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A Patient Pushes an Optician to Bend the Rules. Is This A Gray Area Or Are They Committing Fraud?

The case of the fraudulent filing.

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COLIN WAS STRESSED. His coworker had called out an hour before her shift, leaving him to run the optical floor solo. Two patients were already moving through the frame boards when a tech escorted Dr. Tam out of an exam room and over to Colin.

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. Tam was a local general practitioner. Colin was relatively new to the Utah practice but he had already met Dr. Tam during his son’s eye exam.

“Nice to see you again,” said Colin, pumping the doctor’s hand. “Did your prescription change?”

“My reading power is being bumped up,” said Dr. Tam amicably. “I’ll get new progressives; you have my insurance information?”

“I do! I’m working with a few other people, but I’ll do my best to get you out of here quickly,” promised Colin. “I’ve got five frames pulled for you to start, see what you think and I’ll be right back.” After checking in with the first two patients, Colin bounded over to the reception station and pulled benefit printouts from Dr. Tam’s chart. When he came back Dr. Tam was already seated at an optical station.

“I like these,” he said, clasping one of the pairs Colin had selected, “and I want to order these Maui Jim sunglasses under my son Richard’s insurance plan. Do you remember him? He was in last month.”

Colin sat across from Dr. Tam and used a nearby laptop to look up the boy’s information. “It looks like he wasn’t given a prescription at his exam. Your insurance plan has a minimum prescription requirement to pay for the sunglasses,” Colin explained.

“Oh, that’s right,” said Dr. Tam, reaching into his breast pocket. He pulled out a prescription pad and, in front of Colin, wrote out a prescription for his son. “It needs to be a half-diopter, right?”

Colin nodded numbly, and awkwardly took the script when Dr. Tam handed it to him. “I need to take his measurements…”

“Just use what you have from last year,” said Dr. Tam. “It’s tough to get him in, between everyone’s busy schedules.” Sure enough, Colin found an entry in the EHR for another pair of Maui Jim sunglasses. Colin priced out the orders, took measurements and escorted Dr. Tam to reception to collect his copays.

Later that afternoon Colin found time to enter Dr. Tam’s orders. However, when he entered the authorization number that the front desk had pulled he found it was actually for Dr. Tam’s son – Richard Tam Jr. Dr. Tam’s benefit wasn’t available until the first of next month.

Colin immediately called the number on file for Dr. Tam. His wife answered their home’s landline and Colin explained the situation. “I can hold the order for three weeks and then process the exact day his benefit resets?” Colin offered.

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“No, no,” said Mrs. Tam. “He’s been complaining for weeks, I don’t want to delay. I’ll just give you my credit card.”

Colin rushed the two orders but it was weeks before Dr. Tam finally came back for his dispense.

“Oh, these are great!” said Dr. Tam enthusiastically, studying the near vision card with his new progressives.

Colin beamed. “Did you bring your son? I was going to adjust his sunglasses for him.”

Dr. Tam chuckled. “Well, they’re really for me,” he shared. “Of course I’ll share them with him if he wants, but I need them when I’m wearing my contact lenses, and I lost last year’s pair.”

“Ah,” Colin nodded. “And I assume your wife told you she ended up paying for your glasses since you weren’t eligible?”

“Yes, it reset this past Monday, right?” asked Dr. Tam. “Just give me the invoice with Monday’s date and I’ll submit it.”

“I don’t think we’re allowed to change the date,” said Colin. “Technically the insurance company considers that fraud.”

Dr. Tam scoffed. “If anyone gives you a hard time, you just have them call me,” he replied.

The Big Questions

  • If you were Colin, would you have done anything differently when discovering Dr. Tam’s eligibility was incorrect?
  • Assuming Colin is physically able to revise the EHR to date the order to the first of the month, should he provide the invoice for Dr. Tam to submit his claim?
  • Would you dispense the sunglasses, or return them, accept the loss, and report Dr. Tam for fraud?

 

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Maureen G. Oak Park, IL

Didn’t Colin look at the name on the benefit sheet?! And seriously who would order anything based on a script a patient wrote out? I would have said, “I am sorry I need a valid doctor Rx, otherwise it’s not valid and I can lose my job over it.” We always have the sheet printed out with the patient’s name and benefits eligible highlighted. Colin sounds like a pushover; we have had patients who want to use their frame benefit for plano sunglasses and our answer is always, “No, that’s committing fraud.” I can’t believe any ethical optometrist would endanger his practice by agreeing to do this.

Rigo L. Indio, CA

Let me start by saying we all “bend” the rules from time to time for some of our “VIP” patients. That being said there is a line to draw when bending the rules becomes fraud or feels wrong. As opticians we feel that any professional that walks into our office will always do the right thing. So when doctor Tam wrote an Rx for his son I would have told him that I didn’t feel comfortable filling the Rx, even though I knew what he was doing, and that I would rather talk it over with our doctor. At this point he would have to understand that something smelled fishy. When he asked to change the date, I would be frank with him and just say that I would not feel right doing that. If you bend the rules one time the patient expects the same the following year. Sometimes it’s just best not to do things, no matter who the patient is.

Peter N. Belfast, ME

This case is not uncommon. The simple answer to somebody who asks you to lie to the insurance company is: “Do you want me to lie to you?” The answer is usually, “No.” Then you can say, “I’m not going to lie to your insurance company either.”

Lynn M. Fallston, MD

1) I would have done the exact same thing with the eligibility date. If the patient’s wife chose to pay I would take payment and proceed with the order.
2) I would NOT change the date in our EHR to facilitate insurance fraud. Not happening!!
3) I wouldn’t dispense the glasses…BUT it never would’ve gotten that far because….I never would’ve taken the Rx from a GP to begin with. Is that even legal??

Preet K. New York, NY

I’d explain to Dr. Tam that the practice can get audited at any given time, and this is considered insurance fraud. I would offer a discount on a second pair. Colin should not have accepted the Rx written by Dr. Tam as it is an unethical action taken by Dr. Tam. If the doctor who examined Tam Jr. didn’t prescribe any Rx, Colin should follow that. Ask Dr. Tam to reach out to the insurance to find his options to process the sunglasses order or offer to make the phone call on Dr. Tam’s behalf. (This shows customer service.) If Dr. Tam is uncooperative, call the insurance and inform them about Dr. Tam writing the Rx for Tam Jr. Colin shouldn’t change the DOS for the private-pay order even if the EHR system gives him the ability to. Have the patient discuss this with his insurance as well. I wouldn’t recommend processing the sunglasses order unless Dr. Tam follows the right steps. Document everything. Have Dr. Tam sign a liability form, which protects the practice from auditing.

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Kate G. Arlington, VA

Fraud is fraud. Why sully your reputation?

Amelia B. Charleston, SC

Insurance fraud is any act committed to defraud an insurance process. This occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due.

Theresa W. Austin, TX

Graciously, the optician should have advised the patient that the prescribing physician had not provided a script for his son, so unfortunately the sunglasses would not be covered by insurance. The optician then should ask, “How do you wish to proceed?” There can never be an exception for fraud.

Daniel M. Rockaway, NY

Of course he should not do any of those things. It is considered fraud and he risks at least his participation in the plan if not the license of the practitioner itself.

Genna L. Milwaukee, WI

Colin did the right thing by attempting to contact Dr. Tam. However, it’s important to speak directly with the patient when they’re responsible for their own care. Speaking with Dr. Tam would’ve given Colin an opportunity to assertively avoid possible fraud and any consequences of it. It would’ve been 100 percent wrong for Colin to modify the invoice date to comply with Dr. Tam’s request. Had the claim been audited, the insurance company would’ve found evidence of fraud in everything from the copay dates to material order dates. Dr. Tam, as a medical practitioner, is required to acknowledge that he understands insurance fraud and its consequences, and as such he should not be instructing other health care providers to commit fraud on his behalf. Were I in Colin’s situation, I would suspect Dr. Tam of committing fraud at his own practice, and would absolutely report Dr. Tam and accept a loss on the materials I ordered, knowing that I did the right thing.

Judy C. Virginia Beach, VA

1) Colin did the right thing by calling immediately when the issue arose.
2) NO! Changing dates on a receipt or in patient records is fraud. This is not a “gray area” in my opinion. Unless the offending doctor owns the insurance company, he doesn’t have any clout with them either.
3) Dispense the eyewear and note the conversation in his record. I would also make the practice owner aware of what his patient requested and that he stated that it was done for him in the past at the practice. Let the doctors discuss the issue. Neither Colin nor any other staff members should have to be caught in the middle of this.

Stewart G. San Francisco, CA

1) NO
2) NO
3) I would make him pay for them—nothing more, nothing less. If he refused, I’d send him to collection, AND I’d dismiss him as a patient.

Taylor K. Ellington, CT

1) Colin handled the situation appropriately when he discovered the eligibility issue—he called the patient immediately. HOWEVER, the first issue really arose when the patient wrote his own prescription. We would not have filled the Rx, as it was not valid. Regardless, Colin should have accepted the wife’s credit card for the full charge amount without insurance and continued with the job.
2) I would assume most systems, like ours, allow for date change on the invoice. However, of course, this is fraud and Colin should not do this.
3) I would have dispensed the sunglasses, as they should have already been paid for in full by the wife. I would advise Dr. Tam he can do what he wishes with the invoices, but that the office cannot and will not change any posting dates as it is fraud.

Bob S. St. Louis, MO

I wonder if Dr. Tam is as loose with insurance policy in his office as he expects Colin to be. While technically he did nothing illegal by writing an Rx for his son, it was an ethically reprehensible thing for a healthcare professional to do. Even worse, he expected Colin to risk his job and the reputation of his company by performing an illegal act. Again, I wonder if it is a standard operating procedure to falsify records in HIS office. If I remember nothing else from optometry school, one thing will be forever ingrained in my mind: “Never change a record. Put a line through the original information, insert the correction, initial and date it.” It’s a digital world now but the advice is still as relevant as in the good old (paper) days.

Leisa L. Newport Beach, CA

Dr. Tam’s eligibility should have been checked before the order was taken for his new glasses. However, since Colin notified Dr. Tam indirectly through his wife the order became a private order and was paid accordingly. The receipt date should not be changed to appease Dr. Tam. In regard to dispensing the Maui Jim sunglasses, Colin submitted the order with the proper Rx information provided for Dr. Tam’s son Richard with the required measurements from Richard’s chart. Technically it should be said that Richard is sharing the glasses with his father, not the other way around. This is one of those areas that is stretching the system by Dr. Tam; Colin was following the Rx provided by Dr. Tam for his son.

Judith W. Orange, CA

No, we do not change invoice dates; that is fraud plain and simple and no patient is worth the legal problems. As far as notifying the patient of his options of waiting till the first of the month or paying for the glasses, that is our standard policy. As far as making glasses without having a proper written prescription—either our own (from records) or from another OD or OMD—we would not do it. We do not feel that a primary MD can give a complete comprehensive eye exam, especially if he is just writing out what is necessary for insurance coverage

Jennifer Torrance, CA

I would have discussed all this with management first to see what options they wanted me to proceed with. If those options comprised my morals or ethics, I would then proceed to remind management that we have an obligation to not just the patients but to the practice and employees to make sure we have a secure livelihood by following the rules. If we continue to bend the rules, we will go down a path of no return and will be held hostage by patients that know we shouldn’t be doing this.

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

When This Doc Moved to a Concealed Carry State, She Didn’t Expect Staff to Be Packing

What would you say to an OD who balked at legal firearms in her office?

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DR. COLTAN, A recent NECO grad, was taking a risk. She and her husband, both avid hikers and snowboarders, had relocated from Rhode Island to Colorado to open a new solo practice. Over the last several months, between per diem shifts at local practices, she had worked to build her new office.

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

Soon the time came to begin hiring employees, a task Dr. Coltan had been dreading. She had never even interviewed someone before, but within a few weeks she was able to secure employment contracts with Barbara, a receptionist/insurance biller, and Doug, an optometric assistant who had some optical knowledge.

Barbara and Doug helped Dr. Coltan a great deal with promoting the office leading up to the grand opening, as they had connections with many local businesses and community leaders.
On Dr. Coltan’s first day in business she was ecstatic about the seven exams her team had scheduled. The day flew by for everyone, and after locking the doors she invited Barbara and Doug to the break room for pizza and cake.

“Thank you so much for all your hard work today, and for pounding the pavement this last week!” she said, her eyes misting up.

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“You’re very welcome!” said Doug. Barbara, seeing Dr. Coltan’s emotional expression, reached out and gave her a big hug.

“Thanks Barbara,” she said, sniffling. As she dropped her arms she whacked her hand against something hard on Barbara’s hip. “Oh! Ouch,” she exclaimed. “Oops, are you okay?” asked Barbara.

“What was that?” Dr. Coltan wondered aloud.

Barbara swept her long cardigan back to show Dr. Coltan her sidearm. “I have a concealed carry license,” she said casually.

“Whoa!” Dr. Coltan’s heart skipped a few beats. She had never seen a handgun up close before, and instinctively backed out into the hallway. Doug and Barbara chuckled at her reaction, but Dr. Coltan felt her stomach turn in knots.

“It’s okay!” Barbara called out, “I’ve worn it for fifteen years. It’s an essential safety measure for the office.”

Dr. Coltan, still looking in from the hall, shook her head slowly. “It doesn’t make me feel safe,” she said quietly.

Doug and Barbara gave her a look of surprise. “There will be a lot of patients carrying,” Doug said. “This is Colorado. That’s just the way it is here.”

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The next day, Dr. Coltan found herself avoiding Barbara. She used the phone pager system rather than talking face-to-face and kept clear of the break room during the receptionist’s lunch break.

That evening, she brought up the issue with her husband.

“I don’t know if I can live like this,” Dr. Coltan sighed. “I feel hyper-focused on the hip or pocket of every person that walks in, wondering if they have a gun!”

“Can you put a sign in the window telling people they need to leave their guns in the car?” he asked.

“I mentioned this to Doug today, but he felt sure I’d lose patients,” she said. “I can’t believe I am on edge in my own office… I feel so blindsided by this.”

The Big Questions

  • Should this new business exclude a portion of the local population? How would you phrase signage at the front door?
  • Barbara is an asset to the practice, has done nothing illegal, and is not willing to stop carrying. How should Dr. Coltan proceed?
  • If you work in a state that allows it, how do you feel when interacting with patients who are carrying?
Darrell L.
Goodlettsville, TN

Interesting and thought-provoking Real Deal. The gun debate. A politically charged topic meets office management. I am a Tennessean, from the Nashville area, an optician/owner of a mom and pop optical shop and a believer in self-preservation. Through 40-plus years of dispensing, I have worked with numerous trainers and law enforcement, teaching them how to cope with presbyopia and the front sight. Yet, it is not just those who are paid to protect us, the general public has been coming to me for years who carry, some concealed and some open. At the age of 12, I was given the 12-gauge shotgun you would probably expect a Southern boy to get. I was also taught the proper use of the gun. If you don’t know how to use a tool, whether a lensometer, a hammer or a gun, then don’t pick it up. The doctor did a great job hiring. Barbara and Doug are working for the doctors’ best interest. “Avid hikers and snowboarders” and moving to Colorado implies they did visit before they moved. In Colorado it is legal to carry both concealed and open. Somewhere along the way they should have encountered locals who openly carried. Therefore she should not have been “blindsided” unless she had put on blinders. The first thing the doctor and her husband should do is take a handgun safety course to alleviate the fears they have. I’m not advocating that they buy a gun; they will be better educated after the course to make that decision themselves. They took a risk and moved to Colorado; I’d be more afraid of the bears. Partly, I feel sad that we live in a time that more of the populace feels the need to carry protection. Partly, knowing the person carries and has passed the course to own and carry making them one of the good guys, I feel relaxed. The gun is not the issue—that person needing my service is. But in the end, the doctor has every right to seek like-minded employees, have a pleasant office atmosphere and to decide who meets her criteria for patient base.

Joyce P.
Raleigh, NC

Usually those who have licenses to carry are doing it for protection, not to run out and start shooting the world up. We need to be more concerned about those who are carrying illegally, not legally.

Daniel M.
New York, NY

If you move to a state with open carry laws you have to accept that people will do just that.

Douglas C.
Beachwood, Ohio

Fear is derived, in this case, from ignorance. Dr. Colton needs to go to a range and take a class on gun safety and learn how to shoot. Doing so will allow her to gain an understanding of firearms and will make her more comfortable around them. When people conceal carry, you don’t know they have a gun … but are you safer around them or around someone who you know has one? There’s no difference. The doctor should have a gun policy for the office that states that people who are legally allowed to possess a firearm should be allowed to have it. Whether she likes it or not, it’s legal.

Brian C.
Prescott Valley, AZ

My office is in the Wild West of rural Arizona. Lots of people open and conceal carry weapons. I am not anti-gun. I grew up with weapons, so I was trained to properly care for and shoot pistols, rifles and shotguns. Took hunter’s safety classes as a teenager. I hunted elk, deer, duck, geese, doves for years. I own a shotgun currently. It is locked, unloaded, action open with a gun lock in the action, and the ammo is safely stored in a separate location. I put up a sign on my door that reads “No Firearms Allowed by Section 4-229” that AZ approved several years ago. I see them at the local VA I work in, at the local hospitals, and all the private practice MDs in my area. I am not an outlier on this issue. I did this because in the news at the time, somebody carried a concealed firearm into a business and dropped it causing a discharge (nobody got hurt). At the same time, I had a patient come in wearing TWO .45 ACP semiautomatic Colt pistols in holsters, open carry (Wyatt Earp style). He was wearing camouflage pants and black shirt with menacing writing on it. He revealed in his medical history that he had mental illness. This made my staff very nervous. In the lobby, I nicely asked him to leave his pistols in his car for the exam, showing him the 8×11 color sign on the door. I stated that in the 20 years my office was open that we never had a robbery or shooting or a need for a pistol. He huffed that I was “infringing on his second amendment rights.” I told him he could either leave the guns in the car for the exam or see another gun-friendly OD or MD down the street. He canceled, walked out the door and I haven’t seen him since. I frankly don’t care if I lose the business of people who feel (logically or illogically) that they need to carry a gun everywhere because they perceive a threat (real or unreal). My point is:

1. My office is my private property. I will do what makes me comfortable and safe. I will do what keeps my staff and patients comfortable and safe. I will control my office and what happens in it.
2. My office will be sued if a gun-toting person shoots or discharges a weapon that hurts anybody else. I need to limit my liability.
3. If you don’t feel your life is in immediate danger, then you don’t need a gun. If you feel your life is in immediate danger, and that you really need a gun, then you probably don’t need an eye examination right now.
4. Car accidents killed 11.9 people per 100,000 people in 2017. Guns killed 12.2 people per 100,000 people in 2017. I don’t let people drive cars in my office. I don’t let people have guns in my office either. Accidents killed 00.0 people per 100,000 in my office from 2002 to the present, and I intend to keep it that way.
5. This is not a political issue. It’s a common sense issue.

Sherri H.
Kansas City, MO

In states where conceal and carry are commonplace, to ask someone to leave their firearm in the car could indeed cause them to go someplace else. Dr. Colton feels very uncomfortable because she has not been around firearms. Maybe she should take a conceal carry class to get familiar with what conceal carry is all about. She might even feel empowered by the knowledge and know-how of handling a firearm. I personally feel more comfortable when I know someone is around with a conceal carry on them. She should also talk with other doctors in her area for their advice on this topic.

Angel M.
Cynthiana, KY

Pro- or anti-gun, that is an overly phobic reaction by Dr. Coltan to a trusted staff member. Maybe Coltan should seek counseling or move, because she can’t plant herself in a state that has a conceal carry culture, and demand that the patients and staff change for her. PS: Y’know, she has a gun right in her name…

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Tory M.
Dumas, TX

I would tell Dr. Coltan her fear is unreasonable and is because of unfamiliarity with firearms. Bad people conceal weapons all the time and you weren’t scared about that possibility? If not, you’re very naive. It was only after you were aware of it that it caused irrational fear. People are surprised if I mention I’m carrying concealed, because they can’t tell. Not the fact that I carry, but that they couldn’t tell. My advice is to ask the staff member to take you to the range and learn how to handle one safely and see what it’s like. It’s fun. And it’s freeing if you have a fear of firearms. Just like learning to drive a car, using a power tool, checking angles before dilating to prevent angle closure glaucoma, etc. If you are familiar, nothing to fear. You are going to have people ask you about prescriptions for using firearms; whether long rifles, shotguns or handguns. You might as well have a little knowledge about how they work to be a better expert too.

Brandy W.
Atlanta, GA

1.) You should absolutely NOT exclude concealed-carry patients from your practice.
2.) Dr. Coltan should expand her horizons, take a weapons safety course and learn. She clearly has zero experience whatsoever with weapons, and it seems she is making a judgment based on fear instead of education. I believe that she should respect her employees’ right to defend themselves, which is something she cannot do.
3.) I love to see patients carrying, or anyone for that matter — it makes me feel safer. I also conceal carry and rarely go anywhere without the means to defend myself. Many criminals carry weapons — we know this. I want to be able to level the playing field.

Julie U.
Jupiter, FL

I think the doctor should accept her employee with her weapon … she did before she found out. It is really great for the staff. Heaven forbid if someone came in with a weapon. At least they are protected. I carry in my business too and when customers find out we tend to talk about it in a positive way. The world is a different place, sadly, then it was years ago. I say CARRY on.

Dr. Craig F.
Rushville, IN

I have no problem with someone legally carrying a concealed weapon. This doctor should roll with the punches and learn to live with it. When she goes to the grocery store, or shopping at retail locations, she will be walking by other people that are carrying concealed weapons. Maybe she should take a gun safety class so she can understand the benefits and risks of carrying vs. not carrying a weapon.

Dennis M.
Cedar Park, TX

I’ve been a concealed carrier for over a decade and I suggest getting more educated on self-defense. Those of us with LTC are good people that have had EXTENSIVE background checks. Yes, it’s a way of life for a big portion of our country and is growing larger every day. I would suggest taking self-defense/beginner shooting classes and get to know the community. I’ve taken many first-time shooters to the range and seen their faces brighten dramatically. You don’t have to own a firearm, just be familiar with them. They’re not bad at all if you respect them and be responsible.

John L.
Nashville, IN

Ultimately, the decision of whether a staff member carries a firearm while at work lies solely with the practice owner. There may be serious legal or insurance issues that the doctor may want to discuss with her lawyer. Hoplophobia is a real problem with some people and the decision to relocate to a less conservative area may be necessary. Shooters, particularly presbyopic ones, have special visual needs, something that may help build a new practice.

Dennis I.
Monroe, CT

Dr. Coltan needs to grow up and be more tolerant. In fact, I think she needs to spend a little time at the gun range getting trained in the use of firearms. Who knows; maybe she’ll like it? Fear of guns is irrational. More people die at the hands of a drunk driver than the wrong end of a gun. She is not afraid of cars or beer, is she? Yes, this hit a nerve with me; as I have lost very young patients to gun violence (Sandy Hook). Guns don’t kill people. People kill people. Learn to handle the (whatever object causing fear) and fear goes away.

D Bailey
Huntsville, AL

We all have certain rights that we can choose to exert or not. I have a license to drive a car, but my boss won’t let me park in the spaces saved for our patients. I can buy alcohol, but the doc won’t let me drink at work. We have policies covering these issues. If I don’t agree with the polices, I can always find another job. The owners should set their policies to reflect the type of business/environment that makes them comfortable. As an employee or as a patient, all that is important is that the doctor is providing exemplary service. If so, they will have many people wanting to work and see them, regardless of whether they allow dogs, alcohol, legal marijuana, and yes, even guns on their property.

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

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.

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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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