A child needs glasses, but her divorcing parents are bickering. What can her eyecare team do?
This article originally appeared in the May 2016 edition of INVISION.
Olyn Optics in Los Angeles had a reputation for vision therapy and pediatric care. The office was outfitted with a special pedes-only section in optical, complete with toys and even a tiny dispensing station.
One morning, Dr. Olyn’s first appointment of the day was a new patient named Ruth, a shy 8-yearold accompanied by her mother, Linda. At the end of the exam, Dr. Olyn announced Ruth needed to wear glasses.
“The school nurse sent a letter home recommending an exam. That’s why we’re here,” Linda said. “She won’t wear them, though.”
“Ruth is very far-sighted. I can show you how she sees the world,” said Dr. Olyn, pulling out a pair of -4.00 trial lenses and holding them to Linda’s eyes. She blinked dramatically, peered through them at her daughter sitting in the exam chair, and said, “Why didn’t you say anything?!” She sounded betrayed. Her daughter shifted uncomfortably and looked at Dr. Olyn.
Dr. Olyn brought mother and daughter to the showroom, where an optician showed Ruth some frames that would accommodate the high Rx. “I love these,” she said of a light blue pair, though Linda muttered about the price.
At the front desk, Linda told the receptionist, “I’m going through a divorce and Ruth’s father, Jason, is going to pay for everything. But he doesn’t have custody, so I want you to put a note not to let him see any records.” The receptionist added the restriction in EHR. The optician made a policy exception to put the order through without payment, due to both the high prescription and the payment situation.
Several days later, the office called Linda and told her the glasses were ready and still needed to be paid for. Less than an hour later, Jason walked in and spoke to the receptionist.
Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual eyecare businesses and people.
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 don’t like them,” he said.
The optician looked befuddled.
“It’s clear my ex picked these. If I have to pay for her glasses, I want to pick them,” he said. “And I need a receipt, and I want a copy of her prescription.”
The optician left to find a manager to weigh in on a redo, and the receptionist stood up to lean over the front desk and speak gently: “Sir, your wife informed us you don’t have custody of Ruth, and according to HIPAA rules we aren’t able to share medical information with you.”
Jason threw his head back and gave an exasperated laugh. “Did she give you any proof?” he asked.
“I’m not sure, I’d have to check ...” But Jason cut the receptionist off.
“No, she didn’t, because it doesn’t exist. Nothing has happened yet with that. So I have every right to whatever I want,” he said.
The receptionist was stumped, so she asked for a few days to sort out the custody claims and HIPAA concerns. Meanwhile, the optician came back out and asked Jason to join her in choosing a new frame for his daughter. Jason made his selection, a pair less expensive and decidedly less feminine than the frame Ruth wanted. And because she wasn’t sure how to handle the family’s situation, the receptionist allowed him to leave without paying anything.
A week later, Dr. Olyn noticed the tray for Ruth was still in the stack of jobs to be dispensed. She asked her staff for the story, and they told her they had left several messages, to no avail. Their hearts went out to little Ruth, caught in the middle of her parents’ battle with poor vision and no advocate.
THE BIG QUESTIONS
1. Does Jason have a right to have the eyewear remade, without Ruth’s input, if he is paying and doesn’t like the frame?
2. How could each staff person have improved the quality of their interaction with this family?
3. What can the doctor and staff do to ensure Ruth ends up with glasses she’ll wear?
REAL DEAL RESPONSES
It’s so sad that the power trip between the parents has to affect a child’s sight! Selfish. It seems that the staff handled both the mom and dad of little Ruth properly, for the most part. It’s often difficult when a client tries to strong-arm a receptionist or optician, but I believe that the parent who brings the child to the exam is believed to be the custodial parent. What other conclusion would we make?
Ruth needs to be involved in the selection process, but so too does the individual responsible for payment. If mom wants to pick them out or dad is unavailable to help with selection, she can pay and get the money from the father.
If in the end he is permitted to weigh in on Ruth’s care it may go a long way in having the salesperson or doctor call his number to let him know the HIPAA part was all set. That you wanted to discuss Ruth’s case with him since he was not here that day. That she has a high Rx and had concerns about wanting to wear them, that when she was here she really liked that frame. It goes a long way if the child feels part of the process in getting her to wear them. Since he cared enough to purchase something, talking directly to him may soften him up. He is just angry with his wife, not the practice.
PORT SAINT LUCIE, FL
We have had issues like this before, and it’s a very delicate situation. If mom paid for the exam, the divorcing father may have no right to the records. He shouldn’t have the prescription until the glasses are paid for. I would not make any more glasses until: 1. The original pair had been paid for, or mom approved the second pair. 2. The father brings Ruth into the office for a fitting and leaves a deposit. It should be explained to him that frames must fit to be comfortable, and the daughter must be present for a proper fit. This will give the practice more info regarding custody of the child as well.
Always, always, always collect 50 percent down before you do any job. Even then you are protected from losses if it’s private pay with 2.5 markup. If someone doesn’t pay the other half of any of the major vision plans you pretty much lose the amount they still owe! Always tell the parents or guardian of a young, high hyperope they may already have irreversible vision loss. So they better start wearing their glasses, pretty or not! As for who can see the chart, if there is any question in this case, request a affidavit from their lawyers. But I wouldn’t waste too much time. Lots of people getting divorced really only want to use their kids as pawns. Let them know the kid is your patient and you are here to help. If they are going to go Jerry Springer on you, they can go somewhere else and sign a records release so you can send the chart to their next doctor.
I think it is important for the staff to be sensitive to this family’s situation. The doctor could have explained to the mother, with the right encouragement and positive reinforcement, Ruth will learn to enjoy her new glasses and new vision. The receptionist should have explained to the mother without legal documentation both parents have legal rights to Ruth’s records, and she would be more than glad to provide each a copy. The doctor and staff can ensure Ruth ends up with a pair of glasses she’ll wear by explaining to the parents Ruth is priority and she should be a part of picking out those glasses!
LAKE CHARLES, LA
Divorce cases don’t always make sense. The problem started when they did the job with no money down. Always remember: GYM (get your money). Ruth is stuck with self-centered parents. The doctor and staff can’t do much more.
As a front desk administrative specialist (and a person who is also going through a divorce) I know for a fact that any legal paperwork regarding custody details is absolutely necessary when setting the standards of HIPAA and release of information. That way there is no question of who is and who isn’t supposed to be paying and who is or isn’t allowed to have access to the minor child’s records. The receptionist had a duty to obtain any legal paperwork before deciding to take the mother’s word for it.
DR. STEWART GOODERMAN
STEWART G., SAN FRANCISCO, CA
I would have emphasized to the father that it was the child who picked out the frame with approval from his spouse. A child has to like the frame, otherwise she won’t wear it. I wouldn’t have done the glasses over. I would have told him to talk it over with his soon-to-be ex-spouse. Also, the Rx should have been given to the mother at the time of the exam. That’s the law. I also would have said, pending investigation, HIPAA doesn’t allow us to give any information to him. Information will gladly be released after his spouse’s charges have been found to be untrue.
DR. NORMAN R.
I implemented a policy some years ago to take no part in a divorce situation. We have had similar situations occur over my 52 years in practice. As soon as we ascertain there is a problem between mom and dad, our policy is cash up front. We will provide the prescription and/or records to the parent physically present.