A patient denied before-hours service takes matters into her own hands. 

Sparkle City Optometry normally opened its doors at 8am. Receptionist Heather, a night owl, found she could only manage this by grabbing breakfast at the coffee shop next door and scarffing it down at the front desk. One morning, Heather looked up from her sandwich to see a woman peering in the window. Heather jumped a little, and the woman waved impatiently and pointed at the door. Heather suppressed an eye-roll and moseyed over, keeping her hand on the deadbolt as she leaned her face through the door crack. “Good morning, ma’am, we will be opening in 10 minutes!” said Heather cheerfully.

About Real Deal

Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.

About the Author

NATALIE TAYLOR is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

“I know that, but I need to get my contact lens order and I really need to get to work as soon as possible!” she said.

“Our staff are still arriving and getting the office ready. I will unlock the door at 8am and we can make that happen,” said Heather, stepping back.

“Wait!” the woman exclaimed. “Can’t you just get them for me? I paid already; you just need to hand them to me!” 
“It’ll just be 10 minutes,” continued Heather. “There is a coffee shop next door while you’re waiting?” she said, flashing her best smile at the scowling woman. She grabbed her food off the desk and marched back to an empty exam room, far from any windows.
By 8am the lights and equipment were on and Heather’s coworker unlocked the front door. The woman made a beeline to reception and coolly gave her name to Heather, who had the boxes of lenses ready.
“My eyes are actually bothering me, too,” said the woman. “I think it’s allergies. Can Dr. Wylam see me now?”
Heather grabbed the schedule and studied it, while the woman scanned her name tag. “Yes, I think we can do that! I am going to need to pull your insurance, but I can do that while you’re in with him,” she said. “You have a $30 copay. I’ll take that and a technician will bring you back.”
A few moments later, Dr. Wylam stepped into the exam room, already operating on autopilot. “Good to see you. My notes say you’re having some allergy issues. Let’s take a look at your eyes, chin up here, look at my ear, blink…”

The patient suddenly pulled her head out of the chin rest and shook her head. “Actually, I need to speak to you about your receptionist Heather,” she announced. “She was here at 7:50am and came to the front door but refused to give me my contact lenses. I’m making myself late for work but I couldn’t leave without talking to you. I’ve never been treated so rudely!”

The doctor was shocked. “I’m so sorry that happened,” he said.

“I’m sure you are, but I want to know what you’re going to do about it,” she said, clasping her hands.

“Well I’m sure there will be a conversation, and…”

“I think you should fire her,” the patient said bluntly.

“I’m not going to do that,” said Dr. Wylam without hesitation. “We have an internal system for handling staff issues.”

“Then you’re losing five patients: me, my husband, my son and my parents,” she said. “Now, I really need to go to work.”

Dr. Wylam said goodbye to her and summoned Heather to hear her side of the story.

There was no punishment or follow up, but a few weeks later Dr. Wylam received a voicemail from the patient, livid that the visit had been submitted to her insurance. She threatened to report fraud if he didn’t cancel the claim and reimburse her for the $30 copay.

The Big Questions
  • Did Heather treat the patient badly, or is she blameless?
  • Should this exam have been submitted to insurance? Why or why not?
  • Is there anything Dr. Wylam can do or say to salvage the situation?

Expanded Reader Responses

Greg H. Minneapolis, MN

Bill her insurance. Do not refund her a penny. Your open hours are your open hours…not 10 minutes prior. Let them walk; there are more fish in the sea. Chances are she’ll be back. Too bad for your staff. Sadly, the doctor’s hands become tied whenever a patient makes ridiculous demands, and reprimanding a staff member in front of a patient to assuage the patient’s overly ruffled feathers is a dangerous precedent to set. He was right to defend Heather at that point, but a follow-up apology letter with a gift card afterwards might have helped. PS: What office is still “getting ready” 10 minutes before opening?!!

Lewis K. Milan, TN

Heather should have gone and gotten the lady’s contact lenses. Insisting on firing her was unreasonable. We are there to serve our patients and anything reasonable that we can do to improve our services is indicated.

Danielle S. Fort Worth, TX

The question you should ask yourself is, “If I were the patient, what would I want?” The staff member wasn’t in the wrong, but the manager/doctor was. Your staff doesn’t make the decision when to come in, so therefore you should mandate that enough staff members get there 10-15 minutes before 8am to unlock the door, get the office ready, and avoid problems like this. It’s a simple solution and far more convenient for the patient. In addition, the staff should be trained to go above and beyond for your patients. Don’t leave good behavior up to fate! The charges are a little tougher. If you schedule an appointment with a doctor, you should expect to be billed. The time you took on the schedule is time they lost on other patients with real issues and trouble. However, common courtesy shows the doctor could make the choice to waive the fee, due to the circumstances of the false visit. There isn’t one right answer!

Tim O. Richmond, VA

Not to be too hard on Heather, but she should come to work prepared for the day and ready to work once clocked in. Creating a customer experience will reinforce strong lasting relationships. Heather should have taken care of the customer immediately and not put her off. This would have eliminated the additional issues. Given the actual events, the customer charges should have been voided and no claim sent to the insurance company. It was bad enough that they lost the family’s business; you do not want to do more damage and risk an online review that could deter other customers from doing business at the office. The doctor’s response to the request for Heather to be fired was perfect. I would suggest the doctor go above and beyond once all the event details are known to keep the customer. Except for firing Heather!

Sheri H. Creighton, NE

If Heather did not wish to be bothered before 8 o’clock, she should not have been sitting and eating her breakfast in full view of the windows. Was she clocked in? If she was, she is at work and should have assisted the woman. If not, she should be eating in a break room. Should the appointment be billed? Yes, the patient stated that she was having eye issues. She should simply have asked to speak to the doctor about a personnel matter. The only way for the doctor to defuse the issue was to apologize to the woman in person and explain the insurance issue versus the personnel issue. He should speak to his staff about using the break room. If you are clocked in you are considered to be at work and should assist patients even if it isn’t the stroke of 8 o’clock.

Staci V. Sun City, AZ

While it sounds like the patient was a bit over the top and demanding, I think it could have been handled a bit differently. It sounds like Heather was pleasant and tried her best to delay the woman, but it would not have been the worst if she helped the woman a few minutes early, unless store policy prohibits it or she herself was not qualified to dispense the lenses. While it was underhanded of the woman to make an appointment under false pretenses and she should have been up front about why she wanted to speak with the doctor, the visit should not have been billed to insurance. As for as the woman’s demand that Heather be fired, she was out of line, and the doctor did well in his response.

Stewart G. San Francisco, CA

1. No, the patient was not treated badly. There are many offices where rules are to start business at official opening time, not before. In some cases, premises insurance will not cover accidents during non-business hours. The employee was very polite. However, I would tell staff that they cannot eat in full view of the public. And if the patient had to get to work, why did she waste time creating that ruse right then and there?
2. I wouldn’t have, because the non-medical nature of the visit became apparent at the time the patient spoke to the doctor.
3. He shouldn’t bother. If the patient is offering their business predicated on removing an employee who did nothing wrong, that’s a patient you do not want in your practice. The doctor’s appreciation of their staff in these instances will go a long way to maintaining the office environment and increasing business.

Sondra M. Wichita, KS

Our policy states that we MUST have two people in the office before the doors are opened just to avoid this possibility. This gives an eyewitness to any unhappy occurrence and helps in controlling flow of the office. The only fault I see is that Heather made herself vulnerable by being visible. Office hours are office hours and clearly stated, if we make an exception for one, we must make exception for all. That's bad practice as patients will think they can come and go at their convenience and not stated open hours. Insurance is justifiably filed. She stated her complaint and took the doctor's time. The doctor stood up for his staff, that makes for a great work environment when staff know they won't be penalized for upholding stated business guidelines. However, there should be policy in place regarding eating outside of designated areas.

Kenneth P. Oklahoma City, OK

The practice took a chance on losing a patient or patients for a 10-minute issue. This sounds like an internal problem that needs to be handled quickly. Poor handling will cost the practice patients, reputation, and money. The office manager or the doctor needs to impress on the staff that they are in a customer service profession, and this was a big fail. Heather shouldn’t be fired. Nothing should have been filed. A nice gift card should be sent for the patient’s trouble. With all the competition out there, why would you risk losing this patient and her family for 10 minutes?

Katie A. Nashville, TN

Heather did not have to give the patient her contacts, but it would have been beneficial to the practice if she had. And that should always be the consideration taken by employees — to go the extra mile — especially with the competition from online companies and the unfortunate expectation of instant gratification becoming more prevalent. Our office realizes customer service is our best defense against online sales, so we try to put forth extra effort any way we can, even if it means staying over a little later to give a patient their glasses or working through the occasional lunch break.

Daniel M. New York, NY

She should have handed her the contacts. Nothing can fix this. No exam should be submitted. Copay should be taken in advance.

Scott L. Greenville, SC

Heather was not rude but she did handle the situation incorrectly. She took the time to open the door so it would not have hurt to get the patients’ contacts. She had them ready when the patient came in, so she could have just given them to her. Not a firing offense but punishable for sure. The exam should not have been submitted because the doctor did not actually look at her eyes. I would give her the $30 back and ask her not to return.

Dennis I. Monroe, CT

Unfortunately, Heather triggered a chain of events making a bad situation worse. Customer service is always the first priority. Customer service is what sets eyecare practices apart. Heather should have allowed the patient in and dispensed her contact lenses to her. The patient was already expecting a hassle, being late for work, and Heather just fueled the fire. There is no justification for the doctor billing the insurance company unless he actually gave the patient a diagnosis and a treatment. Since that wasn’t done, the office staff should immediately contact the patient and rectify the situation. There is a whole lot of room for staff education in this scenario and the doctor needs to adhere to appropriate exam protocols.

Angel M. Cynthiana, KY

Heather’s breakfast was not more important than patient relations. It would only have taken a moment to pull up the patient’s records and dispense the contact lenses. No type of examination or medical consultation was given, so she should not have been charged, or the visit filed. That was just throwing fat into the fire and I agree that it seems fraudulent.

Monica T. Charlottesville, VA

It is very frustrating when you come in early to try and get something done prior to opening, however since the contacts where paid for — I would have left her outside and gotten her contact lenses. It should not have been billed to insurance but very tempted to charge for the doctor’s time since she lied. I would refund the money and make notes in case she decided to return. I would also contact the insurance company and let them know to avoid getting in trouble with them. She doesn’t respect other people’s time and could have reached out to the doctor in a different manner. My doctors always shared emails or letters that needed to be addressed. If you want your staff to have the time prior to opening to be undisputed then I would put up a screen on the door so patients cannot see in or have a back desk they can work at — if she was just eating — she should stay in back to avoid this in the future.

Olga C. Yuma, AZ 

Heather shouldn't have let it get that far. If she had let her in and dispensed the contacts in the first place the other issues wouldn't have arisen. Sometimes staff has to use their best judgement with patient satisfaction.

Rick R. Girard, PA

1. Heather is 100% to blame. If she would have eaten breakfast somewhere besides in full view of a potential situation like the one that happened, all of this could have been avoided. No, instead she adds fuel to the fire by not giving the customer the contacts, which would have taken minutes at the most and, again, avoided the situation all together.
2. No, since the exam was never really performed. Granted she mentioned allergies and that in itself could constitute a reason to file, but losing five patients and then getting accused of insurance doesn't seem worth the hassle.
3. I doubt it. He waited too long. Seems like Heather takes the cue from her boss.

Chani M. Highland Park, NJ

Heather didn't treat the patient badly per se, but she did make some serious mistakes. If the office is closed, don't sit near the front window where patients can see you. This would have made the issue a non-event. Once she was spotted AND went over AND listened to her request she should have sucked it up and handed her the contacts, they were paid for anyway. Then she should have told herself never to sit up front again when the office is closed. The encounter with the doctor should not have been billed, I understand she took time with the doctor but how do you legally code this encounter? Not cool. Refund the copay as well. Tough call as to how to salvage the situation. I would hand write a letter of apology/explanation to the patient, telling her how much I value her patronage etc. etc. and that Heather was duly admonished. The patient was definitely not 100% right either, but that's not the point here, the point is the interaction occurred.

Robert M. Edina, MN

Heather should have gotten the patient her lenses and thanked her for her business. This problem escalated when she decided taking two minutes to deliver the lenses could have made the patient happy. Heather could have made a much better decision. You could make the argument for billing insurance, however better judgement could have saved even more pain and distress. Dr. Wylam should retract the insurance bill and refund the patients co-pay since no service was performed or treatment plan developed. He should write the patient a sincere apology for the incident and outline what steps have been taken to prevent its reoccurence. He could include a gift card or an offer of free plano sunwear. He should then follow-up with a phone call inviting her back to the practice.

Lisa T. Mountain View, CA

She wasn't rude, but wasn't friendly about it. The exam didn’t seem to be an exam after all, so the patient should have been charged for doctor’s time, but not billed for any services. The doctor can assure the patient that her concerns are heard and that his staff was following opening procedures. Maybe he can evaluate this procedure in the future. Apologize for the inconvenience.

David G. Beckley, WV

Yes, I believe the insurance should be billed, the patient agreed to see the doctor. There is not much that can be done in my opinion. Pull the shades. I am sure the patient isn’t going to pay Heather for her 10 minutes off the clock. Also, for security reasons the door should be unlocked when the office is fully staffed.

Barbara S. Ohio

Heather should have let the patient in, this is usually an isolated incident and for the client to have seen the employee in the window and even addressed by her made matters worse. The time it took Heather to go to the door and let the woman know she could come back and the ensuing actions, she could have just got the woman her contact lenses which were already paid for. No, the exam should not have been submitted because clearly, the woman, right or wrong was using his time to make a complaint, however, had Heather let the woman in in the first place, this would not have happened. Dr. Wylam could calmly have let the woman know, he will train his staff to let patients know in the future, if they have extenuating needs to pick up product outside of store hours, that they need to call in advance the previous day.

Amy P. Corona, CA

Heather should not have been sitting at the front desk eating in view of the front doors. I understand that they were closed but she should have been somewhere that she was not able to be seen by patients. Personally, for myself I would have given the patient her contact lenses but then again, I also deliver contacts to patients that are unable to make it to my office before I close and they are on my way home. I do not feel the exam should have been submitted to the insurance because it sounds as if an exam was not performed. I would not fire Heather but I would definitely have a talk with her. I always try to treat my patients the way I would like to be treated. It does no harm to go out of your way once in a while. I don't think there is much that can be done to salvage this situation.

Judy C. Virginia Beach, VA

Lesson 1: Don’t eat breakfast, or any other meal, in view of patients. 
Lesson 2: Establish an office policy concerning allowing anyone in outside of operating hours and develop a “script” to use.
Lesson 3: Refund the copay. Cancel the claim. This patient will never let it go if you don’t. Document everything.

Ben R. Rockford, MI

1. No Heather did not treat the patient badly but at the same time once you open the door for a patient you are kind of out of luck. If I had opened the door, I would have taken care of her. That said I would have made a "just a minute" gesture and disappeared out of sight if it was that important that I not open the door a few minutes early. 
2. Depends. Did the doctor find something diagnosable if so then yes the patient used doctor's time that he could have been using for a patient who had an actual concern.
3. No this patient is someone who is just looking for a reason to make everyone as miserable as she is.

This article originally appeared in the March 2018 edition of INVISION.   

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