Earlier this summer summer, I came across a patient care scenario that I had to learn on the fly.
About a year and a half ago, I prescribed glasses for a 5-year-old. I diagnosed her with refractive amblyopia OS. Her wet retinoscopy finding for that eye was +4.50-2.75 x 180 with a best-correct visual acuity of 20/50.
Previously by Dr. Casella: How an externship polished me as an OD
My typical modus operandi after discovering such a finding is to have the usual and customary “polycarbonate lenses full-time wear” conversation with the parent or guardian and schedule the patient back for a visual acuity check, which is typically in two to three months.
This particular patient missed, rescheduled, and subsequently missed several visual acuity checks in a row, then returned again (a little over a year later) for another comprehensive examination.
Fortunately, the child had been wearing her glasses with some degree of consistency, and best correct visual acuity in that eye had improved to nearly 20/25. I educated the parent on compliance and the need to keep follow-up appointments as prescribed so that I can detect a visual acuity plateau and patch if indicated. She stated that she had checked with their vision insurance, and follow-up visits were not covered.
Related: Why ODs shouldn't stop short with patient care
Not just vision coverage
It was then that I realized what was going on. Even though my staff had correctly obtained a copy of the patient’s medical insurance card, the parent thought that because I was an eye doctor, only their vision insurance worked at my office.
I explained to her that refractive amblyopia, unlike hyperopia or astigmatism, was a diagnosis recognized by the child’s medical insurance as a condition requiring follow-up care as indicated. She was simply unaware and trying to avoid a pile of bills from out-of-pocket follow-up visits. She thanked me for letting her know, and we scheduled a subsequent visual acuity check for the child.
Related: Maintain open communication with primary-care physicians
Since then, I have tried my best, when appropriate, to adopt a policy of casually stating that follow-up visits are billable to a patient’s medical insurance company. I’m trying to be careful so I don’t insult patients by causing them think that I don’t believe they can afford healthcare.
I will let you know how this new strategy evolves over the coming months. Truly, anything I can reasonably and tangibly do to enhance patient compliance is worth a shot.
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