Optometric Billing-Why Don't Patients Pay Their Damn Invoices?!

One of the most disconcerting things that I encounter as an optometric billing professional on a daily basis is patients that don't pay their invoices. I assume that it is more frustrating for the doctors whose offices do not rely on someone like me to take care of these mundane tasks.

I get calls from patients all day long, every day. The majority of these patients never even pick up the phone to question their bill until they receive one of our "pastel colored" second or third notices. This suddenly wakes them up and says "oh, a bill. Maybe I should call". Now, here in my office we are equipped to deal with this day in and day out. Receiving one of these harrowing phone calls from an irate patient does not interfere with the daily flow of business at the practices we serve. However, can you imagine what it must be like for some of these secretaries who are charged with the responsibilities of not only making sure the office runs smoothly but then have to process insurance, bill patients, speak to these same patients that call me to complain about that bill, call insurance companies, verify benefits etc?!?!?! These poor men and women have to want to shoot themselves at least once per day, every day. I know I do.

This brings me to the conundrum that we all face in this industry, "why don't patients pay their damn invoices"? The majority of invoices that go out are for deductibles, co-insurances, and charges in excess of their maximum yearly benefit. These patients receive a letter from the insurance company explaining these charges called and "E.O.B or Explanation of Benefits". So why does it surprise these people when a bill for those same charges comes in the mail to their home?

The problem begins the moment a patient walks through that office door. In almost every instance I deal with, a patient tells me that "the young lady at the front desk told me insurance would cover it". BIG MISTAKE.

• IT DOES NOT MATTER HOW MANY TIMES YOU CALL AND SPEAK TO AN INSURANCE COMPANY, IT IS NOT THE DR'S STAFF, NOT ONE OF THEM, THAT HAVE THE RESPONSIBILITY OF TELLING A PATIENT WHAT IS AND WHAT IS NOT COVERED! LEAVE THAT TO THE INSURANCE COMPANY TO TELL THE PATIENT AFTER THE CLAIM IS ADJUDICATED!

The next problem, also at the Dr's office; Patients are not receiving "ABN's or Advance Beneficiary Notices". This easy to draft piece of paper is your written word to a patient absolving you from responsibility for any charge a patient's insurance does not cover, REGARDLESS OF WHETHER OR NOT THAT PHONE CALL YOUR SECRETARY PLACED TO THE INSURANCE COMPANY STATED THE PATIENT WOULD OWE NOTHING AT THE END OF THE EXAM!

• DRAFT AN ABN AND GIVE IT TO THE PATIENT, EVERY PATIENT, EVEN RETURNING PATIENTS, THE MOMENT THEY LEAVE THE EXAM ROOM. WHEN YOU SEE THE DOCTOR'S FINDING AFTER THE EXAMINATION, YOU WILL THEN BE ABLE TO GIVE THE PATIENT A CLEARER PICTURE OF WHAT MAY OR MAY NOT BE COVERED BY INSURANCE.

Another reason patients don't pay their invoices: THEY NEVER PLANNED ON RETURNING TO YOUR PRACTICE ANYWAY! Yes, believe it or not, especially in the eye field, if you practice out of a large box store like Walmart or Sam's Club a good chunk of your patients do not view you as their every day eye doctor. They are lured into the store by the promise of a cheap eye exam hoping never to return. Even worse, the staff that helps them is not your staff and so wrong information is being slung all over the place at every turn and there IS NOTHING YOU CAN DO ABOUT IT!

• YOU WANNA GET PAID? TAKE IT UPON YOURSELF AS A DOCTOR TO INFORM THE PATIENT THAT YOU MAY FIND THINGS DURING THE COURSE OF THE EXAMINATION THAT MAY RENDER THEM A BILL AFTER THE INSURANCES PROCESSES THE EXAM. GIVE THE PATIENT AN OPPORTUNITY TO MAKE AN INFORMED DECISION!

This brings me to what I believe is the crux of the whole situation; PATIENT'S ARE NOT ABLE TO MAKE INFORMED DECISIONS!

• When you are performing an eye exam, GET TO KNOW YOUR PATIENT! TALK TO HIM OR HER. LET THEM KNOW WHAT YOU ARE DOING EVERY STEP OF THE WAY. YOU DON'T THINK THIS WILL HELP? TRY IT FOR A MONTH AND TELL ME IF YOUR PATIENT'S DON'T TRUST AND RESPECT YOU MORE. I SURE AS HELL KNOW I WOULD IF MY DOCTOR WOULD TALK TO ME THE WAY I AM COUNSELING YOU TO SPEAK TO YOUR PATIENTS!

When you communicate EVERYTHING to your patients you will be viewed as more reputable and more professional. You become more than just that "walmart" or "len's crafters" guy. You will be that patient's EYE DOCTOR. You will be the person that the patient comes to rely on for his or her eye health and you will be able to provide that patient with valuable health tips that could even save their life one day. It won't matter where your practice is located and subsequently that patient will be more than happy to pay any balance they owe.

On the flip side of all this some patients think insurance is the cover-all and will take care of anything. They throw all insurance correspondence in the trash thinking it is just informative and never even bother to look at that bill we send them. These patients almost never pay our damn invoices; of course, they don't pay anyone else either :)

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