Wiki Package pricing on lenses?

whitekae

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Seattle, WA
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Our optical practice has recently started using package pricing - we include lens material and AR coating with our flat price for SV and PAL lenses rather than offering enhanced materials/AR as "add on" charges. As far as I understand it, this is fine for patients paying out of pocket.

However, we have also been using these package prices to bill insurance companies, and so are including the price of material and AR under the code for lenses. To make it totally clear, here's an example of how we would bill a pair of lenses before the package pricing change (numbers are just examples):

V2100 $50
V2100 $50
V2750 $70
V2782 $80

TOTAL: $250

Here's an example of how we would bill the exact same lenses (with hi-index and AR) after package pricing:

V2100 $110
V2100 $110

TOTAL: $220

Now, this seems to me that it could be a problem (even though our package prices are overall lower), especially for insurance companies that will pay for base lenses but not for lens enhancements. Is this fraudulent? Or am I just being paranoid?
 
If you are billing insurance for the lenses, you should break down the fees fo AR, high index and PALs etc. That's the proper way to do it. Whether you have any package prices that may be lower than what you bill insurance, makes no difference.
 
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