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Real Deal

A Bad Online Prescription Induces Prism with the Correct Rx, What’s an Optician to Do for Her Frustrated Patient?

How far would you go to serve a patient uncomfortable with the correct lenses?

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CAMILLE WAS ORGANIZING frame cases in the showroom when Dr. Rourke and a patient approached her for a hand-off. 

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 owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

“Camille, I’d like you to meet Doug,” said Dr. Rourke. “Doug’s around a -5.00, he’s new to our office and has a bit of an astigmatic change so he needs to update his glasses. To address his accommodation needs I’d like for him to try a progressive lens.” Dr. Rourke patted Doug’s shoulder and headed back to the exam lanes. 

“Would you like me to find you a pair similar in style to your current glasses?” asked Camille, gesturing at the tortoise P3’s on his face. 

“I think I’d like to find something different,” he said, “Maybe with nose pads? My glasses are always slipping.” 

“Sounds like a good plan! I’m going to select a handful to get us started,” she said. 

Doug eventually decided on a drill-mount with high index and used his vision benefit for a deep discount. Several days later Doug met with Camille for his dispensing appointment. Camille completed her speech for first-time progressive wearers and encouraged Doug to wear his new glasses for the full day tomorrow. 

A few days later Doug came back to see Camille. “I just don’t think I can get used to these,” he confessed. “It’s really hard to work at my desk – after a few hours I had to take them off. Can I just get the kind of lenses I’ve always had?” 

“Of course you can,” reassured Camille. “I hope you’ll keep your mind open to progressives in the future, but for now I will remake your lenses at no charge.”

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At Doug’s second dispense, his reaction to the new prescription was frustration. “These don’t feel right. Everything looks weird and it feels like my eyes are… pulling? It’s hard to describe.” 

Camille took both new and old pairs back to the lensometer. Dr. Rourke had changed the axis in each eye by about 20 degrees, so she coordinated a same-day prescription recheck for Doug and met with them after. 

“Well, it seems like Doug really prefers his old prescription,” said Dr. Rourke. “Let’s remake these lenses, and please put a rush on it.” 

“Also, while you were working on the glasses I looked around and found a different frame I like better. Would I be able to change?” asked Doug. He held up a zyl frame retailing for about half the cost of his original drill mount. 

“Sure!” said Dr. Rourke, “That’s not a problem, right Camille?” 

Camille submitted the change to the lab, which charged 50% retail for the second remake. Dr. Rourke approved the charge as a write-off for the practice. Doug came back a few weeks later for his third dispense; Camille wasn’t anticipating any issues so she was caught off-guard when Doug reported the same uncomfortable pulling sensation. 

Perplexed, she asked to see his previous glasses again and went to the relative privacy of the lab. After a few minutes, it hit her: she dotted the optical centers in the lensometer and took them to Doug to try on. Sure enough, his pupils were easily 10mm higher than her marks. 

“Can I ask where you got this pair of glasses made?” she asked.

“I ordered them online; I didn’t have vision insurance back then,” Doug answered. 

Camille did her best to explain induced prism to Doug, but she could see in his expression he thought she had made a mistake and was trying to assign blame elsewhere. Losing his trust was an unhappy moment for Camille. 

“So what is the next step here?” asked Doug. “These lenses are too uncomfortable to wear.” 

 

The Big Questions

  • Should Camille knowingly make a pair of glasses with that much induced prism, even if the patient has adapted to it?
  • The lab bill for another remake will likely be 100%. Should Doug be asked to pay some [or all] of this?
  • Would you keep the difference in cost of the frames, as Doug used a managed care plan for the purchase? Why or why not?
 

Expanded Real Deal Responses

Richard K., OD, Rochester, NH

I would keep the money from what is paid for the first frame. I would redo the lenses one more, (third) time with induced prism, but, I would warn the patient, that it would be the last time and he must accept them as they are, with no refund. Or, he could get a refund from whatever he paid to that point and the frame, too, with a 25 percent restocking fee, which is stamped on all my questionnaires. There has to be a limit on redo’s because, who knows when it will end. Better suck up the loss, then continue to lose more and more. Lastly, if he takes the refund, then dismiss him afterwards from the practice. Likely, he could be a never satisfied patient.

Christopher B.  Iselin, NJ

I would trial frame the Rx with half the amount of prism and try to find out how little BD prism he is willing to tolerate. Once I landed on the amount that the client is comfortable with I would take my findings to the doctor and see what he thinks about it. My plan would be to reassess how much BD prism can be pared down on future visits, with the goal of eliminating if possible down the road. If the doctor approves of the Rx change I would remake under the lab’s doctor Rx change.

Rob M., OD Merrillville, IN

Due to the induced prism, I would recut the lenses with half the prism value into the new frame. I would have the doctor explain why the change has occurred and that over time, we would be able to reduce the prism entirely until we had the best Rx available. We would ask our laboratory for a one time voucher to help gain patient confidence. Hopefully by solving the problem with a thorough explanation, the practice will have gained a patient for life. The minor loss on these glasses will be offset by future purchases and the goodwill the patient will spread for the practice.

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Steven G. Houston, TX

When you checked the patients old RX, as a standard procedure you should check and document the WOC’S (wearing optical centers), the height and base curves if plus Rx over 3.00 diopters.

Robert M. Edina, MN

She should not remake the glasses again until she has Dr. Rourke see the patient for a re-check. Trouble shooting a customer’s problems is part of what we do. This type of thing is easy to miss the first time through. The glasses should be carefully evaluated before remaking them and solve all the problems at once. At this point it is still Dr. Rourke and Camille’s problem and Doug should not be charged. We do not resell frames that customers had worn. Therefore, since he is buying both frames, I would bill the vision plan for the first one as it was dispensed. It is always best to spot centers on glasses when you are evaluating for an optical concern.

Stewart G., OD San Francisco, CA

The technician should discuss the situation with the doctor. As a practitioner, I had a similar situation with a patient who swore that every pair of glasses she wears came from me, when, in fact I was fooled because the frame she was wearing I used to carry, but she never purchased it from me. After making her glasses, she had the same reaction as this patient did. It was only when I insisted she return with her old glasses that I realized that I had never made the glasses she was wearing (and I proved it looking at all her orders over the past 15 years) and that her current glasses had a DBC that was off by 6 mm from her actual PD (and she’s a -8.00!). I put her Rx into a trial frame, and moved the DBC slowly until her symptoms disappeared and that’s what I used for the remake and she was happy. I told her that she has now become a rehab patient.

Paul G., MD Tucker, GA

A relatively simple, easy, and cheap solution could be press-on Fresnel prisms. Explain to the patient that he had induced prism with his old glasses, and that by tapering the prism over time, he would probably adjust to the new glasses without any prism.

Amber C. Glen Burnie, MD

Our practice model has the glasses checks begin in the optical with a recheck of the patient wearing the old glasses and the new glasses (when possible). We include a note of the patient’s complaint and compare all aspects of the glasses, which hopefully would catch the prism. We may also trial frame the patient with the induced prism and the new Rx for comparison, notating for the doctor. Since we have already done one glasses check, and assuming both pairs of glasses were compared, we would again review our findings including the induced prism with the doctor (assuming it was missed initially). We want to be respectful of the patient’s and doctor’s time. The doctor will advise, which may include asking the patient to try over the next week or two without the prism, if the exam did not find it medically necessary. However, given these circumstances if it was found the patient did need the prism to comfortably see, we would then remake the glasses as a courtesy.

Rick R. Girard, PA

1. Camille cannot make another pair of glasses and induce the prism. She needs to explain the error on the part of the online glasses and reassure Doug that it will be a continual problem, in the future, if he doesn’t correct the problem now.

2. Only if they decide to remake the glasses once again. Which they shouldn’t. The online glasses are the mistake, not Camille’s.

3. Since the online glasses were made incorrectly, creating the problem, then I wouldn’t refund the cost difference because they have already taken a loss on the remakes.

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Vlad C. Hackensack, NJ

I would not knowingly make a pair of glasses that will induce prism that’s not part of a patient’s original Rx without the OK from a doctor. I recommend Camille explain what happened to the patient and give the patient more time to get used to the proper Rx first. If that doesn’t correct the patient’s symptoms, then ask the doctor if he’s comfortable Rx’ing prism to match the patient’s previous eyewear. As far as financials, I would wave additional costs if the patient is not a habitual offender. Assuming the patient brought his old glasses in with him during his initial visit, it’s only fair to conclude that the prism error was not his fault, but an important lesson to learn for both the patient and the optician when dealing with online glasses.

Tami T. Cincinnati, OH

No, you don’t remake the glasses knowing that would be wrong. He needs to give his brain time to readjust to the correct glasses. It’s an eye brain coordination that has to happen and that takes time.

Jeff R. North Sioux City, SD

It is our job to create a pair of glasses that most accurately represents the doctor’s Rx. If a patient purchased something in the past that counters that, it’s on the patient. Creating a pair of glasses with induced prism is no different than voluntarily changing the doctor’s script. Show the patient the optical center on the old glasses to help explain and inform that anything you do to attempt to duplicate is a random guess at best. Check with the insurance company on their frame change policy and fall back on yours if necessary. No refunds on downgraded frames, just like lenses. If the patient wants you to go forward, get your doctor’s inclusion and any recommendations from them. Full price, you have already made the correct pair twice. This is upon request of the patient. 

Leisa S. Newport Beach, CA

Camille should have done a more thorough assessment of Doug’s glasses from the very beginning. Why were the glasses slipping and how much time was he wearing them in the wrong fitting position. Unfortunately, once a patient has adapted to the wrong RX it really is not wrong any more it becomes the proper or tolerated RX. The practice is responsible for the remakes because of a lack of proper assessment. I would not charge the patient for the redo; allow him to choose a different frame at no charge but I wouldn’t refund any money to him directly. I would suggest he try a progressive again with the new RX because of what was stated initially from the doctor about his needs in very day life.

Bob EyeHelp LLC Florida

Quite a dilemma. How many remakes before you cut a patient loose? Everyone gave up on the PALs too quickly and now you’ll lose a customer and who knows how many others when he shares his story. Remake one more time.

James Barnes, Boise, ID

I would make at half the prism so that it’s not such a shock. And then the next pair of glasses he gets reduce the prism again.

 

What’s the Brain Squad?

  • If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.
  • Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

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    Real Deal

    How Should an Office Handle this Disgruntled Patient with Unpaid Bills and Ongoing Medical Needs?

    The doc wants to keep treating him and hopes to erase that negative online review despite his overdue balance.

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    DEENA, BILLING MANAGER at Rose Family Vision in southern Rhode Island, was reviewing an accounts receivable statement when her extension rang.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

    “Hi Deena. You asked me to tell you when Edwin was about to check out. Can you come to the front desk?” said a receptionist.

    “I’ll be there in a minute,” she replied, grabbing her clipboard.

    Edwin, an older gentleman, was pacing the showroom when Deena arrived. He saw her and nodded in recognition. “Nice to see you again, Edwin,” said Deena, extending her hand. “Let’s sit someplace quiet.”

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    Deena escorted Edwin into an empty exam room and closed the door. “So, I know you had your eye exam today with Dr. Rose,” she said, “and we still have the glasses you ordered in 2017.”

    Edwin rolled his eyes, both annoyed and embarrassed.

    “You paid half, but you do still owe $240 on these glasses, and we have a $15 monthly late fee which has essentially doubled your bill,” she said slowly. This elicited a short expletive from the patient, but Deena continued. “At your insistence, Dr. Rose agreed to schedule your appointment today and will bill your insurance, but we do need to address this past due balance.”

    Edwin leaned forward in his chair. “I was hospitalized for a month and couldn’t get my glasses when they were ready, then I was recovering, and then I started getting the late fee bills and harassing phone calls, and decided I didn’t want them anymore,” he huffed.

    “Yes, I did read that in your online review,” Deena said delicately, pulling from her clipboard a printout of the two-star evaluation. “However, glasses are custom made for you, and as I had said last year, we can’t cancel an order after it is completed.”

    “Those glasses are useless now,” he replied. “I got cataract surgery down in Florida last winter and the prescription is completely different now. Why should I pay for something that I can’t even use?!”

    Just then Dr. Rose knocked gently on the door and came in.

    “Hi Edwin. Hi Deena,” she said gently, sensing the tension. “I wanted to join the conversation after today’s exam.” She took a seat next to Edwin and faced Deena. “Edwin needs a LipiFlow treatment, and we discussed using CareCredit to make that happen.”

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    Deena looked at her boss, dumbfounded. Awkward silence followed.

    “Edwin, why don’t you come out with me, one of our staff is going to explain CareCredit and help you fill out the application paperwork,” said Dr. Rose.

    Deena stayed put. Dr. Rose returned a moment later.

    “I know what you’re going to say,” began Dr. Rose, “but he needs medical care. Attach the optical bill to the new charges and put it all thru CareCredit, if that makes things easier for him.”

    “What a mess,” moaned Deena.

    “We need him to change that bad online rating,” said Dr. Rose. “It’s killing our average.”

    “I’d rather fire him as a patient,” she replied.

    “Come on, Deena,” Dr. Rose scoffed. “I need you to get Edwin back on our side.”

    The Big Questions

    • What can Deena do about the outstanding optical bill and “useless” glasses?
    • Should an outstanding optical bill ever block ongoing medical care?
    • If you were Dr. Rose, would you have done anything differently?
    Craig F.
    Rushville, IN

    I think Dr. Rose should have made this suggestion to Deena away from the patient. It would have put Deena in a less awkward position. Also, Dr. Rose should have backed up Deena and told Edwin he needs to pay for the glasses. If Edwin is belligerent, ask him to pay 50 percent of the glasses cost. That should cover the costs of making them.

    Nikki P.
    Gunbarrel, CO

    Look at the actual frame and lens cost to the practice; how much did the practice lose? Charging him that amount may be a good compromise and no one is at a total loss. An outstanding optical bill should never block ongoing medical care. If Dr. Rose had already discussed his options with him and both agreed CareCredit was the best solution, Dr. Rose should have told Deena immediately and assisted Deena in the conversation the whole time to ensure a smoother conversation.

    Barry S.
    Seaford, NY

    Opticians should become more aware of just what their added value is to an “eyeglass product.” If you subtract this added value, you come close to what online would charge for the same materials. So, if the buyer/patient isn’t receiving this added value, why are they being billed for it? It seems to me that the years of control we’ve had over the eyewear transaction have imbued most offices with a sense of entitlement to the buyer’s dollars. If nothing else, the situation described speaks volumes for separating the eyewear purchase from eye-based medical care. In any event, hope they enjoyed punishing the client for not picking up the eyewear and paying in full for it. I think we can all agree that the 50 percent deposit more than covers the lab costs for the lenses, while the frame can…well, you know. Think about it.

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    Gigette H.
    Washington, NJ

    My office has patients pay in full prior to processing any order of eyewear. We have a cancellation policy and a restocking fee policy. We state on the back of our superbill all the policies regarding payments, refunds and warranties. We also research deductibles, copays and coinsurances extensively prior to the patient’s visit. My staff and the patient know the patient’s financial responsibility at the time of service. Because of the work done pre-appointment, we have almost no billing afterwards. After years in practice, I try to be prepared for most eventualities.

    Craig L.
    Coconut Creek, FL

    After six months of not picking them up I would donate the lenses and write the rest off. You did not lose money. The deposit covered the cost of the lenses and the patient has nothing. I would then note on his chart in the future that he must pay in full upfront from now on. I would never bring it up to the patient. They lost $250 and have nothing. The patient is always first, and the profit comes from good optical karma!

    Greg K.
    Dodge City, KS

    The situation should have been handled within 90 days of the original order unless the extenuating circumstances had been explained to the office. Multiple attempts to communicate with the patient should have been made. If no response, then the frame could have been returned to inventory to reduce the patient’s balance and the “custom” lens cost remains the patient’s responsibility. We bend over backwards to accommodate a patient’s needs and situations, but with no explanation from the patient, at the 120-150 day mark the account should have been turned over to collections. At that point, all future orders are paid in full on the day of the order.

    Lynnette G.
    San Mateo, CA

    I too would’ve taken the patient to a quiet place and reviewed the charges. 1. Offer to remove the monthly service fees, allowing the patient to pay the original balance with CareCredit. 2. With his Rx change, depending upon the new Rx, offer to redo the lenses to a single vision lens in an Rx for whichever works best for the patient (no additional cost/SV lenses are relatively inexpensive). 3. Sign the patient up for CareCredit and wrap the remaining balance up into CareCredit. 4. Meet with the doctor prior to the visit and discuss what she was doing/set up a protocol with regards to handling patients. There is no right answer and communication is key.

    Stewart G.
    San Francisco, CA

    First of all, the practitioner should never have come in and changed the conversation without consulting his office manager first. It completely undercut the OMs credibility. Alternative forms of payment should be presented in a unified manner. Given how long the glasses had not been paid for, there should have been rules within the practice to handle this: It should have been sent to collection and/or a dismissal letter sent so that the review should be superfluous. This way, the bad review could have been discussed online because the patient is no longer a patient of the practice. If none of this is an option, treat the unpaid bill as bad debt and ask for all payments in full in advance of any services being rendered to the patient.

    Judy C.
    Virginia Beach, VA

    How badly do you want to retain the patient? 1. Update the Rx in the glasses he ordered two years ago. 2. Put everything including his medical treatment into CareCredit minus the late fees. 3. No one should ever withhold medical treatment. Ever. 4. Happy patients tell everyone they know how happy they are. 5. Unhappy patients tell anyone who will listen how unhappy they are. The practice has all the control in this case.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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    Real Deal

    How Did This Trunk Show Turn Out So Wrong?

    They had such high hopes: What can the practice do better next time?

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    FUNG EYE CARE WAS an established optometry clinic on the outskirts of St. Louis, MO. Dr. Fung and her two partners employed 20 staff, a few of whom had just returned from an out of state conference. Lead opticians John and Mike were buzzing about all the new frames at the event, and asked to meet with the doctors to discuss an idea.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

    “We would really like to throw a trunk show at the office,” said John.

    “John and I will do all the prep work, but we want to do it the Friday afternoon before Labor Day weekend, from 3-6 p.m.,” said Mike.

    “We’ve never done something like that before,” said Dr. Fung. “Where would we start?”

    “Normally two doctors see patients Friday afternoons. I’d like to reschedule the last two hours and block that time out, so if someone comes to the event without an active prescription they can be seen immediately,” John replied.

    Dr. Fung looked at her fellow practice owners, who nodded their agreement. “Okay guys, I like your confidence! Obviously, there’s some pressure to be profitable to make up for the lost appointment times, but an event could be a lot of fun for the community,” she said.

    John and Mike spent the intervening five weeks in party planning mode. Two of their frame reps with multiple lines agreed to attend. The pair decided on a tropical theme and accumulated a variety of grass skirts, streamers, leis and cardboard signs.

    Mike posted several times on the practices’ Facebook and Instagram accounts, and John reached out to the local paper to ask a reporter to visit during the event. The front desk mentioned the event to everyone who called in, and a framed sign was placed at the check-in counter. In the week leading to the big day, the opticians noticed several patients opting to hold off on purchasing to take advantage of trunk show discounts.

    Friday morning the staff arrived in Hawaiian shirts, full of energy. The day flew by and soon it was 3 p.m. The office looked fantastic: the frame reps had plenty of space to spread out their trays, the food and drinks were beautifully displayed, and a dozen helium-filled balloons at the sidewalk swayed in the breeze. The team waited eagerly near the front door.

    At 3:15 p.m., a man with his two small children came in and went straight to the food table. Mike greeted them.

    “Oh, I’m your frame rep’s husband,” the man said, pointing towards the showroom. “We’re on our way to camp for the holiday weekend as soon as she’s done. Six o’clock, right?”

    “Right,” Mike replied feebly.

    A couple who had exams earlier in the week showed up to browse and enter the raffle, but by 5 p.m. it was just the staff and the reps.

    Eventually Dr. Fung cornered Mike and John. “Guys, what’s going on? Where are the people?” she asked.

    Just then a woman walked through the front door. “Hi, I’m a reporter with the Post Dispatch,” she said, greeting the group.

    John and Mike looked at each other weakly.

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    The Big Questions

    • What could John, Mike and the rest of the staff have done differently to attract more attendees?
    • Is there a way to salvage this event? How would you handle the reporter?
    • Should Dr. Fung, as the practice owner, have done something different? As owner, would you agree to another trunk show in the future?
    Sam M.
    Princeton, NJ

    Five weeks wasn’t enough time to prepare. You have to do mailings, email, social media etc. Did you do newspaper ads? Did the participating vendors help in marketing? I also wonder if there were too many brands shown. A trunk show should be something special. We do a Lafont Trunk show every year because it IS a special line. We sell 30-35 frames in a three-hour period. Also, don’t give up! Trunk shows build on themselves. Every year you will get more people coming in. Make it a yearly event.

    Anissa L.
    Berkeley, CA

    It’s so hard to put together an event such as a trunk show. So, kudos to the lead opticians for the excitement. There are a few things I would have changed. 1. It’s never a good idea to put an optical event directly before any holiday. At that time families are spending time and money together. Solution: It would have been smarter to put the event two weeks after Labor Day. That way there would have been a better turnout and any vacation money would have been put back in people’s bank accounts. 2. Advertise! Post! Retweet! Anything to get the word out. It seems like that wasn’t done to entice people to come into the office. Maybe they didn’t know it was happening. 3. Too much excitement. When an office isn’t known for a trunk show, wait until the third go to get maximum turnout. Next time’s the charm!

    Scott K.
    Dover, OH

    First: Never have a trunk show on a holiday weekend — too many people traveling. Second: Send postcard mailers to specific household income or net worth homes in the surrounding area. On one side of the postcard make it simple and eye catching. On the other side, give some details about the trunk show but keep it clean and easy to read. Third: If possible, email your top customers. Fourth: Have the sale the same weekend every year to build up awareness over time. Fifth: Run a large ad in the local paper — go big or go home.

    Judy C.
    Virginia Beach, VA

    1. Wrong day, wrong theme. Never schedule an event on a holiday weekend. Never. Tropical theme is great, but perhaps during cold weather when everyone is dreaming about their summer vacation. Have a Kid’s Day in early August or a Mom’s Day in the spring.
    2. Nothing to salvage. Divvy up the food among the staff and reps and call it a day. Use the time with the reporter to talk about eye health and lens/frame options.
    3. Start planning the next trunk show immediately. Choose a date and a theme and set a timeline for publicity. Build excitement beyond the practice. Invite the neighborhood!

    Lois S.
    Winter Park, FL

    I think they had the right idea, but needed to NOT have it on a holiday weekend, and hold it during the week, in the daytime or afternoon. Perhaps they could stay an hour later to accommodate people after work. I would have it on a busy doctor day, so your patients coming out of the exam room will purchase. If you have no more exam spaces available, write up the order, hold it in the computer, make an exam appointment, and offer them the special pricing then. Perhaps they could have contacted their best-purchasing patients by phone or postcard to inform them of the event.

    Jenna G.
    Fargo, ND

    First thing: BAD DATE/TIME. The Friday before a long holiday weekend is not a good time to try and get people to come shop. They want to get out of town. Why clear the schedule? Instead, use that time to target patients who want to buy glasses, have them come in for their exams, and have a bigger selection to choose from. Let them know there is going to be a party and you want them there! Use the reporter to talk about the practice, not just the event. Maybe they should sit down with the practice owner and talk about what is unique about the practice. Don’t send away free advertising! Unfortunately, you can never totally predict turnout. We have had trunk shows where I have done the exact same amount of marketing, and some are hits, and some are misses. Document and evaluate. Be brutally honest about what went well, and what didn’t. Learn from it, and do it differently the next time.

    Jon L.
    Madison, IN

    As the founder of McDonald’s would say, “Early to bed, early to rise, advertise, advertise, advertise.” Ray Kroc knew that if you want business, you have to let everyone know what you are all about. Don’t think that happened here.

    Alicia M.
    Anchorage, AK

    Their first and biggest mistake was the timing of the show — Friday afternoon on Labor Day weekend. The only thing folks want to do is get off work early and finish loading up the camping and boating stuff, and leave for the weekend. Not go visit their eye doc’s office. I think if they had picked another day, possibly a Tuesday or Wednesday afternoon not preceding a holiday weekend, they would have done better.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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    Real Deal

    What Would You Do If You Were This Office Manager Who Caught Her Doctor and Optician in a Sneaky Sun Swap?

    Rx lenses are made but they never get dispensed so that a plano sun gets covered by insurance.

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    WEST VIRGINIA’S BALFORD Vision Center had recently hired their first practice manager, Ellen. She moved to town specifically for the opportunity, bringing nearly 20 years’ experience. The small staff was eager to impress, yet anxious at the prospect of Ellen exposing various flaws and inadequacies.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com

    One day Ellen was covering the lab while optician Leslie took her lunch break. A patient arrived for an eyewear dispense, and Ellen reviewed his tray: a sporty, wrapped frame with G-15 polarized lenses. Ellen also found a baggie containing an additional set of heavy, clear lenses.

    She checked both pairs in the lensometer and popped back out to see the patient.

    “Sir, I just need another moment. Your glasses are here but I need to insert your prescription lenses into the frame,” she said with a smile.

    “No, no, I don’t want the prescription,” he replied. “The other person said she was going to give me the plain lenses so I’d have sunglasses to wear over my contact lenses.”

    Ellen cocked her head to one side. “Strange. I wonder why she made you lenses,” she said quietly. “Well, I will go get your sunglasses for you!”

    Ellen spent some time adjusting the man’s frame and once more confirmed he didn’t want his prescription lenses. As he stepped out, Leslie walked in.

    “Hey!” said Ellen amiably. “Can I ask you about that guy’s order?”

    “Sure, what’s up?”

    Ellen grabbed his tray and started rifling through it. “Why did you order prescription lenses, but not dispense them? He told me he just wanted the demo sunglass lenses.”

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    “He wanted to use his vision plan,” explained Leslie.

    “Oh,” said Ellen, and paused. “I guess I don’t understand.”

    “Well, they don’t allow patients to buy plano sunglasses, so I just order a pair of lenses that are completely covered or just have the minimum copay, then swap the lenses out when they come back from the lab and throw them away,” she said matter-of-factly. “If they have a co-pay, we deduct that from the frame copay so they aren’t paying anything extra. Patients are fine with waiting, as long as they can use their plan.”

    Ellen nodded slowly. “Is that what the doctor wants, or is that your own workaround?”

    “Yeah, Dr. Balford told me to do it that way,” said Leslie.

    Ellen sat down with the practice owner a few hours later to explain the situation and her concerns.

    “We can’t order lenses with no intention of dispensing them,” explained Ellen.

    Dr. Balford shook his head. “I don’t remember ever discussing this,” he confessed. “But it seems silly not to be able to give the demo lenses to a patient — it should be considered a part of the frame purchase!”

    “If we get audited, there’s a risk our contract will get canceled,” warned Ellen.

    “That’s a big ‘if,’ Ellen.”

    “You have also encouraged an employee to commit insurance fraud. I reviewed our records for the last 12 months and I see 20 instances of Leslie processing fake lens orders,” she said. “We need to take action of some kind.”

    Dr. Balford shrugged his shoulders. “I feel like this is a gray area — I’m not convinced we should change anything.”

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    The Big Questions

    • Do you agree with Dr. Balford that demo lenses should be included as part of the frame purchase?
    • How do you protect the business if it gets audited by the vision plan in question?
    • If you were in Ellen’s position and Dr. Balford elected to continue this policy, what would you do?
    Jess G.
    Leesville, LA

    Patients are responsible for any eyewear purchase that is not covered by their allowance plan. If they don’t need prescription eyewear, they should re-evaluate the money they are spending on their monthly vision plan premium compared to what they would pay out of pocket for an eye exam and plano sunglasses and ask themselves: “Is this vision plan really saving me any money?”

    Cory S.
    Las Vegas, NV

    As frustrating as it may seem, most vision plan contracts prohibit this type of activity. The intent is to defraud a vision plan. If there is a plano sunwear option it will be stated in the benefit. You will not only lose your contract, but also face heavy fines, penalties and possibly legal action. Something similar would be for a patient to “give” their frame to a friend or family member. This also constitutes fraud. Better have your ducks in a row to show you were not complicit in the scheme.

    Caitlin W.
    Montrose, CO

    I would not be comfortable with the situation at all. Letting patients know that is insurance fraud would be my first step. Also, most companies will write out the policy, which I would show to the patient and explain why it is not something we are willing to do at our practice.

    Missy D.
    Spokane Valley, WA

    We always let the patient know what their insurance benefits are. If their prescription is valid for lens coverage but the patient just wants plano sunglass lenses, we explain that we will need to fill the lens prescription to utilize their lens benefit and we dispense the eyewear with the prescription lenses mounted in the sunglass. We give the patient the stock plano/demo sunglass lenses and let them know if they don’t like the prescription in the sunglass after giving them a try we can mount the plano/demo lenses back in. We’ve used their benefit according to their plan, explained coverage to the patient but also allowed the patient to keep all parts purchased. The original stock plano/demo lenses were part of the frame the patient is purchasing (even if they are using their insurance coverage), so they should be allowed to keep them. It becomes up to the patient after that, what they do with those lenses.

    Pat R.
    Irving, TX

    According to both VSP and EyeMed this is fraud. We don’t do it where I work. We have patients try and we tell them no. However, as long as the patient is really getting prescription lenses they will actually use, I don’t mind giving the plano lenses to them for future use if they can no longer use the Rx lenses.

    Judy M.
    Pittsfield, MA

    I would give demo lenses with a sunglass frame. I would not order Rx lenses knowing the patient is not going to use them at all. I do agree with the doctor to give the demos to the patient as long as they have ordered Rx lenses that they will use. The reason I give demo lenses is if in the future the customer wants contact lenses or to let someone else have the sunglasses, they have the demos. If the business gets audited, they will have to face the consequences. If I were Ellen and the doctor wanted to continue this practice, I would look for another job.

    Judy C.
    Virginia Beach, VA

    The doctor and optician may consider it a gray area, but the vision care plan will not. Fraud is fraud, no matter how well intentioned. Another big “if” is the patient seeing another, different practice and expecting the same “help.” One complaint to his vision care plan about perceived unfairness will surely trigger an audit and will definitely expose other discrepancies for as many years as are investigated. Regardless of the doctor’s actions, the office manager should document both her findings and her conversations about the issue with the doctor. Whether the office manager stays or leaves is a personal choice, but she must understand that her professional reputation will be at risk if and when an audit is done. In addition, she may be liable for hiding the fraudulent claims.

    Jennifer L.
    Dansville, NY

    You have to abide by the contract you commit to with the insurance company. If they do not allow plano eyewear you must not make a revision so they can get plano eyewear. I also believe that when you sell a plano pair of sunglasses then Rx them, that person bought the demos with it — give them to them. If they decide later to swap out the Rx lenses for the planos then do it. It’s ridiculous to nit-pick some of these things but you have to honor the legal contract you agree to. Explain the situation to the patient, how illegal activity can shut down your business, and how important it is for you to be legit. Tell them you can’t control what they do when they leave the office or in the future, but what happens in your office is always above board and transparent. Your reputation and integrity are top priority.

    Leisa L.
    Newport Beach California

    Where a patient uses their insurance plan for sunglasses and the frame has plano lenses mounted the lenses are part of the frame purchase and should be at least offered to the patient when dispensing the completed glasses. If the patient also wears contact lenses and decides to use the plano lenses that is their choice. If a pair of lenses are cut for the patient that are not actually the patient’s Rx, that is a completely different situation. It should not be considered insurance fraud when making the proper Rx for sunglasses. There are other ways to handle the sunglass sales. Recommend two different pairs, one for wearing over the contact lenses and a second Rx pair without the contacts. In fact, there have been several sunglass frames made with pop-out lens ability just for this purpose. The Porsche Carrera and a Cazal come to mind immediately.

    Rigo L.
    Indio, CA

    Wow, this is a tough one, depending on how you see it or how you work the insurance. Where insurances don’t pay much, in a small private office where we want to make some money off insurances, why not? On the other hand, I have worked in a larger practice with multiple locations where this was out of the question. I don’t see a fraud issue as long as the patient has the minimum Rx, they understand what we are doing and the lenses get dispensed. Where it becomes a very dark gray area is when you are trying to save the patient money and you bill the insurance for a different frame and not dispense the lenses. Even though the patient has an Rx you are basically lying to the insurance company and this can be a big issue. In Ellen’s case she sounds like, and I could be wrong, an old school optician. There is nothing wrong with that as long you are good with, and open to, change.

    Stewart G.
    San Francisco, CA

    1) VSP guidelines state that the demo lenses are not to be given to the patient. So, the answer is no.
    2) You can’t protect the business. The business has committed insurance fraud. And VSP guidelines are such now that they can go back years and request you pay them back for all those orders plus interest plus penalties AND you can get kicked off the roster.
    3) Ellen may need to put what she said in writing to protect herself, or start looking for a new position in a different office.

    Pablo M.
    Alpharetta, GA

    1. No, we do not hand out the clear demo lenses, so why do the color ones? It is supposed to be an Rx job for insurance purposes, right?
    2. How do you protect the business if it gets audited by the vision plan in question? Turn witness for the prosecution, your honor…
    3. I would try to explain to the good doctor why this is all a bad idea all around, and if the doctor decides to keep doing it, it will be without my help. I deal too much with insurance as it is to get involved in these kinds of messes.

    M. Pastor
    Phoenix, AZ

    In this scenario, Ellen is completely correct! The doctor/owner is a complete idiot and should not be in business if he is willing to commit insurance fraud! Ellen, find a new job with an ethical practice!!

    Donna
    Mission, British Columbia

    I would never do this; it’s insurance fraud. My credentials and reputation are worth way more. I would never protect or work at a place that allows it.

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