Independent Eye Care

Patient role play videos: Discussing out-of-network eye care

Our customer success team role played some of the scenarios your staff might run into as an out-of-network provider. Watch the videos here!
Published 7.9.2021

Discussing out-of-network benefits with patients can seem intimidating. How do you tell them you're not in-network with the vision plan they pay for? What do you say to someone who doesn't want to pay more for their eye care? It's why every eye care provider who's considering dropping vision plans should role play various patient scenarios.

Even if you've already dropped vision plans you should role play these interactions. Better yet: Every ECP, in- or out-of-network, should have their staff train patient scenarios. This can go a long way toward ensuring your team is comfortable in all sorts of circumstances. When they can confidently navigate these conversations your staff can help patients clearly see that out-of-network does not mean out-of-benefits.

Make out-of-network conversations a highlight of patient interactions

These discussions with patients shouldn't be the reason your practice decides against dropping vision plans. If going out-of-network is what's right for your practice or retail optical, then it's too important to avoid these conversations. Instead, role playing can help you ensure that these patient interactions are a feature of your journey toward out-of-network prosperity rather than an obstacle. People will value these discussions and how helpful your staff is in ensuring patients using their out-of-network benefits.

Because we understand how important practicing these conversations is, we're helping you get started! Our customer success team role played some of the scenarios your staff might run into as an out-of-network provider. Karita Licio and Corey Walker are each customer success managers with Anagram. In these scenarios Corey plays the patient and Karita plays the staff member. Karita has previous experience working at a small practice in upstate New York.

Out-of-network patient role play videos

Karita and Corey covered a number of scenarios your staff might run into after you drop vision plans. You can watch each one below and then train these interactions with your own team!

Patient role play #1:

"I saw you in-network last year. Why should I have to pay in full, up front this year?"

Karita starts by making sure Corey knows that even though she's out-of-network with his vision plan she can still help him exercise his benefits. Most people don't know they have out-of-network benefits they can use. Getting that objection out of the way first can make the rest of the conversation easier.

After assuring Corey he still can use his benefits, Karita explains that when she was in-network she wasn't able to provide the same quality care that she is now. No longer limited by vision plans, she notes that she can offer Corey the patient experience and materials that work for him, not his vision plan.

Finally, she makes sure Corey knows that she can still file his claim for him using Anagram.

Patient role play #2:

"I'm not interested in paying up front at this time."

Keep in mind: If someone is calling you, then they're interested in something you offer. Is it proximity to their location, your practice speciality, your reputation for excellent quality care? There's a reason they're speaking with you already. Honing in on that can help you overcome any apprehension on the patient's part.

If they're not interested even after you remind them of your unique value, that's alright too! You shouldn't expect to capture every single patient. Look for the patients who appreciate the value you offer and who will become loyal, returning patients for along time.

Patient role play #3:

"Why is it more expensive to visit you/What do you mean you spend more time with me than an in-network provider?"

Explaining to patients why they'll have to pay that higher cost can be difficult without the right preparation. It can be a touchy conversation. No one likes spending more than they should. So why is your care worth this new, higher price?

Karita immediately acknowledges the higher pricing before explaining what goes into that cost. For example, she notes that the price can include fundus photos or additional testing—everything necessary to make sure Corey is will be okay until his next eye exam. Most providers won't include that kind of comprehensive care in their price. Finally, she adds the price also includes out-of-network claim submission.

Patient role play #4:

"Do you accept my vision insurance?"

When Corey asks if Karita accepts his insurance she initially answers that yes, she does accept all insurance plans as an open access provider. Of course, most people don't what this means. But if offers her an opportunity to explain the unique benefits of visiting her practice.

When Corey follows up to find out more about open access, Karita explains what it means for his patient experience. She will still take his insurance, use his out-of-network benefits and make sure he gets reimbursed. However, now she can spend more time with him, provide more testing and generally ensure that Corey feels taken care of after the appointment. It may not be the same as in-network, but she makes sure Corey knows his patient experience will be much improved.

Patient role play #5:

"What is my cost going to be/Why does this cost more?"

Here again Karita explains to Corey why it cost more to see her as an out-of-network provider. She acknowledges she is charging more, but adds that there is a reason for it. An in-network eye exam is probably limited to just the exam and doesn't offer much time for Corey to learn about his eye health. On the other hand, Karita can offer all sorts of testing and thoroughly explain to Corey how he can ensure healthy eyes until his next appointment.

Patient role play #6:

"Do you accept my vision insurance?" (patient doesn't know their plan)

Here Karita cannot help Corey verify his benefits because he does not know his plan. However, she makes sure to offer him as much help as she can in finding his plan information. She walks him through the various ways he can determine what his vision plan is and texts a link to him that he can use to provide that information once he finds it. Although she can't tell Corey his plan, she makes sure Corey is set up to easily do so himself.

Connor McGann
Connor McGann, Content Marketing Manager
Connor McGann is Anagram's content marketing manager. He joined Anagram in February 2020. Previously he was a finance writer and animation project manager at a marketing agency, and managed content for a live chat provider that serviced various industries including health care and plastic surgery.

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