Should Optometrist Agree to Refund Patient Fees?

In my experience, most patients are honest, and courteous and understand that doctors must be paid for services rendered. However, more doctors are experiencing patients requesting their money back after it is provided. So, what should ODs do? How should we handle refund requests?

A Real-Life Example

Many years ago, I had a patient who came in for an eye exam. She had never worn glasses and was noticing blurry vision when working on the computer or reading. She was concerned about this issue because she hated the idea of wearing glasses. I suggested contact lenses as an alternative, and she was thrilled. After six visits, we finally found a suitable fit. She ordered a year’s supply and left our practice happy.

Three months later, she called requesting a full refund for both the contact lens exam and her yearly supply. She claimed the lenses felt dry after 16 hours and that she needed them to last 24 hours. After all, isn’t a day 24 hours long? She felt misled and demanded her money back. Oh, and did I mention she was an attorney?

As bizarre as this may sound, it’s an increasingly common scenario. Refunding fees is a challenging and evolving concept that must be handled case by case. Many factors come into play, and it’s essential to consider the following before deciding whether to return a patient’s fee.

Reasons Not to Refund

Many doctors and risk management experts believe it is unwise to refund a patient’s money for several reasons:

1. Perception of Guilt: If the patient claims your prescription or recommendation didn’t work or caused discomfort, a refund could be perceived as an admission of guilt. This could come back to haunt you if the patient decides to file a malpractice claim.
2. Violation of Insurer Agreements: Not collecting fees may violate third-party insurer agreements or provisions of your professional liability policy.
3. Setting a Precedent: Agreeing to a refund “just this once” could set a precedent, encouraging more patients to request refunds. It could also lead the patient to expect you to cover additional tests or treatments.
4. Expectation of Free Services: Once you start reimbursing fees, it’s challenging to return to charging. Patients may expect free services in the future.

If the patient’s refund request is without merit, you may decline it without significant repercussions, especially if you’ve established a strong relationship with them. In these cases, it may be easier to find a middle ground.

Reasons To Refund

Returning money to patients may be a growing trend, akin to the retail and service industry’s “money-back guarantee.” While not common in healthcare, this practice is emerging.

Here are reasons to consider a refund:

1. Preserving Relationships: Refunding a patient’s fee may prevent an unhappy patient and help maintain a lifelong relationship.
2. Preventing Negative Reviews: A refund could prevent negative reviews online, which can impact your reputation.
3. Avoiding Complaints: Refunding may prevent the patient from filing complaints with your state board or, worse, pursuing legal action.

While refunding fees can seem like a less costly option, it doesn’t guarantee the patient won’t take further action, such as leaving negative reviews or filing a complaint. It’s not a perfect solution, but it’s an option worth considering.

A Balanced Approach

There is no right or wrong way to approach patient refund requests. However, understanding the issue from the patient’s perspective can lead to more amicable resolutions. Keep in mind that patients may discuss billing concerns with your staff before you’re aware of them, which is why it’s essential to have standardized procedures for refund requests and to train your staff thoroughly on these protocols.

If trust has been broken between you and the patient, it may be best to end the doctor-patient relationship after resolving the issue. Ensure you provide them with a list of other providers to avoid any accusations of abandonment.

My Patient Story: The Resolution

Remember the patient I mentioned earlier? Fortunately, I had a contact lens agreement that all my patients must sign, which outlined our refund policy. Since she refused to come in, my office manager reviewed her options according to the signed agreement. We denied her request for a refund on the services but refunded her for the unopened boxes of contact lenses after she returned them. We provided her with a copy of her exam records and a list of other providers for continued care. In short, we “fired” her, and I never heard from her again.

The key takeaway? Having a standard protocol for handling refund requests can help reach a resolution that protects both your practice and your patients.

For more tips on handling patient expectations, click here to read our article on what to do when patients have unrealistic expectations.

Call to Action

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