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A Non-Adapt Takes Her Anger Out on the Practice Instead of Her Insurance Company. How Would You Salvage This Situation?

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OPTICIAN JESSICA WAS engrossed in inspections one afternoon when she heard her name through the pager system. “Amanda is here. She says you’re expecting her?” the voice said.

“Yes, I’ll be right there. Please have her sit at a dispensing station,” she replied. Her throat was tight, anticipating a stressful encounter.

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 [email protected]

Last month Amanda was prescribed progressive lenses for the first time. Her insurance coverage limited the choice of progressive lens designs, but Jessica selected one commonly used by her coworkers for first-time wearers. The dispense had been fairly uneventful, but a few days later Amanda called after hours and left a voicemail. The lenses gave her a headache; she couldn’t walk in them, didn’t feel safe driving. Jessica called her back and arranged a recheck.

The combination of her complicated, high-cyl prescription and the limitations on lens choices stumped Jessica, so she decided to use the available one-time redo and made single vision lenses instead. Amanda was now here for the second dispense.

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Jessica had the tray prepped and ready, and headed out with a reassuring smile plastered on her face. Amanda looked harried but leaned forward as Jessica slid the frame into place.

“Much better,” she reported.

“Oh, I’m glad!”

“Now is my refund check coming from you or will the insurance company mail it to me?”

Jessica paused to consider the question. “A refund… for the lenses?”

“Yes, I paid for progressive lenses but they didn’t work. I know these lenses are much less expensive so I’m owed the difference.”

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The optician cleared her throat nervously. “Actually, the insurance company doesn’t refund because the lenses were made custom for you, but on the plus side they made these new lenses at no extra cost.”

Amanda sat back in her chair and shook her head vigorously. “I don’t accept that. The lenses were wrong. They were bad—I’m not paying more for their mistake. No.”

“Technically the lenses were made correctly, it was an adaptation issue,” Jessica said cautiously.

“Then did you make a mistake? Because I know that I didn’t make a mistake, and I can’t wear them!”

“If I were you I’d call the insurance company directly. They may elect to do a partial refund but they tend to want to speak directly with members.”

“Fine, I’ll call them myself. Thanks for your help,” Amanda said sarcastically.

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A few weeks later the practice owner called Jessica into her office; the company bookkeeper was seated next to her at the edge of the desk.

“We have a disputed charge for a patient you worked with,” Dr. White explained. “The credit card company says the exam and glasses were reported as a fraudulent charge, and several hundred dollars have been reversed. Not to mention we have lab chargebacks. What the heck happened?”

Jessica’s mouth gaped. “Amanda? She wanted a partial refund from the insurance company, but she HAS the glasses! She never returned them to me!”

The Big Questions

  • Was this an office policy gaffe? What could Jessica have done differently?
  • The bookkeeper wants to pursue the money; what would your best advice to her be?
  • Would you consider this a criminal act, and would you pursue it as such?
Margot L.
Madison, WI

While we do not work with insurance, we also do not give refunds for lens changes, even if less expensive. We are, however, upfront with the customer before moving forward in a way that doesn’t set them up assuming something will go wrong but lays an expectation for them. “Our lenses come with anti-reflective, anti-scratch, full UV and a two-year warranty. We also have a two-month non-adapt period from the time the lenses are completed that allows us to make changes for unforeseen reasons at no charge to you.” Usually the customer will ask a follow-up to that so then we can further explain that it is “risk free” to try a certain lens because if something ends up not working, which is rare, we will remake in a different style at no charge. I can’t even remember the last time someone disputed it… and they are paying out of pocket! Up front and honest always helps.

David B.
Dayton, OH

I would threaten her legally. This is fraud. Obviously, I would contact the credit card company first.

Monique B.
West Hartford, CT

That is a toughie to respond to. I wouldn’t know a better way than what Jessica did in that moment. The key was to set them up from the beginning —explain the possibility that they might not adapt to PAL. From there you can candidly let them know they will get a free pair of lenses of their choice to either SV or BF. Now in their minds they know the deal: no money back, if they ask. But have the discussion ahead of time.

Stewart G., OD
San Francisco, CA

In effect, her credit card was rejected. Send her a bill, and after the second month when she doesn’t pay, warn her that you’ll be sending it to collection. If she still doesn’t pay, send her to collection on the third statement.

Barry S.
Seaford, NY

Simple: Stop taking VCPs. Easy-peasy

Les M.
Santa Monica, CA

1. We always warn patients that progressives are not for everyone, although most people do adapt. We also explain that if they happen to be one of the few that can’t adapt, the lab will redo in bifocal or single vision at no additional charge. No refund though! The choice to go ahead then falls upon the patient.
2. With respect to the “fraudulent charge”, you should have documents showing the exam date and the glasses charges as well as a credit card signature authorizing the sale! This info needs to go to the credit card company to show she authorized the charge. If they do not reverse the chargeback in your favor, and the patient refuses to pay, get the insurance company involved.
3. Last resort, I would send to collection!

Craig F., OD
Rushville, IN

If Amanda wasn’t informed (verbally or in writing) of the PAL remake policy prior to paying for them, I think the office should have refunded the money. If she was informed (which we do with every PAL patient), then I think Jessica did the correct thing. We also have the patient sign a form that says he/she understands the PAL remake policy. The bookkeeper should contact the credit card company with a detailed explanation, including any written policy that was presented to Amanda at the time of the PAL order. The insurance company should be contacted to return the funds for any materials and exam fees that were “charged back.” I would also contact Amanda and ask her to return the glasses, explaining that since the credit card company has reversed the charges, then she technically hasn’t paid for any portion of the glasses she has in her possession. Offer her a big discount (maybe as much as the wholesale cost of the frames and SV lenses). If she declines, then call the prosecutor.

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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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