Payment For A Eye Exam

[HOLLYWOOD]

What Do You Think You Should Get Paid For An Eye Exam?

---

Members don't see this ad.

 

[jjmcentee@hotma]

What Do You Think You Should Get Paid For An Eye Exam?

Charges are pretty driven by insurance companies. But most charge around 60 for a complete exam. 50 without a dialation, and 60 with. But insurance companies usually reimburse about 80% of that. 39-40 per exam and you would of course get the copay. In my area about 80% of the population has an HMO type insurance plan.

If an OD works in an MD's office, the office will charge an MD rate, between 80-110$ and bill the insurance company the MD rate (yes this is perfectly within the confines of the law, even though it seems kinda odd, its industry standard.

Additionally most places charge an extra 30-40 or 50 for a contact lens fitting. So if you do the math, most od's see at least 2 exams an hour and work an 8 or nine hours a day.

But then you have to take into consideration who's office your working out of ect.

jim

 

[redrabbit]

Charges are pretty driven by insurance companies. But most charge around 60 for a complete exam. 50 without a dialation, and 60 with. But insurance companies usually reimburse about 80% of that. 39-40 per exam and you would of course get the copay. In my area about 80% of the population has an HMO type insurance plan.

If an OD works in an MD's office, the office will charge an MD rate, between 80-110$ and bill the insurance company the MD rate (yes this is perfectly within the confines of the law, even though it seems kinda odd, its industry standard.

Additionally most places charge an extra 30-40 or 50 for a contact lens fitting. So if you do the math, most od's see at least 2 exams an hour and work an 8 or nine hours a day.

But then you have to take into consideration who's office your working out of ect.

jim

i know so OD's who charges over 100 for just the contact lens fitting (1st time wearer. I think it i worth it tho, they spend so much time with the pt. and they also have to train them to wear it. just my thought

 

[HOLLYWOOD]

So do you guys think $45 is alot of money for an exam? my wife pays $65 FOR A HAIR CUT and her sister pays $200 for a cut and color . I pay $15 but ask your female friends what they pay for a hair cut.

 

[Smorr18]

very good point!

 

[redrabbit]

So do you guys think $45 is alot of money for an exam? my wife pays $65 FOR A HAIR CUT and her sister pays $200 for a cut and color . I pay $15 but ask your female friends what they pay for a hair cut.

very true!!!!

 

[jefguth]

So, why don't optometrists collectively charge higher rates for their services?

 

[VA Hopeful Dr]

I could very easily be mistaken on this, but I think that Medicare pays somewhere around $90-100 for a comprehensive exam on an established patient. Anyone have any definite information on this?

 

[PLPrincess]

So do you guys think $45 is alot of money for an exam? my wife pays $65 FOR A HAIR CUT and her sister pays $200 for a cut and color . I pay $15 but ask your female friends what they pay for a hair cut.

$45 isn't a lot....the office I work for charges $85 for an exam without dialation and $65 for a contact lens re-evaluation. New fits are just about always above $100.

You're very right about your hair cut comparison....most women don't think twice about going to get their hair cut/dyed 3-4 times a year and end up spending $300-600 a year for their hair, however when it comes to their eyes i have to hear about how unfair it is they have to pay $65 for the re-evaluations....sad.

 

[JennyW]

$45 isn't a lot....the office I work for charges $85 for an exam without dialation and $65 for a contact lens re-evaluation. New fits are just about always above $100.

You're very right about your hair cut comparison....most women don't think twice about going to get their hair cut/dyed 3-4 times a year and end up spending $300-600 a year for their hair, however when it comes to their eyes i have to hear about how unfair it is they have to pay $65 for the re-evaluations....sad.

I charge $150 for a new patient
I charge $120 for a returning patient

For contact lenses, I charge an additional....

For spherical wearers, I charge $125
For toric/RGPs/mono I charge $175
For bifocal fittings I charge $250

For returning patients who just need the power of their Rx changed, and not refit into a different lens type, I charge $30.

For patients who object, I tell them that I'm the best, and that I have virtually all lens types at my disposal. I tell them that they can drive a Mercedes, or they can drive a Ford Taurus. (me being the Mercedes. lol) If they still object, I gladly give them a copy of their eyeglass Rx and they are free to get a fitting from someone who charges less.

For longtime patients, I will sometimes reduce my fee a little bit if they get a good outcome with the 1st trial, and it doesn't take multiple visits to fit them.

Jenny

 

[HOLLYWOOD]

But what does insurance pay you?. 95% of my pts. are ins. based.

 

[al-majhul]

What Do You Think You Should Get Paid For An Eye Exam?

Well, the doctor at the office I work at right now (a solo, private practice) charges $79 for a comprehensive exam. She includes the dilation as part of the exam IF THE PATIENT WANTS IT. She doesn't reduce the cost though if the patient doesn't want it. That's for patients paying 100% out-of-pocket.

If the patient is using insurance, the doctor adds a couple more procedures to the exam that makes it extra comprehensive so that she can then charge $125. (of course the patient only pays their co-pay, but we bill the insurance at $125 - this is all, of course, perfectly within the confines of the law). Insurance then pays about $60, I believe, for the total exam.

For a contact lens fitting, we charge $41. So the total is then $120 for out-of-pocket patients.

There is no distinction between 'new' versus 'returning' customers' fees.

This is a brand new practice, in a rather pricey area, but these prices are pretty close to standard, I believe, for Southern California's Inland Empire. The only difference is that most places keep the dilation and other exam fees separated. At the other office where she works, they charge $49 for the exam, and I think around $30 for dilation.

Hope that helps

 

[JennyW]

But what does insurance pay you?. 95% of my pts. are ins. based.

Medicare and blue cross pay about $120 for a new patient and about $90 for established. Some of the other insurances pay a little bit less. I think my worst one pays about $88 for a new patient and $67 for a returning patient.

Since they don't cover contact lenses, the patients pay my full fee for that.

Jenny

 

[HOLLYWOOD]

do you take vision service plan? Even my medical plans don't pay as much as you say.

 

[JennyW]

do you take vision service plan? Even my medical plans don't pay as much as you say.

Anyone who participates in VSP, Eyemed, Spectera, Cole, Davis or any other of those lousy vision plans deserves whatever they get.

I participate in none of them.

What are you getting reimbursed from your medical plans?

Jenny

 

[jjmcentee@hotma]

Charging a high price on a new fit is really an excellent idea. Alot of patients are reordering through 1800 CL companies, and it seems as if they are always a step ahead of our litigation on supplying them. So charging 100 on a cl fit is excellent. Get paid for your services.

The biggest lesson from this thread seems to be Charge for your CL fit, choose your insurance companies carefully, and there is a big difference depending on where you live.

 

[HOLLYWOOD]

Jenny it depends on the plan. Since my practice is 3 years old and on the 15th floor I 'am on all the medical plans. But the range is anywhere from $50 to $120 for a 92004 plus the co-pay. I have noticed that I get paid more if I bill under the M.D.'s name (I have 4 M.D.'s in my practice) . I thought that od's and m.d.'s are to be paid the same. I just called the optometric society to see if they know if this is legal. I haven't heard back yet.

 

[redrabbit]

Jenny it depends on the plan. Since my practice is 3 years old and on the 15th floor I 'am on all the medical plans. But the range is anywhere from $50 to $120 for a 92004 plus the co-pay. I have noticed that I get paid more if I bill under the M.D.'s name (I have 4 M.D.'s in my practice) . I thought that od's and m.d.'s are to be paid the same. I just called the optometric society to see if they know if this is legal. I haven't heard back yet.

can OD bill for the 99204 or is that just for MD? at the place i work at we bill 150 using 92004 and we get more money back then when we were billing 95 for an exam. (this is for VSP)

 

[JennyW]

Jenny it depends on the plan. Since my practice is 3 years old and on the 15th floor I 'am on all the medical plans. But the range is anywhere from $50 to $120 for a 92004 plus the co-pay. I have noticed that I get paid more if I bill under the M.D.'s name (I have 4 M.D.'s in my practice) . I thought that od's and m.d.'s are to be paid the same. I just called the optometric society to see if they know if this is legal. I haven't heard back yet.

Most plans pay ODs and OMDs differently. Medicare is the exception. There is no distinction between ODs and OMDs with Medicare. There are one or two plans in my area that also pay the same, but most do pay ODs less than OMDs.

It is definately legal.

Jenny