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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

    A Sublease Eye Doc Didn’t Work Out

    Should the optician/owner pursue their non-compete?

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    ROXANNE WAS AT HER desk on a Sunday afternoon reviewing bills and rubbing at stress hives on her neck. The optician-owner of a gorgeous boutique near Sioux Falls, Roxanne was at her wits’ end with her sub-leaser, Dr. King. The women had a meeting scheduled to try to resolve their differences.

    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

    The pair met the previous year at a CE event and hit it off. Dr. King, a stay-at-home parent of several years, was inspired to return to work part time, and Roxanne was inspired to offer eye exams to her loyal client base. They created a two-year contract including a non-compete clause limiting Dr. King from practicing within 3 miles of her office within a year of contract termination, on penalty of several thousand dollars. Once the commitment was made, Roxanne retrofitted storage space into an exam lane and purchased second-hand equipment.

    Roxanne, waiting impatiently, now ran through the details in her mind to prepare for a contentious discussion. The terms of their agreement were 8-10 comprehensive exams in 4 hours for a flat rent. Patients scheduled with Dr. King directly so she could book around her family commitments. She billed and collected all exam fees, while Roxanne’s employees pretested, collected co-pays, and processed contact lens orders.

    For a few months everything went well. Then the financial disagreements began: Dr. King started scheduling just 2-3 patients a day and decided it would be fair to only pay rent every second or third week. Payments on the equipment leases were now greater than the rent. Roxanne was also seeing lots of shipping charges for contact lens trial orders, which Dr. King felt were the responsibility of the business as they profited from supply sales.

    The front door squeaked and a moment later Dr. King sat down at Roxanne’s desk. She looked worn but resolute. “I know you called this meeting,” she began, “but I’d like to speak first.”

    Roxanne nodded and pushed her paperwork to the side. “Okay, I’m ready.”

    “I’ve given it a lot of thought, and I just don’t think this is a good fit for me,” said Dr. King. “I’m tendering my resignation, effective 2 weeks out. I don’t have any patients booked past then anyway.”

    Roxanne’s eyes bugged. “You’re quitting?!” she managed to get out, throwing her head back and staring at the ceiling. “You’re quitting.”

    “This just isn’t fun for me,” she continued. “I don’t like your stress towards me, and I feel like I’m being nickel-and-dimed.”

    “Are you leaving to go work somewhere else?” asked Roxanne.

    “No, my wife and I don’t rely on my income,” she said.

    Roxanne sighed. “Well, it sounds like your mind is made up. It stinks we weren’t able to resolve things, but … I get it.” As soon as Dr. King left, Roxanne got to work posting the job vacancy online.

    A few weeks after Dr. King’s last day, Roxanne’s lab tech stopped her in the hallway. “I just heard through the grapevine, Dr. King is seeing patients over at Family Vision Center,” he whispered. Exasperated, Roxanne thanked him and went to call her lawyer about enforcing the non-compete clause. Family Vision Center was less than 2 miles away!

    The Big Questions

    • In what way could Roxanne and Dr. King have changed their agreement to mutually improve the situation?
    • If Dr. King bills for a contact lens fitting and the boutique bills for the supply, who pays the shipping and handling of trial lenses?
    • Is a non-compete clause justified for a sublease doctor? If the lawyer deems the contract enforceable, would you pursue?

    Expanded Real Deal Responses

    Andy H.
    Jacksboro, TN

    This scenario poses a significant problem for the optician/owner. I’m not sure how I’d resolve this situation, but it could’ve been avoided if a reputable business consultant had designed the contract. A professional consultant would have covered all the disputed variables. I think it’s interesting that a recent INVISION survey showed a mere one in four ECPs use consultants, and this Real Deal demonstrates the need to do just that. We’re all pretty smart about eyes, but not many of us can claim to be experts in business.

    Chris G.
    Inver Grove Heights, MN

    First, I didn’t see a copy of the non-compete document. Some of these documents are unenforceable depending on the laws in the state where this occurred. Second, all costs should be negotiated at the beginning of the employment. Third, even if a lawyer deems the contract enforceable, it can still be nullified by a myriad of other factors. Having said this, if all the contingencies are met in the agreement and it is enforceable, I would go after it immediately. Another part is who owns the files in the office. That should be negotiated as well.

    Bill K.
    Houston, Tx

    Bad terms of agreement upfront. Starts bad, ends bad.
    1. More concrete terms and understanding.
    2. Cost of trials? Ever hear of fitting sets?
    3. Non-compete should hold up if written correctly.
    Not a bunch of 2-year-olds at play. Grow up and live up to your commitments. “I don’t feel like I am respected.” Blah blah blah.

    Anna T.
    Claremont, CA

    First of all, they should have spoken more about what was expected from the lease. Possibly going through a broker to have a legal agreement prepared with terms stating that the lease was to be paid every week and that X amount of patients were expected per week. Also, they should have agreed upon the costs of the lenses, and who was paying for shipping charges in the agreement. Ultimately, I think that the doctor just did not have the right work ethic for this sort of collaboration. I think that the doctor’s fees should cover the trial shipping costs. I believe the non-compete is justified. However, since this doctor did not spend very much time working at the location, I am not sure that she would be much competition if she were to set up office in a nearby location. Most likely with her work ethic she would not be much of a business owner in the future.

    Rigo L.
    Indio, CA

    Ohh, the drama! It’s always easier to blame the other person. Both Roxanne and Dr. King gave up too soon; communication is key. It was unprofessional for Dr. King to quit. It’s not expected but the doctor should feel heavily responsible — in this case it looks like it was all business. The shipping and other stuff could have been worked out if both were willing to keep to their agreement; at the end of the day they still made a profit. As far as pursuing the non-compete clause, it sounds exhausting, expensive and time-consuming, but if this is going to save my business, I would go ahead with it.

    Darrell L.
    Goodlettsville, TN

    The contract should have spelled out the particulars of fees, bills and supplies. Leaving things open-ended always creates problems. The non-compete is justified and was agreed to in writing, therefore it is binding. If the tables were turned, the doctor would likely pursue reimbursement for damages from the optician.

    Frank U.
    Bakersfield, CA

    No lawyer; lesson learned, find another doctor.

    Wilfredo M.
    Philadelphia, PA

    Unless Roxanne and the doctor agreed to bringing another doctor to work more hours, I don’t see how. Two or three exams a day doesn’t justify the expense of equipment, or cutting the space to put in an exam room.

    The optical should pay for shipping for trials, but also keep in mind that for trials at least a commitment for the sale of the contacts should be engaged, or an order for glasses should be placed — and then seen as a courtesy from the optical, not from the doctor.

    Whatever is the right and legal thing to do. If the income was not the issue based on Dr. King’s answer, why work in a place that close? People should not be allowed to conduct a market study while working with you and then become your competition! Keep in mind that patients are the “property” of the doctor, who did the billing.

    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.

    Continue Reading

    Real Deal

    A Compensated Lens Design Tripped Up This Eye Doc

    The patient wants his glasses and exam refunded.

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    IT WAS A BRIGHT SATURDAY morning in Baltimore and Dr. Garcia’s optician Elena was engrossed in auditing last month’s lab bills. Ten months ago she had been recruited from a bank teller position by Dr. Garcia. His previous optician had quit unexpectedly, and after a month of trying to hire someone with experience, the optometrist trained Elena himself.

    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

    Dr. Garcia interrupted her concentration with a patient hand-off. “Elena, you may remember Victor, he had an exam a month ago,” he said. Victor and Elena nodded to each other in recognition. “Well, Victor had his glasses made down near D.C. and they aren’t right.”

    Victor handed Elena his spectacles: progressives in a drill mount frame. “I just picked them up yesterday. Since I live closer to you guys, and you did the exam, I thought I should have you check them.” He threw his hands up in exasperation and added,

    “I just can’t drive in them!”

    Elena cradled the frame. “Let me read the lenses, I’ll be right back!” Victor sat down at the dispensing table and Dr. Garcia followed the optician into the lab.

    “I checked them already,” said Dr. Garcia quietly. “They’re off — the left lens in particular is 12 degrees off-axis, and the right lens has cylinder even though I didn’t prescribe any. Look at the add power — I wrote for 2.50, but they made a 2.44 and a 2.45. What the heck is that?!”

    Elena gave Dr. Garcia a look of shock. “What should we do?” she asked.

    Dr. Garcia squinted through a few thoughts before grabbing the frame from the lensometer.

    “Follow me,” he instructed, heading back to his patient.

    “Victor, these lenses aren’t what I prescribed,” confirmed Dr. Garcia. “You can go back and tell them to make them again, but if I were you I’d ask for a refund and get your glasses made here.”

    Victor frowned. “Fine, I’ll get a refund the next time I’m in D.C. I just want glasses I can use,” he said.

    Elena helped him find a flattering acetate frame, took his measurements and promised a quick turnaround. Dr. Garcia took the job directly to the local lab before work on Monday, and on Wednesday afternoon the patient, delighted, picked them up.

    The following Wednesday evening, Victor was back again. Dr. Garcia was with patients, but he found Elena in the lab.

    “I took these glasses back to the place I got them from, told them you said they were made wrong and asked for a refund,” he recounted. “The owner drew on them with a marker and spent about 15 minutes bending them, and then I saw great. He said if you guys think they were made wrong, you shouldn’t be in the eyeglasses business!” Elena’s face flushed and her eyes started to burn. “I obviously want to return the pair you made me, as I don’t need or want two pairs of glasses. Frankly, I see better with the other pair anyway.”

    “I’m so sorry about that,” stammered Elena. “Dr. Garcia approves our refunds and the bookkeeper issues the money.”

    “Fine, here are the glasses,” he said, handing her a beat-up gift bag. “I expect that recheck visit to be refunded too. Completely ridiculous,” he muttered, and stormed out.

    The Big Questions

    • Dr. Garcia is clearly unfamiliar with compensated lens designs. Is there anything anyone could have done better in this situation?
    • Elena now has a returned frame that has been worn a week. Should it go back on the board for resale?
    • Victor is insisting his recheck fee of $50 be refunded. How should Dr. Garcia proceed?

    Expanded Real Deal Responses

    Rachael D.
    Burlingame, CA

    I find these situations very tricky. You don’t want to call out the doctor or make any accusations and potentially ruin a business relationship. Assigning blame doesn’t necessarily instill confidence in a patient or client either. I would have printed out the compensated lens Rx and discussed that with the doctor and patient. The numbers game can be very deceiving. I would have encouraged the doctor to contact us to discuss her findings before making statements that may not be true. I would afford her the very same professional courtesy. There shouldn’t be a fee for a recheck if she did the original exam. The frame gets donated.

    Manuel L.
    Midland, TX

    Dr. Garcia should have checked the glasses on the patient’s face, made proper adjustments, tried to bend the axis maybe 2 or 3 degrees, and probably could have made the Rx work. He never should have charged $50 for a recheck. That should have been considered a bit of professional service gratitude.

    Taylor K.
    Ellington, CT

    1. Dr. Garcia should have had Elena contact the fabricating location and learn more about the lenses. Elena could recommend to the dispensing location the doctor’s suggestions to address the patient’s issues before encouraging the patient to order a new pair. We would never force a new pair on a patient unless it was their idea, and we would emphasize that we do not return orders.

    2. Elena will need to assess the wear on the frame. If it is in great condition. then clean it, add new demo lenses, and put it back on the board. Otherwise, return it under warranty.

    3. I would advise the patient that because there was not an issue with the prescription, they are responsible for the re-check fee. I let the patient know for future reference that had our office made the glasses or there was an error in the prescription, then there would be no charge. The dispensing office’s errors do not constitute free chair time for a patient that is not loyal to the practice.

    Yen N.Dallas, TX

    Digital or high index lenses have been known to cause a compensated Rx. Not knowing the difference, since he may not be knowledgeable about that, the doctor probably assumed they were made incorrectly. (I know this from personal experience.)

    Knowing all lens possibilities in this industry — whether doctor or optician — is vital so that there are more reasonable conclusions for the guest. Ask more questions about what the client purchased, and what type of specific vision issues could be ruled out by adjustments. The frame could be marked down, with the next customer being informed that they were a frame worn and returned within a week. But get it cleaned and polished by the lab before putting it back on the shelf. If your business does not do that then request an RA if possible. The recheck fee should definitely be returned. The client should not have to pay for something that did not benefit him. A lost customer is not worth the $50 in the end.

    Leisa L.
    Newport Beach, CA

    Before Dr. Garcia and his optician suggested returning the drill mount glasses, there should have been more communication with the patient regarding the actual areas where his vision was not comfortable. Adjustments could have been made by Dr. Garcia’s office staff to correct the problems. The patient was charged a recheck fee, which is questionable considering the original Rx was done by Dr. Garcia. The end result would have been a better relationship between Dr. Garcia’s office and the patient.

    Yvette R.
    Cincinnati, OH

    Adjustment should be an additional consideration when a patient says that he cannot see. Dr. Garcia would benefit from a continuing education class on digital lenses and position of wear. He needs to arrange for Elena to receive training from a lab rep. Elena could ask Dr. Garcia if the extra pair of glasses could be given to the angry patient as a back-up pair and a gesture of apology. I would refund his re-check fee as well, and hope that he returns for his routine exams.

    Bob S.
    Pinellas Park, FL

    Both the doctor and Elena need to get up to date on lens technology. They need to request help from a lens rep and take some CE courses on the subject. If the frame is not damaged it could be sanitized and go back on the board. His recheck fee should be refunded since it was unnecessary.

    Charley A.
    Hurst, TX

    Cut your losses. Refund all fees subsequent to the initial exam. No one said the “glasses were made wrong,” just that they did not appear to be made to prescription. Confirming the patient’s understanding regarding the follow-up exam and the refund/remake policy regarding the second pair or glasses might have helped. The patient will not remain happy. Be on alert for his return.

    Rigo L.
    Indio, CA

    Let me start by saying this is a rookie mistake by Dr. Garcia. Doctors should never talk money with patients and more so, never recommend patients to return/refund glasses and get them at their office. Elena didn’t do anything wrong; she is not an optician, she is learning the business. We all hate when patients get glasses elsewhere and want us to figure out what is wrong, but the best way to handle this is by sending them back and having the office who made them figure out what is wrong. There was no reason for Dr. Garcia to do an Rx recheck. Even if the glasses were made wrong, they should have been remade correctly before any recheck. Nobody likes the idea of wearing a used frame, but in small optical shops and in cases like these, they are not going to take a loss on a frame. Compensated Rxs are not something new; by now everyone should be familiarized with digital lenses. This looks like a lose-lose situation: lose money and a patient.

    Maureen G.
    Oak Park, IL

    Dr. Garcia clearly needs some CE classes. At the very least get your lab reps in to talk about the latest digital designs and compensated Rx. He should also have Elena go to classes; joining a group such as PECCA would help immensely. If the frame is in usable condition, you can discount it and be upfront about prior wear and definitely refund his money.

    Andrews, MD
    Hurst, TX

    Cut your losses. Refund all fees subsequent to the initial exam. No one said the “glasses were made wrong,” just that they did not appear to be made to prescription. Confirming the patient’s understanding regarding the follow-up exam and the refund/remake policy regarding the second pair or glasses might have helped. The patient will not remain happy. Be on alert for his return.

    Stewart G.
    San Francisco, CA

    1 The only thing I can think of is perhaps calling the place where the patient originally bought the glasses and discuss the issues.

    2. I’m uncomfortable with that, but offices will do that.

    3. It depends on whether or not the Rx was changed radically in the first place. I wouldn’t have charged him in the first place if the prescription had not changed significantly. I would only have done the recheck if the Rx had changed.

    We have a case here of the blind leading the blind. This professional doesn’t know about these lenses and he’s teaching a novice about things he doesn’t even know? OMG!

    Judy C.
    Virginia Beach, VA

    I learned years ago that you can’t make yourself look better by trying to make someone else look bad. The first move should have been for Elena to call the office where the glasses were made and ask for all the pertinent information, letting them know that their mutual patient was unhappy. Simply relying on a neutralization is not enough. Checking the adjustment of the frame should have been the second move. Finally, there is no excuse for not knowing about current lens technology. Education is available from multiple sources and in multiple modalities.

    Rick R.
    Girard, PA

    1. For one thing Dr. Garcia should have never told Victor to return the glasses for a refund and purchase them at his office. I wouldn’t be happy with either office. If the office where he purchased the glasses had to spend 15 minutes “bending them” I certainly wouldn’t be feeling too comfortable. Especially drill mounts.

    2. If the frame was still in good condition, I’d put it back on the board at a reduced price.

    3. Dr. Garcia should give back the recheck fee. Clearly (no pun intended) he was in the wrong.

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    Real Deal

    An Order is Canceled After the Insurance Company Steals the Work. How Must the Office React?

    An order is canceled after the insurance company steals the work. How must the office react?

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    SECOND LOOK OPTICS, a well-established optometry practice near Iowa City, IA, offers a lot to patients. The optical displays over a thousand frames, the doctors accept all regional insurance plans, and their schedule includes evening and weekend appointments. Late one Saturday, optical manager Zack was paired with new patient, Bonnie, who was on a mission to find the perfect frame.

    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

    “I really like the Warby Parker look,” Bonnie explained. “Roundish, nerdy, and preferably clear with a hint of gold or silver. Do you have that?”

    Zack knew there was an older Kala frame somewhere in a yellowish crystal, and after searching a few drawers in the dispensary he found it. Bonnie put them on and faced Zack.

    “So, I don’t think this is a flattering color on you,” he said. “Also, the keyhole style doesn’t really fit your bridge.”

    Bonnie looked in the mirror and grimaced.

    “Can I pull a few frames together for you to try?” he asked.

    “Yes! I almost bought something like that online … I’m so glad I didn’t,” she said.

    Zack quickly assembled a set of four disparate frames and after half an hour of deliberation Bonnie selected one quite different from her original intention. She and Zack then carefully went through the math to determine if her vision benefit should be applied first to her contact lenses or the eyewear. Bonnie hadn’t had new glasses in six years and was struggling to accept the frame and lens prices, even with the discounts. Eventually everything was settled; Zack entered the orders and collected her co-pays.

    The following Monday afternoon Bonnie called to speak with Zack about canceling her order.

    “I sent you an email; did you read it?” she began.

    Zack found the message, time-stamped 20 minutes earlier. It was a forwarded e-mail from her vision benefit plan, encouraging her to purchase her glasses through their internet portal. It was sent late Saturday evening.

    “I’ve been on the phone with them, and their prices are much more reasonable than yours,” she continued. “I don’t really understand why you didn’t mention this was an option available to me? I made it clear I really need the most affordable pair possible.”

    Zack was unsure of what to say, but Bonnie seemed to genuinely expect him to explain himself.

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    “Well, of course you are not obligated to fill your eyeglasses prescription from the same office as your exam services,” he finally replied. “However, I have already submitted your order to the lab and the work has begun.” Zack held back a key detail: the practice had a strict no-returns policy.

    “I called my insurance and they just told me to call and cancel the order, that they would approve it,” Bonnie replied. “I have the lady’s name I talked to, if you need it.”

    “Okay, I’ll call and then ask our bookkeeper to mail you a refund in the form of a check,” said Zack.

    “Hang on, I also got an email yesterday from a contact lens website. They said I was eligible to try their new brand of contact lenses — which they sell for less than what I paid at your office — and if I did I’d get a $50 gift card to Amazon. So I need a refund on the contact lens order as well.”

    “Your contact lens brand is chosen by the doctor, you’d need to come in for a follow-up exam if you want to change brands,” explained Zack.

    “I don’t think so,” Bonnie said skeptically. “They already processed my order. I even have a tracking number.”

    Zack assured Bonnie the bookkeeper would be in touch and hurried her off the phone to find the bookkeeper.

    The Big Questions

    • Second Look Optics has a no-refunds policy. Should the policy always be overridden by vision plans or is there a middle ground?
    • What can Bonnie’s doctor do regarding her use of mystery contact lenses?
    • Now that Zack is aware these emails are being sent to patients, should his department treat patients with that insurance plan any differently?

    Expanded Real Deal Responses

    Mina K.
    Brooklyn, NY

    No refund policy should stand. Customer dissatisfaction can always be solved with a redo, exchange, store credit, etc. The doctor should educate the patient that trying inferior contacts is not appropriate for her wear schedule and detrimental/risky to her ocular health. The recommended contacts are the best and can be made more affordable by buying in volume and with rebates. Zack needs to affirm that his services/care rendered are valuable, and personal attention is unmatched by anything bought online by any service or insurance company. This goes for any customer, regardless of insurance.

    Kenneth P.
    Oklahoma City, OK

    Definitely a no-win situation for Second Look Optics. If you don’t give her a refund you look like a jerk, even with the no-refunds policy, but if you give the refund you are losing money because the lab already started the job and potentially will not no-charge the lenses. (Depends on the insurance company and lab, of course.) Since this is a new patient do you risk the blowback from an angry patient and the potential social media lashing? Do you take the time to call the insurance company and say what the heck? Do you explain to the patient that the insurance company is using inferior products to what you are selling hence the price difference? Make very detailed notes that the patient is ordering non-prescribed contact lenses from an online vendor. If the emails are standard policy, there is a need to consider whether to stay with that insurance company, but always try to educate the patient that buying elsewhere means inferior quality for their eyes.

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    Leonard H.
    Downers Grove, IL

    Move to the medical model of eyecare, use the terminology of optometric physican, refer to your practice as an eye clinic, write contact lenses as a prescription and stop trying to sell boxes of contacts, explain up front to patients “your glasses order is being placed as we speak, we will cover any and all issues with our prescription for you for 45 days. We know you will be happy with our eye exam and our optical expertise.” Face it fellow OD’s, we are being attacked from all sides. The old way is gone.

    Rigo L.
    Indio, CA

    I have seen this issue before in slightly different ways and the end result should be in my opinion the same; the office should not take a loss because of the patient finding a “better deal.” An easy way to avoid most of these issues is to always have the patients sign the office policy on returns/refunds. Policies should be included in new patient forms and should be scanned or saved. I have seen policies from no refunds to a 50 percent refund to restocking fees. In an office where the doctors go out of their way to care for patients and open late and on weekends, there is no room for patients that are trying to find “the most affordable pair;” in that case go to chain stores or the other cheap places — some take insurances. Zack should have been firmer with their “no refund” policy. The contacts should have been verified with the doctor before any changes. Not all patients are like Bonnie, so I would keep an eye out with that insurance.

    Cory O.
    Key West, FL

    The vision plan scheme is a zero-sum game for private practices. If you care about the quality of care you provide for your patients, and also want to turn a profit, then you cannot participate in any vision plan. Every day there is another layer of absurdity added to the process by the vision plan companies. This fictional article was only the tip of the iceberg in terms of the day-to-day confusion and problems that arise. Best advice that I have is to discontinue all vision plans or do lots of meditation and double the dose of your blood pressure meds.

    Judith W.
    Orange, CA

    Our policy is displayed throughout our office and printed on all receipts. All sales are final and non-refundable. We have had this happen to us and informed that patient that since the lenses were already in process that we could not cancel the order without charging their credit card for the lenses, since we would have to pay for them. The few times that patients have wanted to change the parameters of the contact lenses to match their wallet we have insisted that they come in for a refit. We explain that their eyes will react differently to each lens material and curve/diameter design and must verify that they will not react adversely to the lens, causing permanent damage. If the patient is not willing to come for the refit, then we will not approve the change and only confirm for what was prescribed. Since this has happened to our office, we do not pull authorization till the day of service and submit immediately once the patient has left.

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    Richard K.
    Castle Rock, CO

    I would write a letter to the insurance company explaining my feelings regarding them stealing my customers and ask to be removed from their network. I know that this reduces exams, but if enough ECPs do this, they may get the message. Unfortunately, it may just be around the corner that the insurance companies offer online refractions and cut out the ECP altogether. Otherwise, a clearly posted significant restocking fee retained on all canceled orders might help. As far as the patient getting different contacts than prescribed by the doctor, I’d at least check the state law and bring it to the attention of the state Attorney General’s office, as well as the FTC.

    Martha D.
    Wheatfield, IN

    Maybe they can match the price her insurance is giving for a new pair of glasses. Match what she would be getting from them and discuss with Bonnie the differences.
    Make a note in her chart and do not give her a prescription for the new contacts. Let her know if she decides to not see the doctor; it is on her, not the doctor for the contacts.
    Maybe call the insurance company in the future when dealing with someone who carries that plan.

    AJ S.
    Houston, TX

    I think it might be time to think about a class action lawsuit against the insurance companies that have this practice. Multilevel practices are destroying independent optical practices. Essilor and China are using the lack of control conditions to hurt rather than help our quality of care. Millennials think that computers can do everything, but they lack the human touch and so will the new generation of future adults. Time, patience, knowledge and personal communication should still matter in any medical situation. Eyecare and eyewear must be important and not be a computer program that is handled through greedy insurance companies that worry about the bottom line rather the human experience.

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