"It’s Third Party, 
You Can Cry If You Want To..."

Working as a mobile Optician in dispensary consulting, the topic of “third party insurance” is inevitable.

While observing OD and MD practices in motion, I hear the daily woes of ECPs and how time-consuming insurance can be, in comparison to its allotted reimbursement. It is extremely important for ECPs to frequently monitor quality-of-care and insurance verbiage. Misery loves company and if you aren’t careful, your practice could end up singing the insurance blues. 

A one and a two and…“It’s third party, you can cry if you want to...” However, before you cry, you should determine your practice’s "Insurance Tolerance Level.” Do you have empty chair time for insurance patients to fill? Does the plan require sending orders to a contracted lab? If so, is the lab reputable? How many patients do you estimate losing by not taking the plan? If the plan requires using certain frames, do the frames measure up to your standards? How quickly are services paid from the date of claim submission? 

A word of advice to insurance participating practices: Hire staff that have exceptional attention to detail and inquisitive personalities. With the rapid changes in insurance, practices need to keep updated and well organized provider materials on hand. A common mistake is a practice that is “handicapped” due to insurance staff being out on sick leave, vacation, or simply, out to lunch. Cross training or job trading may be the answer (stay tuned for a future article). 

In the perfect optical world, every patient would know his or her pertinent insurance information. It is not always easy to convey to the patient that the direct insurance relationship is between them and the insurance company. In reality, ECPs verifying and explaining the different insurance plans to patients can sometimes lead to the unfortunate: patient disservice. Fixating on the patient’s insurance can be so distracting that ECPs lose sight (no pun intended) of the health-related aspects of vision care.

There is a popular theory that states it takes 21 days to break a habit. If you catch yourself using these types of phrases, try the 21-day theory and STOP using them:

• You aren’t “eligible” at this time for new lenses. (eligible is defined as "worthy" in Webster's dictionary)

• You don’t qualify for a frame until next year. 

• Your plan only pays for an eye exam every two years, so call us back when you are ready.

• Do you want to use your own frame since your insurance won’t pay for a new one?

• Progressive lenses are not covered with this plan, do you want them anyway?
  If you want the lenses that change, you know you have to pay more.

• You have to pick from this selection of frames.

• Do you want to order what your plan covers?

• Your plan only covers contact lenses or eyeglasses. You have to choose one or the other.

Who are we to dictate or predict what a patient with vision insurance can or cannot do? We are ECPs, not insurance psychics. Patients will find a way to pay for something that offers them a better quality of life. They will also find a way to pay for what they really want. It’s all about the patient’s perception of value. Our words can help or hinder our patients and make or break our practice.


ECP Practice Tips 
New patient with XYZ insurance calls your practice for an appointment.

• ECP collects information and schedules appointment.

• Patient reminded to bring photo ID, insurance cards, current eyeglasses, sunglasses on appointment day.

• Upon their arrival, SMILE and welcome them to the practice.

• Make sure you do not verbally exchange any confidential, insurance information across the front desk into the reception area.

• If this happens, otherwise settled patients, start to get anxious about their visit and show symptoms of insurance paranoia. Without invitation, they jump on board the conversation. Suddenly you are answering their same questions again while wishing you could hide under your desk.

Loose lips will SINK ships! So will HIPAA!

I see you nodding your head up and down, you know exactly what I mean. Keep reading.

• Technician records patient's visual health history, chief complaint, current medications, allergies, visual requirements.

• The punctual doctor provides a thorough eye health examination and prescribes optimal visual solution. 

• She/he stays out of the insurance loop all together. 

Now it is time for the “hand off”, “baton pass” or maybe an “ECP intervention.”

• Doctor escorts patient to the dispensary and transfers authority to ECP.

• ECP asks patient about current eyewear likes, frustrations of daily vision obstacles, what hobbies they have …etc.

• If patient states they only want what is “in plan”, let them own that option.

• Cordially advise them on what you recommend based on what the doctor has prescribed.

• It is your obligation as an ECP to offer optimal vision health solutions.

Avoid technical overkill and insurance babbling.

• Patients don’t want to hear a confusing spiel on: lens index of refraction, ABBE values, seg heights, cutout charts, which progressive lens category they need (N,F,J,K,L,M), …etc.

• Patients want to hear see good, look good, feel good spiels: superior vision, gorgeous frames, closest lens design to natural sight, lenses that are preferred for driving at night...etc.

•  The more composed and attentive you are, the more receptive they are.

Now it’s time to let them decide.

• Let them process the conversation. Shhhhh. 

• If the decision is a YES: Make sure to take all of the proper measurements.

• If the decision is a NO: Remain composed. Don’t back pedal. Respect NO to avoid buyer’s remorse.

• Our reaction to NO will be remembered by the patient. 

• Don’t be surprised if they return saying YES after they sleep on it.

Patients should always leave the dispensary pleased and confident about their purchase decision.

• Show a side-by-side itemized comparison of U&C charges without insurance and adjusted pricing with insurance. 

• Price comparison aids in eliminating visual sticker shock.

• Never apologize to the patient regarding your prices or fees.

• Some practices attach branded product brochures to the patient’s receipt.

• Pre-appoint patients for next year, regardless of insurance.

• Lastly, find out if they have any final questions, if not; thank them for the opportunity to serve them.

That was easy.

Now the beginning of the middleman end of the rest of your insurance transaction cycle is ready to take place. 

Say what? 

• As ECPs we should discipline ourselves to process each patient’s insurance promptly and in respective order. If time does not permit, begin the following business day where you left off. 

• Many times ECPs are guilty of picking and choosing the easier plans to work with and processing those first. 

• So what happens next? We end up trying to rush the lab order, disappointing the patient by extending the order turnaround time, delaying the EOB, creating bogus excuses for the delay…etc.

• We wonder why everyone is acting so uptight? Face it, no one wants to work with a “third party pooper.” 

So, remember to treat patients and co-workers the way you want to be treated, change those bad third party habits, and think before you speak.

Until next time, “Party On”!

Ginny Johnson
LDO, ABOC