I find changing perspective helps me to see things a little clearer. Think about homeowner’s insurance. I have a home, and I have insurance on that home. Some things are covered, and some are not.
I made several decisions on coverage, deductibles, and other benefits when I signed my policy. For the last several months, my wife has been hearing something in the attic. I claimed it was nothing, but the critter removal specialist who she called confirmed the presence of squirrels nesting in our attic—which is a bigger deal than you may think.
When you have squirrels in your attic, you can either put a Band Aid on it, or you can fix it for good. We wanted it fixed for good. I asked the critter removal specialist if my insurance would cover it, he said, “I don’t know, I doubt it.”
In fact, my homeowner’s policy does not cover critter removal. The critter removal specialist didn’t change his recommendation based on my dilemma, he just asked me for the money.
Put eye care first
As eyecare providers, ODs are expected to be experts in diagnosing and treating eye conditions. By default, we are also expected to understand and communicate insurance coverages to our patients.
But eye care must come first.
Just as ODs shouldn’t order an unneeded test because the insurance will pay for it, our recommendations should not change based on who’s paying the bill. To eliminate any personal bias, it is a good practice to make recommendations before knowing the patient’s coverage.
If a patient needs a new Rx, write it and tell the patient he needs new glasses. If your patient needs an imaging or retinal photography to confirm your potential diagnosis—order the test.
Document your initial recommendations and orders prior to checking coverages.