Being in network with insurances impacts every part of your practice, from how you position your practice through your online presence to how you follow up with your patient to remind them their annual appointment is right around the corner.

It affects how your team talks to your patients about your available products and services to the point where nearly every recommendation can be subject to an insurance plan’s ability to cover, or a patient’s willingness to pay for something their plan doesn’t allow.

To be a successful provider for both vision and medical insurance patients, the entire practice must be well versed at communicating the benefits and limitations of a patient’s coverage as well as the products and services being provided in addition to baseline coverage.

If this is starting to sound complicated, that’s not an accident. Insurance benefits, allowances, and various coverage limitations are often opaque and take concerted effort to understand and explain.

In this article, we’re going to dig into how the operations at the front desk of an independent eye care practice can be affected by being in-network with insurances. There are some significant and some less significant impacts, but understanding as much as possible will benefit your practice, your staff, and your patients.

Appointment Scheduling

Insurance Verification

Front desk best practices include verifying patient insurance coverage before scheduling an appointment. This involves checking eligibility, determining what services are covered, and understanding the limitations of the plan. This step can be time consuming and may require additional communication with the insurance provider.

Eligibility Checks

Many vision insurance plans have restrictions on the frequency of visits or specific services covered, such as annual exams, frames, lenses, contact lenses or more general discounts on glasses. Front desk staff must ensure that the patient is eligible for the products and services they expect to recieve, which can influence the timing and scheduling of appointments and add further follow up work for the front desk to reschedule.

Coordination of Benefits

In cases where patients have more than one vision insurance plan, the front desk staff must coordinate benefits, ensuring that the primary and secondary insurances are billed correctly. This adds complexity to scheduling and can lead to delays if not handled properly.

Patient Communication and Education

Explanation of Benefits: Patients in general have little to no understanding of how their vision insurance coverage actually works. Vision insurance companies don’t provide as much clarity as perhaps they should, but patients do (for the most part) understand that they have some benefit.

Front desk staff are responsible for explaining the details of their benefits, including what is covered, copays, deductibles, and any out of pocket expenses they might incur. Clear communication is essential to avoid confusion and ensure patients are adequately prepared for their visit; unfortunately even with the best possible effort and intention, patients can still be confused and frustrated by the gap between their expectations and the realities of their vision benefits.

Cost Estimates

Some of the most commonly asked questions received by the reception desk in an eye care practice are related to setting expectations for a patient’s out of pocket costs. Trying to accurately calculate that cost based on the many variables in insurance coverage, patient diagnostic needs, and lifestyle requirements can be challenging and even counterproductive. This includes calculating copays, determining if any services fall outside of insurance coverage, and explaining potential additional costs.

Handling Insurance Issues

Practices often provide services that are, for one reason or another, not regularly covered by vision insurances. It’s likely that patients will raise concerns about why their insurance coverage doesn’t include a given diagnostic test or service, or why they have surprise out-of-pocket expenses. This can and sometimes will create friction between the patient and the practice. Front desk staff need to be trained to understand benefits, capably address these issues, and sometimes follow-up with the insurance company to be able to provide additional patient education.

Check In Process

Insurance Card Collection

When the patient arrives for their appointment, it’s best practice for the front desk to collect, scan, and verify the patient's major medical and/or vision insurance information. This includes checking that the insurance details on file are up to date and correct, and verifying that any pre-authorizations done are still applicable.

It’s important to note that even when an insurance benefit is verified, insurance companies will stipulate that the information is not a guarantee of coverage or reimbursement. Policies being listed as active in an insurance portal doesn’t necessarily mean that it’s paid current. Understanding those limitations is key to mid and long term success.

CoPay Collection

In addition to accurately interpreting the patient’s insurance coverage as it relates to services and materials, the front desk must also collect copays as indicated by the patient's insurance plan(s). It takes time and consistent training for everyone on the team to properly understand the patient's benefits and how they apply to the services being provided during this visit.

Pre-Authorization

For certain procedures or tests, a given major medical insurance may require preauthorization. While a different department may be responsible for actually receiving pre-authorizations, the reception team must ensure that any necessary authorizations are in hand before the patient arrives.

Getting this done ahead of confirming the patient’s appointment goes a long way to creating a seamless and smooth visit for a patient, mitigating the risk of surprise fees or uncovered services.

Data Entry and Record Keeping

Insurance Information Entry

The front desk must accurately enter and update insurance information in the Practice Management System (PMS) and/or Electronic Health Record (EHR). This includes not only basic details like policy numbers but also specific plan benefits, coverage limits, and authorization requirements. It’s usually best practice to also scan a copy of the card into the patient record for future review if necessary.

Claims Documentation

The up front work done at the reception desk that ensures accurate documentation is crucial for processing claims as smoothly as possible. Errors in recording or neglecting to ensure that all necessary patient and insurance information is recorded correctly will cause delays, denials, or rejection of insurance claims which will cause the billing department having to investigate, clean, and resubmit claims.

Take it from us, duplicative work is one of the most frustrating things a medical billing expert has to deal with on a regular basis.

Coordination with Other Departments

Clinical Team

The front desk team should be working closely with the clinical team to ensure the technicians and doctors are aware which products and services are covered by the patient’s insurance plan, which (if any) are discounted and which would be completely out-of-pocket.

This seemingly simple step is often overlooked due to the time constraints that come with running a busy practice, working with many different insurances, and trying to optimize for patient care. This interdepartmental communication works best when done ahead of time so the clinic side has the opportunity to plan for their patient workflow.

Unforeseen financial outcomes on the services side has a knock on effect on the materials side. Further, it can rub the patient the wrong way to the point that they may not return to your practice. Eye care is uniquely competitive in that way, recognizing that how you communicate and set expectations with your patients is as important as the quality of services and products they receive.

Billing Department

Continuous coordination between the front desk and the billing department is a vital component to your practice’s ongoing success as an insurance provider. In addition to ensuring that all insurance details are accurately recorded, the reception team must communicate any issues or discrepancies to the billing team to avoid delays, denials, or rejections when it comes time to file insurance claims.

Dealing with Denials and Appeals

Denial Management

The patient’s primary point of contact at your practice is the front desk, whether over email, SMS, or over the phone, the first place a patient will register a complaint is with reception. Along those same lines, if an insurance claim is denied due to incorrect or incomplete demographic information, front desk staff may need to assist in resolving the issue by gathering additional information from the patient, correcting errors, and assisting in claim resubmission.

Patient Advocacy

One of the most heartening and consistent things about working in the eye care industry is how truly committed opticians, optometrists, technicians, and front desk staff are to taking excellent care of their patients.

It’s not uncommon for reception specialists to act as a kind of advocate for the patient, helping them understand and navigate the appeals process if a claim is denied. This requires a solid grasp of insurance policies and pitfalls, a sense of compassion for the patient, the ability to communicate effectively with insurance companies, and the more challenging ability to properly convey that information to the patient.

Time Management and Efficiency

Increased Complexity

Being contracted with major medical and vision insurances adds layers of complexity to every facet of your practice, but perhaps most acutely at the front desk. If your practice was entirely cash pay and never required your staff to spend time on tasks like verification, patient education, or claims management, how much easier would the average day be?

The efficiency and effectiveness of the front desk, especially in practices with a high volume of insured patients, is almost entirely dependent on their ability to navigate the increasingly complex world of insurance administration and communication.

Staff Training

It is unfortunately all too common for any given practice’s front desk staff to be the least tenured on the team, with the shortest amount of time devoted to initial or ongoing training. At a casual glance, it sort of makes sense if you think the position is just answering the phone and booking appointments; but as we’ve laid out here, being a successful reception specialist requires deep understanding of insurances and how the practice operates through them.

Your front desk teammates to be well trained in managing various major medical insurance and vision plans both in a general sense and in terms of ongoing education. Changes in insurance policies and procedures happen frequently and if your front desk is unaware of changes that impact your patients, it may lead to negative patient experiences, poor online reviews, staff dissatisfaction and eventual turnover, among other knock on effects.

The Hidden Cost of being contracted with medical insurances or vision plans

Your practice’s front desk team is more than just folks who pick up the phone; they’re your first and last line of communication for the lifeblood of your business: your patients. The ongoing training your team requires is expensive and time consuming, but if you’re going to be an in-network provider, it’s a vital investment to keep your practice growing.

Being in-network with both vision and medical insurances adds complexity to every part of your front desk’s workload from scheduling to patient communication to the volume of associated administrative tasks.

While it may enable more patients to access care by reducing their out-of-pocket costs, it also requires your front desk team to manage much more detailed processes related to insurance verification, patient education, and claims management; as well as accounting for human error and erroneous claim denials or rejections that come up from time to time.

If your goal is to grow a more successful practice and you’re using insurances to add to your patient base, your front desk must be capable of effectively handling and overcoming the insurance related obstacles presented so your patients can receive the excellent care you wish to provide.