To charge or not to charge

At a recent meeting, I was fortunate to connect with some fellow ODs who practice in different settings, and we were discussing different contact lens fitting and follow up practices. Some ODs charge for a fitting and each time a patient comes back in for a follow-up, they are charged. Other ODs collect for the fitting up front, and that covers all follow-up care and trial lenses within a certain time frame. Other ODs charge one simple fee for any contact lens evaluation, no matter the complexity. Yet others break down the contact lens evaluation, depending on difficulty.

I am curious to what you all do when it comes to contact lens fitting and follow up care?

Some burning questions:

  • Do you charge only at the fitting (are follow-ups included)?
  • If you charge for follow-up care, is the patient charged the same amount every time they are seen?
  • What if the patient needs to come in every week to be seen?
  • For those who only charge one fee, no matter what complexity, have you seen increases or decreases in profits? Or no change? How have patients reacted to this type of change? How long did it take to incorporate?
  • When making a major change in fee structure, did you let patients know prior to their appointment? Did you send a mass mailing to all patients notifying them of these changes?
  • If you do not charge for follow-ups, how long is the time period of free care? 30 days? 60 days? 90 days? 1 year?
  • If a patient comes in after their time frame ceases (let’s say on day 45 when they had a 30-day fitting agreement), what do you do in that case? Do you charge them again? If so, is it at a different rate?

It amazes me that practices all have developed contact lens fee structures so vastly different, yet they are all successful. Personally, I entered into a practice who charged nothing for contact lens fittings (or a very low amount). It was difficult and we did get some patient pushback when I first began practicing, but now that I have been with the practice for almost 6 years, our patients are used to the fees involved. We also have all contact lens patients sign an agreement when they arrive, so they understand what the fee is going toward (special measurements and equipment, and follow up care within 30 days, etc). The contract also outlines the different fee structure depending on the complexity of the contact lens, so they are fully aware of the fees before they even begin the exam. This has worked very well for our practice, but we are always looking to improve. Perhaps a one time fee annually would work well for us someday in the future or some other method. I am curious to hear about your structure and what is covered.