Empowering out-of-network patients

Harris Williams & Co’s most recent Vision Industry Update found that “investors are highly interested in the vision industry due to its large addressable market, fragmentation, combination of retail/healthcare characteristics, and growth opportunities.” As a result, insurance carriers are looking for new ways to streamline operations, boost profits, and keep investors happy.

Three examples of this at work:

  1. Insurance companies looking to expand their influence in the market have sought to increase their footprint through consolidation.
  2. Many insurance companies continue to tightly control supply chains — encouraging patients to choose certain products and services that boost the bottom line.

  3. Insurance companies also are reportedly tightening their belts when it comes to reimbursements. We’re hearing from a growing number of Eye Care Professionals (ECPs) who complain of being nickel-and-dimed to death via chargebacks, etc.

Unfortunately, Harris Williams & Co’s report also finds that ECPs’ largest stream of revenue relies on the very insurance companies who are in charge of reimbursements. When insurance companies constrict reimbursement payments, ECPs’ biggest stream of revenue takes a hit — which hurts these businesses in a real way.

What to do?

So what should an ECP do when the single largest slice of its revenue pie begins to shrink? To paraphrase this article from Forbes, when the world seems like its gone absolutely bananas, focus on what you can control — not what you can’t.

… and capture as many out-of-network patients as you can.

Out-of-network patients

According to research we conducted with the help of 20+ ECP offices in different areas, we’ve seen that (on average) about 22% of the total number of people who walk into an ECP's office are out-of-network patients. These patients represent a huge opportunity for many ECPs to make up for eroding revenues elsewhere, as they often come without many of the pain points that accompany in-network patients.

Unfortunately, this same 22% of potential customers are also the most likely to leave an ECP’s office when they learn that they are out-of-network — often because:

  1. They don’t understand how to properly leverage their benefits, and

  2. Most ECPs aren’t set up to effectively and efficiently capture patients who are out-of-network.

Improving out-of-network capture rates

Boosting capture rates for out-of-network patients starts with a paradigm shift. Gone are the days of “passive” patients; today’s patients expect to feel empowered — and equipped to utilize their insurance benefits. Equip patients with knowledge — how the out-of-network process works, exactly how much they should expect to be reimbursed, what the insurance company will/won’t cover (and why), and who they can contact if something isn’t right. They’ll be much more inclined to do business with you — and your out-of-network capture rates will skyrocket. (And, you’ll be able to remain cash pay with these patients!)

Because, in our experience, there aren’t too many ECPs — or businesses in any sector — who can afford to ignore the needs and wants of 22% of potential customers.

To learn how Patch can help you boost your out-of-network customer capture rate, get in touch with us. We’d love to see how we can help.