Responses to My Fitting Fee Inquiry
Tara Dailey
Description
Collection
Title:
Responses to My Fitting Fee Inquiry
Creator:
Tara Dailey
Date:
11/27/2013
Text:
I have been asked to post the responses that I have gotten so here you go!
Post: We are coming across this more and more where we will be fitting the patient with a brace, ots, and while that's happening the person they are with is googling the exact item. Of course they find the item on the internet cheaper and now they don't want to sign and take the item we just fitted them with.
If they don't end up taking the item, which means we aren't going to bill the insurance, is it permissible to charge the patient fitting fee that they pay out of pocket? I understand we can't charge a fitting fee or missed appointment fee because of our contracts and such, but what about our services rendered? It's not that the patient doesn't like the item, it's that they know they can buy it online cheaper.
How is everyone else dealing with this issue with OTS items that can be purchased on the internet?
Thank you in advance.
Responses:
1.We tell the patient there's an evaluation fee. We tell them this up front before they ever go back in the room with the clinician. If they proceed with the prescribed item that fee is waved or can be put towards their deductible. This way, we get paid for our time and it's not wasted as much because the patients who are on the fence about getting an item usually change their minds and leave.
Good luck!
2.I am constantly telling people to try Amazon. I state that if we need to get involved, the charges also include the evaluation and the followup, etc. If it is only a knee sleeve, I would rather they fight with Walmart or Amazon. In this way, if it is necessary for me to become involved (and we tell them that we are happy to do so), they understand that it requires some expertise to address this stuff. We then sell the we are here to help and we do this with everyone. I then tell them two things. One is that we must provide medical grade devices which are more expensive than consumer grade stuff. The other is that I tell them that I would rather spend more time working on a complex prosthesis or custom orthosis instead of fitting wrist splints that are also available at the local drugstore.
This then provides a way to reach out to the community and to care. Just like Miracle on 34th Street when Santa refers to another toy store, we find that people have a wonderful impression of us. You save them money, they refer their friends. Win-win!
3.You will probably have difficulty collecting any fee after the fact.
Perhaps you should consider a Patient Evaluation Fee that you collect up front that will be applied to any deductible or copay if the service is finalized. If you go this route have signage and patient info sheets detailing the fee and how it is essentially refunded (applied to purchase) if service and delivery completed.
But, if patient decides to not complete then fee is kept.
As to your insurance contracts, I am not familiar with any contract that pays O&P for patient evaluation, rather the insurance coverage begins only when patient accepts delivery of the device. Therefore, for all intents and purposes, all patient/provider interactions prior to patient acceptance and delivery are considered non-insurance related and fee-for-service. Thus making the charging of a Patient Evaluation Fee defensible.
You are in a license state, does your license law require you to have a Dr's Rx to treat the patient? Treatment begins with patient evaluation, therefore you must (should) keep the Rx for your files showing you were in compliance with law. If the patient chooses to go to another provider they would need to revisit Dr and get another Rx.
4.Just a thought, and this probably sounds harsher than I mean it to sound, but why are you allowing that? Especially if they are taking pictures of your patient or product. I'd have to tell them I didn't allow that due to privacy concerns.
If it's an OTS item, they should pay for it FIRST then you adjust it to fit them after they own it. Who would want a pre-worn, pre-adjusted brace if they walk away from it? Should they fuss before they pay, you smile and say I know, but we can't put it back on the shelf once it's been fitted to you. When you go to a nice store and buy a pair of slacks, they don't hem them prior to your paying for it either, right? When they say, right... you ask for method of payment, process the sale and then fit the device.
If they say I can get it cheaper on-line you smile and say While that may be true, you don't get personalized service nor would you enjoy our expertise is helping you adjust it to fit correctly. We only fit/adjust those items purchased here. Would you want to take a chance of a bad fit or would you like me to assist you?
There are some business classes at OandPEdu.com if you would like additional suggestions for increasing your sales and profits without jeopardizing your patient care standards. You get CEU's for taking them.
5.Sell it to them for the Internet price plus a fitting fee for your expertise and follow up possibility of problems. Ofcourse you tell them supporting the fitting and processing insurance costs money. Is it really better for them to pay out of pocket than to use insurance and have you fit correctly? That's why small artsy stores won't let you take photos. Good luck
6.permissible to charge the patient fitting fee that they pay
out of pocket?
There is no L-code for a fitting fee that our industry can use to bill. We gave up these kinds of opportunities many years ago when we had the opportunity to include them.
7.In cases as these we have billed pt for consultations
8.I am not sure why your patients would buy an item off the internet if insurance was going to cover the item in the first place. If a customer is to pay cash for small items like cock up splints I usually just refer them to places where I know they can obtain the item at an inexpensive price. Otherwise I suppose you can ask for copays and deductibles upfront. Maybe a non refundable deposit for ordering an item...say enough to pay for a companys restockin fee
9.You are being manipulated.
Patient signs and pays...Up front or you don't waste your time.Then if they walk you haven't lost anything. Worried about your doc getting angry? You think he is spending a second of his time with them and NOT getting paid?
Yep, I thought so :)
No offense but hearing your complaint makes me worry about what else you are allowing to happen in your practice. Seriously, I hope this helps you.
10.It's unfortunate that this type of thing is happening more and more. What the patient/customer has to understand is that if they get it off the internet, they can't submit it to their insurance for reimbursement. It has to be fitted and dispensed by a certified practitioner. That should be explained in the patients insurance plan that items are only covered under their plan when properly fitted and dispensed. That can be part of your Here's why you should get it from us conversation. Also, talk up the fact that if there are any adjustments to the item, they can come back to you to have those 'expert' adjustments made.
Is it part of your intake procedures that patients sign for their HIPAA and Patients Bill of Rights? I'd put in the packet a letter of understanding that 'Your insurance carrier may be billed for labor costs incurred should there be a cancellation' that they read and sign prior to their evaluation for their brace.
Implement 'No electronic devices' and 'No photography' in the fitting room or office.
Have you already taken their insurance information from them for their file before they decide not to get the item from you? I'd then call their insurance provider and ask what their plan says about undelivered canceled items.
Also, is this happening when you've placed a special order for something that you didn't have in stock?
11.I think you should let the insurance pays for the patient, so the patient don't need to pay. If the insurance won't pay and you have the item in stock, just fit it and get the money. However, if you need to order the item and the patient find it cheaper on the internet, there is not much you can do.
12.Ouch, don't let them know what the item is. In other words in most cases I never being the box in the room. Also on some it gets to be special panels that are added. This is only an example. Truly I have this as a potential problem but so far they understand the level of expertise is valuable and don't second guess.
13.Let them buy it. Also, explain, what is that they are paying for when YOU fit the brace. Expertise; follow up; warranty' problem solving; potential skin issues prevention. If they were dumm enough to go for online sale, let'm have it, but advise not to come to YOU for adjustments and repairs.
I have simple example. We do plenty of HFADs. We charge $370 and we TELL Pt they can buy it online for $220 plus shipping. We, also, loud and clear tell them that there will be no warranty or follow ups, if they buy online, which is fact. We did not have a single Pt to balk out of buying it from us.
14.Great question. I have to ask, are the items you are referring to covered by insurance or are they non-covered? Are they simple knee wraps without hinges, or back braces without rigidity? If they are simply retail items then you should be able to compete with most on line venues through your costs. Your margins will shrink but this should not represent a majority of your business. You would sell an item at a reduced profit margin in exchange for the opportunity to show the patient the difference in dealing with a medical professional! Much like services your car, while the patient is in your facility, you should inform them of all of your services. Word of mouth is still the best advertisement. Don't waste an opportunity.
If they are items covered under insurance their co-pay should be far less than the retail price at a big box store. Can you give specifics?
15.Explain to the that the brace is going to need adjustments. I always compare it to an oil change. Throw it an extra set o knee pads & they'll be happy
16.I've seen a sign at a local outfitter that tells clients they charge $5.00 fee for trying on shoes when there's no sale. Seems that people were coming in to try shoes on to determine their size to buy shoes online. You could post a similar sign and try to collect but another solution is to ask clients (and their friends/relatives) to turn off all cell phones when they enter the building.
I appreciate all of you responding. Thanks!
Tara Dailey
Post: We are coming across this more and more where we will be fitting the patient with a brace, ots, and while that's happening the person they are with is googling the exact item. Of course they find the item on the internet cheaper and now they don't want to sign and take the item we just fitted them with.
If they don't end up taking the item, which means we aren't going to bill the insurance, is it permissible to charge the patient fitting fee that they pay out of pocket? I understand we can't charge a fitting fee or missed appointment fee because of our contracts and such, but what about our services rendered? It's not that the patient doesn't like the item, it's that they know they can buy it online cheaper.
How is everyone else dealing with this issue with OTS items that can be purchased on the internet?
Thank you in advance.
Responses:
1.We tell the patient there's an evaluation fee. We tell them this up front before they ever go back in the room with the clinician. If they proceed with the prescribed item that fee is waved or can be put towards their deductible. This way, we get paid for our time and it's not wasted as much because the patients who are on the fence about getting an item usually change their minds and leave.
Good luck!
2.I am constantly telling people to try Amazon. I state that if we need to get involved, the charges also include the evaluation and the followup, etc. If it is only a knee sleeve, I would rather they fight with Walmart or Amazon. In this way, if it is necessary for me to become involved (and we tell them that we are happy to do so), they understand that it requires some expertise to address this stuff. We then sell the we are here to help and we do this with everyone. I then tell them two things. One is that we must provide medical grade devices which are more expensive than consumer grade stuff. The other is that I tell them that I would rather spend more time working on a complex prosthesis or custom orthosis instead of fitting wrist splints that are also available at the local drugstore.
This then provides a way to reach out to the community and to care. Just like Miracle on 34th Street when Santa refers to another toy store, we find that people have a wonderful impression of us. You save them money, they refer their friends. Win-win!
3.You will probably have difficulty collecting any fee after the fact.
Perhaps you should consider a Patient Evaluation Fee that you collect up front that will be applied to any deductible or copay if the service is finalized. If you go this route have signage and patient info sheets detailing the fee and how it is essentially refunded (applied to purchase) if service and delivery completed.
But, if patient decides to not complete then fee is kept.
As to your insurance contracts, I am not familiar with any contract that pays O&P for patient evaluation, rather the insurance coverage begins only when patient accepts delivery of the device. Therefore, for all intents and purposes, all patient/provider interactions prior to patient acceptance and delivery are considered non-insurance related and fee-for-service. Thus making the charging of a Patient Evaluation Fee defensible.
You are in a license state, does your license law require you to have a Dr's Rx to treat the patient? Treatment begins with patient evaluation, therefore you must (should) keep the Rx for your files showing you were in compliance with law. If the patient chooses to go to another provider they would need to revisit Dr and get another Rx.
4.Just a thought, and this probably sounds harsher than I mean it to sound, but why are you allowing that? Especially if they are taking pictures of your patient or product. I'd have to tell them I didn't allow that due to privacy concerns.
If it's an OTS item, they should pay for it FIRST then you adjust it to fit them after they own it. Who would want a pre-worn, pre-adjusted brace if they walk away from it? Should they fuss before they pay, you smile and say I know, but we can't put it back on the shelf once it's been fitted to you. When you go to a nice store and buy a pair of slacks, they don't hem them prior to your paying for it either, right? When they say, right... you ask for method of payment, process the sale and then fit the device.
If they say I can get it cheaper on-line you smile and say While that may be true, you don't get personalized service nor would you enjoy our expertise is helping you adjust it to fit correctly. We only fit/adjust those items purchased here. Would you want to take a chance of a bad fit or would you like me to assist you?
There are some business classes at OandPEdu.com if you would like additional suggestions for increasing your sales and profits without jeopardizing your patient care standards. You get CEU's for taking them.
5.Sell it to them for the Internet price plus a fitting fee for your expertise and follow up possibility of problems. Ofcourse you tell them supporting the fitting and processing insurance costs money. Is it really better for them to pay out of pocket than to use insurance and have you fit correctly? That's why small artsy stores won't let you take photos. Good luck
6.permissible to charge the patient fitting fee that they pay
out of pocket?
There is no L-code for a fitting fee that our industry can use to bill. We gave up these kinds of opportunities many years ago when we had the opportunity to include them.
7.In cases as these we have billed pt for consultations
8.I am not sure why your patients would buy an item off the internet if insurance was going to cover the item in the first place. If a customer is to pay cash for small items like cock up splints I usually just refer them to places where I know they can obtain the item at an inexpensive price. Otherwise I suppose you can ask for copays and deductibles upfront. Maybe a non refundable deposit for ordering an item...say enough to pay for a companys restockin fee
9.You are being manipulated.
Patient signs and pays...Up front or you don't waste your time.Then if they walk you haven't lost anything. Worried about your doc getting angry? You think he is spending a second of his time with them and NOT getting paid?
Yep, I thought so :)
No offense but hearing your complaint makes me worry about what else you are allowing to happen in your practice. Seriously, I hope this helps you.
10.It's unfortunate that this type of thing is happening more and more. What the patient/customer has to understand is that if they get it off the internet, they can't submit it to their insurance for reimbursement. It has to be fitted and dispensed by a certified practitioner. That should be explained in the patients insurance plan that items are only covered under their plan when properly fitted and dispensed. That can be part of your Here's why you should get it from us conversation. Also, talk up the fact that if there are any adjustments to the item, they can come back to you to have those 'expert' adjustments made.
Is it part of your intake procedures that patients sign for their HIPAA and Patients Bill of Rights? I'd put in the packet a letter of understanding that 'Your insurance carrier may be billed for labor costs incurred should there be a cancellation' that they read and sign prior to their evaluation for their brace.
Implement 'No electronic devices' and 'No photography' in the fitting room or office.
Have you already taken their insurance information from them for their file before they decide not to get the item from you? I'd then call their insurance provider and ask what their plan says about undelivered canceled items.
Also, is this happening when you've placed a special order for something that you didn't have in stock?
11.I think you should let the insurance pays for the patient, so the patient don't need to pay. If the insurance won't pay and you have the item in stock, just fit it and get the money. However, if you need to order the item and the patient find it cheaper on the internet, there is not much you can do.
12.Ouch, don't let them know what the item is. In other words in most cases I never being the box in the room. Also on some it gets to be special panels that are added. This is only an example. Truly I have this as a potential problem but so far they understand the level of expertise is valuable and don't second guess.
13.Let them buy it. Also, explain, what is that they are paying for when YOU fit the brace. Expertise; follow up; warranty' problem solving; potential skin issues prevention. If they were dumm enough to go for online sale, let'm have it, but advise not to come to YOU for adjustments and repairs.
I have simple example. We do plenty of HFADs. We charge $370 and we TELL Pt they can buy it online for $220 plus shipping. We, also, loud and clear tell them that there will be no warranty or follow ups, if they buy online, which is fact. We did not have a single Pt to balk out of buying it from us.
14.Great question. I have to ask, are the items you are referring to covered by insurance or are they non-covered? Are they simple knee wraps without hinges, or back braces without rigidity? If they are simply retail items then you should be able to compete with most on line venues through your costs. Your margins will shrink but this should not represent a majority of your business. You would sell an item at a reduced profit margin in exchange for the opportunity to show the patient the difference in dealing with a medical professional! Much like services your car, while the patient is in your facility, you should inform them of all of your services. Word of mouth is still the best advertisement. Don't waste an opportunity.
If they are items covered under insurance their co-pay should be far less than the retail price at a big box store. Can you give specifics?
15.Explain to the that the brace is going to need adjustments. I always compare it to an oil change. Throw it an extra set o knee pads & they'll be happy
16.I've seen a sign at a local outfitter that tells clients they charge $5.00 fee for trying on shoes when there's no sale. Seems that people were coming in to try shoes on to determine their size to buy shoes online. You could post a similar sign and try to collect but another solution is to ask clients (and their friends/relatives) to turn off all cell phones when they enter the building.
I appreciate all of you responding. Thanks!
Tara Dailey
Citation
Tara Dailey, “Responses to My Fitting Fee Inquiry,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235814.
