Informed Financial Consent
Position Summary
Information about treatment costs will usually be provided to patients prior to their confirm their cover and the benefits that the insurer will pay for any optical appliances or services.
1. Background
1.1. The Optometry Board Australia has a Code of Conduct which has identified the requirements for obtaining informed patient financial consent prior to treatment.
1.2. Some Third Parties also require healthcare practitioners to obtain informed financial consent from patients before proceeding with a course of care.
1.3. Provision of a written quotation or estimate of fees and costs and recording its acceptance by the patient prior to treatment is good business practice and results in fewer disputes over accounts and fewer bad debts.
1.4. Due to the plethora of different private health insurance policies, there is inconsistency between rebates for particular optical services.
1.5. Patients are responsible for contacting their private health insurer to confirm their cover and the benefits that the insurer will pay for the optical service.
1.6. Optometrists and Optical Dispensers cannot be expected to know the difference between their optical fees and the benefits (gap) payable by private health funds for an optical service.
1.7. The amount of rebate for a service from a third-party funding agency is normally a contractual arrangement between the patient and the agency.
Definitions
1.8. BOARD is the Optometry Board of Australia.
1.9. FUNDING AGENCIES are third parties, which make contributions to the payment of the fees charged by Optometrists/Optical Dispensers.
1.10. INFORMED FINANCIAL CONSENT is consent given to the Optometrist/Optical Dispenser by a patient to the fees to be charged for treatment agreed to be performed.
1.11. PATIENT is a person receiving health care or any substitute authorised decision maker for those who do not have the capacity to make their own decisions.
1.12. THIRD PARTY is an outside body that can influence the relationship between the Optometrist/Optical Dispenser and the patient.
These include but are not limited to:
- funding agencies (e.g. government departments, agencies and statutory authorities, private health insurance and private health organisations) which have responsibility for the entire fee for service, or part thereof;
- owners of optometry clinics who are not Optometrists, including health insurance funds, corporations and the public sector (government departments);
- regulatory authorities;
- the optical industry;
- professional indemnity providers; and
- appointment and rating websites
Position
2.1. Informed financial consent should be part of sound ethical professional practice.
2.2. Informed financial consent may not be appropriate if it would delay and therefore compromise emergency patient care.
2.3. The clinical relationship between an Optometrist and a patient is independent of the source of funding for the patient’s treatment. Nevertheless, an ethical approach to patient healthcare should incorporate consideration by the provider of the ability of the patient to pay out-of-pocket expenses for optical services.
2.4. Optometry fees may be based on either an itemised schedule of treatment or on the time taken to complete the optometry procedure or service. Accordingly, the Optometrist may only be able to estimate a range of fees based on the expected time to undertake the procedure and the anticipated complexity of the procedure. Similarly, if the planned procedure is changed during the procedure due to unforeseen circumstances, this may also result in a change to the final fee charged by the Optometrist. Any such change should be advised at an appropriate time and as soon as practicable.
2.5. Any information about expected charges provided to the patient prior to treatment should include advice that the estimate is not guaranteed and the cost may increase if additional procedures are required.
2.6. Where charging is based on an itemised schedule of treatment, Optometrists should provide the patient with the relevant item numbers from the appropriate government schedule item numbers for each of the proposed optical services to enable the patient to confirm the applicable private health insurance benefit or government rebate.
2.7. In some instances, patients may wrongly assumed that the fee for the optical service is fully or mostly covered by their health fund. Patients should be encouraged to contact their health fund to better understand applicable benefits and be afforded the time to give due consideration to the out-of-pocket costs of treatment before treatment commences.
2.8. Where patients are concerned with the cost of optical services, they should discuss their concerns directly with their treating Optometrist.
2.9. Optometrists should ensure that a patient or the person responsible for the optical account has adequate capacity to give informed financial consent.
2.10. Optometrists and Optical Dispensers should take reasonable steps to confirm that patients have adequately understood the estimated cost of treatment.
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Policy Statement – Informed Financial Consent