Should Optometrist agree to refund patient fees?

More doctors are experiencing patients who request their money back after care is provided. So what should ODs do?  How should we handle refund requests?

I had a patient many years ago who came in for an eye exam.  She’d never worn glasses before and was noticing some blurry vision when she worked on the computer and when she read. She was very concerned about this issue because she hated glasses. 

She was so relieved when I educated her about contact lenses as an alternative to glasses.  She opted to get a contact lens exam and was very excited. After 6 visits, we finally got a satisfactory fit.  She ordered a year supply of the lenses and left our practice very happy.

Three months later, I was surprised when she called to request a full refund for the contact lens exam and the contact lens annual supply. She claimed that the lenses felt dry after 16 hours of wear and she needed them to last 24 hours.  She couldn’t understand why her daily disposables didn’t last 24 hours. After all, isn’t a day 24 hours long? 

She felt that it was false advertisement and she wanted her money back.  I was shocked! I had never heard of such a claim.  I didn’t even think such a claim was possible. I offered to have her come in to discuss the situation, she refused.  She just wanted her money back because the contact lenses I gave her did not meet her needs as promised. Did I mention she was an attorney? 

As crazy as this patient story may sound, it’s unfortunately common. Hence the need for this conversation.  Refunding fees is a challenging and evolving concept that must be handled individually. Many factors are at play, and before deciding whether to return a patient’s fee, it can be helpful to consider the following.


Reasons Not to Refund


Many doctors and risk management experts believe it is not wise to refund a patient’s money for a number of reasons:

  1. If the patient claims your prescription or recommendation didn’t work or caused discomfort and/or injury, a refund could be construed as an admission of guilt should the patient decide to pursue a future malpractice claim against you.
  2. Not collecting fees may be in violation of third-party insurer agreements and provisions of your professional liability policy.
  3. Agreeing to return a patient’s money “just once” could set a precedent that could spiral on indefinitely.
    • For example, if the patient needs further testing, or additional treatment then the patient will likely expect you to pay for it. Also, this may spill over to other patients and they may start having similar expectations.
    • Once you begin reimbursing for fees, it can be difficult to start charging again. Many times, the patient will expect free services for life.

As with most issues, it can be helpful to assess the situation. What is the real reason for the refund request? With online shopping so prevalent these days, it’s increasingly likely the real issue is that the patient found a similar product or service cheaper online. If you reimburse in this case, you may create a culture in your practice that will result in loss of profits.

If there is no “legitimate” reason for the patient’s request and it is without merit, you may be able to decline to refund the fee without incurring the wrath of the patient. If you have previously established a good relationship and credibility with the patient, it will be easier to find a middle ground.


Reasons to Refund


Returning money to patients may be a new trend, one that’s simply a twist on the common business practice of providing a “money-back guarantee.” For years, this approach has been used in the retail and service industries, and there are some indications it’s taking root in healthcare.

Reasons for refunding fees:

  1. From a practical perspective, agreeing to refund a patient’s fee may prevent an unhappy patient and salvage the lifelong relationship.
  2. Refunding the patient may prevent negative reviews online. 
  3. Agreeing to refund a patient’s fee may prevent them from submitting a complaint to your state board or worse file a malpractice suit against you.  

For these reasons, you may conclude that agreeing to refund a patient’s fee is potentially less “costly” than the consequences of refusing to do so. However, refunding fees doesn’t guarantee that patients will not take any additional course of action. They may still leave a negative review for your practice or file a complaint with your state board. Refunding is not always the solution.

Here are some additional tips on how to handle refund requests from

In Conclusion


There is no right or wrong way to approach patient requests for their money back. However, understanding the problem from the patient’s point of view will go a long way toward reaching an amicable resolution. In addition, remember that patients may discuss billing issues with your staff before you’re even aware of a problem. That’s why it’s essential to have standardized procedures for patient refund requests and to thoroughly train your staff on these protocols. 

Regardless of what you decide to do when handling refund requests, it may be advisable to end the doctor/patient relationship if the element of trust has been broken. In these instances, make sure to avoid an allegation of abandonment by providing the patient with the names of other doctors to continue their care. 

Remember the story of my patient earlier? Well, I didn’t tell you how we resolved the situation. Luckily for me, I had a contact lens agreement that all my patients must sign.  This agreement clearly outlined our refund policy and we had a copy with her signature. Since the patient wouldn’t come for a visit, I had my office manager contact her and review her options according the signed agreement.

We denied her request for the refund of services. Then we asked her to return the unopened boxes of contacts and we refunded her for those boxes.  We gave her a copy of her exam records and a list of other providers she can contact for continued care. In other words, we fired her! I never heard from her again. 

As I said earlier, there is no right or wrong way to approach patient requests for their money back. However, understanding the problem from the patient’s point of view and having a standard protocol will go a long way toward reaching an amicable resolution.

For more tips on how to handle patient requests, click HERE to read our article on what to do when patients have unrealistic expectation.

Do you have standardize procedures in place to manage patient interactions in your practice? Is your team thoroughly trained on these protocols? Are they able to confidently handle issues in your absence?

If you need help creating a Standard Operating Procedures (SOP) Manual, click below to sign up for our CEO of YOU™ consulting program where we help you create a success blueprint for your practice. 

Until next time, remember to Dream Big, Take Risks and become the CEO of YOU™!

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