowable so we are consistent with all patients.
Charging for Refraction
Refraction is data gathering that any well trained tech can do.
Prescribing is making a well thought out treatment plan to help the patient maintain healthy eyes with clear comfortable vision.
We are "doctors". Charge appropriately. If you are a professional, then every service performed should have a professional fee. Don't worry about what your neighbor charges, charge what you are worth.
Everyone knows (including patients) that you get what you pay for.
there is a code for it
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.
We are liable to educate, instruct, encourage but the patient still has a choice and if they want 'just' a refraction I don't see a problem with that.
I know it would be better to have the patient in for an exam, especially if they are due for an annual exam but we shouldn't have to assign a liability risk for performing a refraction only.
Refraction only
The Trial Lawyers association would be delighted if we all started having patients sign waivers, "Not responsible for eye disease detection." Isn't this a lot like the signs at garage sales, "Not responsible for accidents"? Give me a break!
If I were the attorney for the plaintiff, I would start out with something like this:
"Dr. Johnson, when you demanded that my client sign that waiver, do you think she understood that she could suffer irreparable damage to her eye from a large number of eye diseases that could have been treated, and that she did not know she had?" Dr., how could you think that????
I think you'd better settle out of court on one of these. I wouldn't want to be your insurance company.
Yes we do accept current
Yes we do accept current patients who have had a comprehensive examination within two years for a refraction only. We do not have the patient sign any waivers. I too would want to do a level 2 or 3 established examination on a patient being seen by a retinal specialist. It is possible that medications or general health conditions may cause blurriness and need to be ruled out as the cause.
Another question becomes what is standard of care for the time between routine examinations. Is it 2 years as dictated by many insurance companies one year or something else. This comes into play should a patient that you have seen 13 months earlier comes in for the refraction and has an asymptomatic tear that develops into a detachment prior to their next full examination. What is your medical legal responsibility for the macula off detachment?
I agree with most of the
I agree with most of the other doctor's responses on refraction only fees. It should be circumstantial and used discreetly in rare occasions. More often than not, it's our time and expertise that came with what patient perceived as "refraction only" worthiness. Besides, if one starts to allow patients to pick and choose what services are deemed necessary, soon enough, the patients will run the show and they become the doctors, in which we simply handed over our rights to them. Just imagine, a patient goes to his or her family physician and tell the doctor, I don't want my blood pressure measured because I am healthy and all I have is nagging headaches. So, give me a pain medicine that is strong enough and I will leave you be. By the way, don't charge me for the blood pressure measurement. That sounds ridiculous enough. Doesn't it?
Refraction only
My fee for 92015 (refraction) is now $28 but it is billed with medical codes so the patient knows they will have to pay the noncovered refraction. I haven't done a "refraction only" in years unless due to an Rx non-adapt from a recent patient visit. I have done a few "free" refraction-only checks on patients who have brought in an outside prescription that we made into expensive glasses ($500-1000).
Rather than sending non-adapters back to the original eyedoc or MD's technician wasting the patient's time and risking our remake warranties, I will re-evauate the Rx as a courtesy to save them a trip elsewhere and back. This goodwill gesture protects me from the blame game and fixes the problem quicker.
I don't feel this creates any risk to me and benefits the patient.
Refraction Only
Our current refraction charge is $25 dollars. However, if a patient needs to have their prescription evaluated then we have established a practice of charging a $59 evaluation and refraction fee (our Rx Check).
Remember that the refraction procedure only is what our minimal charge ($25) covers and is never done in isolation.
As eyecare practioners we do more than just refract for such an appointment (machines can do that). We ask the patient what change they are experiencing, when it started, under what circumstances is it better or worse? (just to name a few). At times, if warranted, we may even pull out the slit-lamp for closer evaluation.
We then communicate changes and educate the patient or parent about the change and finally we recommend professional ophthalmic materials to aid in the correction of the change. All of this is worth more to patients than $25.
We should never apologize for our fees or feel guilted into cutting them. Optometry is already the best value in all of healthcare. WE have to do a better job of communicating that.
refraction only
If a person is established in my practice and needs a quick update, I charge $28 for a refraction. An example of this would be for a myopic child who had an exam 6 months ago and mom thinks the Rx has changed. Do they need dilated again after 6 months? I don't think so. If pathology has been involved with the change, eg someone who has had retinal injections and then wants to see if we can improve their vision, I wouldn't do just a refraction. If they are still under continued care of the specialist, I would still want to do at least a quick assessment of their disease status — maybe a level 2-3 established. Then I would do the refraction in addition.