I Just Want What’s Covered – How to Turn Patient Objections into Successful Outcomes

by | Nov 28, 2022 | Administration, Managed Care

“I just want what my insurance covers.” Is there any other phrase in our optometric and optical practices that slam the brakes on the patient/staff (or patient/doctor) relationship quite like that? I know in my practice we could be clipping along, having a great day, firing on all cylinders, when in the optical we hear that dreaded phrase, and the day seems to fall apart after that. I will admit that it grates on my ears too, but what is the patient actually asking?  Do they have a basis for what they are saying (demanding?), or is it simply all they know to ask? What are some ways we can answer this without being pushy and confrontational and listening to what the patient actually wants and needs? With a little forethought and planning you can turn patient objections into successful outcomes.

Start Early

When a patient would call to make an appointment at my previous practice, our front desk staff was well trained in making sure they knew all the co-pays and additional costs for testing upfront before they arrived.  Our office performed wide-angle, digital retinal photography and OCT screenings, and patients who were not expecting these additional charges could be surprised and angry. We let all patients know when first making an appointment what testing we did that was not covered by their insurance, and what that would cost them (including a range for contact lens examinations). This was all documented in the patient appointment record so anyone speaking to the patient after would be aware. We would remind patients when they checked in about additional fees, and rarely had a difficult encounter about unexpected costs. Our staff would verify all insurance plans (vision care plans and medical) along with deductible information before the patient arrived at the office. Did this take more time, manpower and effort?  Absolutely. But it significantly cut down on unhappy patients at the front desk and lowered our accounts receivable since patients knew what their expectations were.

What is the Real Patient Objection?

Vision care plans and medical insurance is confusing. I mean, really confusing! I recently had an issue with my insurance company after I got a bill for an MRI that I had. I had a letter in my hand from them saying “your MRI will be covered,” yet my bill for over $1000 said something different. After speaking to 3 people from my insurance company, they said, “well, in the small print in your plan notes, you will see it is only covered after you have met your deductible, which you haven’t.” After getting annoyed at the insurance company, I realized it was my own fault- I didn’t properly understand my coverage. If we can’t begin to understand our own medical insurance, and it’s the language we speak, how can we expect our patients to have the slightest idea?

How many times do we have patients come in saying they are here for their “free” exam, when it is spelled out plain as day that they have a co-pay for the exam, or have to meet their deductible first? Or they are here for “free” glasses, when VSP says something different? Or their “last doctor never charged them for a contact lens examination?” 

Before getting frustrated and annoyed, I encouraged my staff to take a deep breath, put a smile on their face, and have a different conversation with the patient. “Mrs. Smith, I’d be happy to go over your coverage with you- insurance companies don’t make it easy to get to the bottom of your coverage. I have a hard time understanding my own, and it’s my job! Let’s go through it together, and I’ll help you understand what is due at the time we see you, and what gets billed to them.” Working together as a team shows the patient you are in it together.

When signing up for insurance benefits, patients rarely read the fine details. They just make an assumption that their company is giving them the best plan and care, and that everything will be covered. When they come to our office, they feel that they are entitled to the best- because that is what their HR department promised. Very few, if any, understand the co-insurances, deductibles and percentages that we deal with on a daily basis.

Don’t Take It Personally

I also urge my staff not to take it personally when someone just wants what is covered. Most of the time, they are not saying this to make our day more difficult (while it may seem that way!). They are using behavior that they think is appropriate. This is our chance to wow them with our services and products – which may cost a little more! We need to be strategic if we’re going to succeed and turn patient objections into successful outcomes

Quality Counts

It was very rare a patient left our office getting just “what was covered.” Did most leave spending more on their exam, contact lenses and glasses? Absolutely. Did I believe the care and products were worth it? One hundred percent. I would be open with my patients and tell them insurance companies are in business to make profits, and this is done by providing less care and paying providers less. Insurance companies are not their friends, and not out to cover the very best. However, in my office, patients do get the very best, and this costs extra, beyond what their coverage typically was. We had very few patients balk at this because we provided value and quality in everything we did.  Education goes a long way in this. Have your staff be well versed in talking about the benefits of any additional testing you may do. Why do your frame and lenses cost more than they could get elsewhere? Make sure your team has an answer for every objection and believes in what you are doing.

Instead of having a knee jerk reaction to the dreaded “I just want what is covered,” I hope you and your team can now have a plan on educating, aligning with, and wowing all of your patients – even the ones who come in expecting to pay nothing. Changing the mindset on these patients can really go a long way in the day to day culture in a practice and turn those patient objections into successful outcomes.

Yours in success-
Jennifer L. Stewart, OD

By Jennifer Stewart, OD

Optometrist, internationally recognized speaker, writer, consultant, and entrepreneur.


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