Real DealA Small Practice, a Deaf Patient, an ASL Translator Paid For … What Happens When the Patient Cancels? A request for ASL translation shakes up this small office. Does the practice have any options? Published 1 year agoon January 30, 2018By Natalie Taylor Invision February 2018 Issue Online Extra Share Tweet SANGAMON VISION SERVICES, an efficient office of one optometrist and two employees, was situated near the capital city of Springfield, IL. One day a man called to schedule an appointment for his son … with an unexpected request.ABOUT REAL DEALReal 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 AUTHORNATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at firstname.lastname@example.org“My son is deaf and will need a professional translator,” explained the man briskly.Receptionist April paused to process the request and stumbled on her words. “Oh, uh, well, we don’t have any one at the office who knows sign language,” she explained, “is there something on the internet saying we offer–”The man interrupted her. “No. It’s a requirement, under the Americans with Disabilities Act.”April quickly asked if he would hold, and went to find the optometrist, Dr. Simms. “The patient is a deaf child, and his father is going to be in the exam with him,” she explained, handing the receiver to him. “He is requesting an interpreter.”Dr. Simms took the phone and greeted the patient. “I’ve examined deaf patients before,” said the doctor, “we don’t need an interpreter, I have a system that works well.”“That’s all well and good, but for medical visits I need someone fluent in ASL,” replied the father. “I have the phone number of a local service if you want it?”Advertisement The doctor cleared his throat and said, “Okay, give the receptionist the number and we’ll make it happen.”April made the call and was told a translator would come to the office for a two hour minimum, at $150. The translator also reminded April that the office was responsible for the fee, not the patient. The appointment was scheduled for the following Friday, first thing in the morning. As the translator found a seat in reception, April checked the voicemail. She found a message from the patient’s father asking to reschedule. Dr. Simms called the patient’s father himself.“My son is physically getting sick and needs to stay home, so we need to reschedule for another day,” the man explained. “That’s fine, but we did pay the translator $150 to come today,” said Dr. Simms. “Would you please contribute to that balance before we reschedule you?”“This service is supposed to be covered by the office!” said the man. “Besides, I did call and cancel.”“According to the machine, we got the message at 9pm last night, so we weren’t able to reschedule the translator,” continued Dr. Simms. “Even if you covered half, that will make me feel better that this won’t happen a second time.”“Absolutely not!” he said.“Then I’ll be happy to refer you to a colleague locally, but as a small office I just can’t help you. Maybe a larger practice will have better resources,” said Dr. Simms. The Big QuestionsIs there anything April and Dr. Simms should have done differently prior to the appointment?Should the patient be expected to incur a penalty for no-showing? What if it happens a second time?Is it ethical and fair for Dr. Simms to refer this patient to a larger practice? Expanded Real Deal ResponsesDJ S. Pinson, ALThe law is the law and unfortunately there’s nothing you can do but factor the cost of those appointments. Be very careful with how you handle such appointments and make sure you get the translator to fill out a W-9 form because that fee you pay is tax deductible. Also, offices large and small need to understand that when that person does come in the office, you and your staff need to speak directly to the patient (not the translator) during all services, from the exam room to the sales desk. It’s up to the translator to follow along and convey your message to the patient.You have to operate like the patient doesn’t have a disability even though it’s covered by the Disability Act. These appointments have worked well for us in the past. The translator sees whether you truly care and will recommend other deaf patients to your office. Embrace and love on them and the profits will come.Dr. Tex S. Citrus Heights, CAOn the initial call I would have told the father I will find an eye doctor that is proficient in ASL. Several years ago, I needed an ophthalmologist that could sign in Italian. I found such a doctor and the patient had cataract surgery. It all worked out OK.Advertisement Pam P. Downers Grove, ILIf you currently have a cancellation fee policy that was established with the patient, then charging the patient for the cancellation would be appropriate.If the patient is insisting and the doctor has additional patients that could benefit from the service, perhaps a “signing” day or two would be beneficial to the doctor and the community.I believe there is a tax credit for this paid service. The service is paid at this point whether the patient is seen or not. Make a note for your accountant!Tim S. Philadelphia, PADirectly from ADA.gov: “For people who are deaf, have hearing loss, or are deaf-blind, this includes providing a qualified note taker; a qualified sign language interpreter, oral interpreter, cued-speech interpreter, or tactile interpreter; real-time captioning; written materials; or a printed script of a stock speech (such as given on a museum or historic house tour). A “qualified” interpreter means someone who is able to interpret effectively, accurately, and impartially, both receptively (i.e., understanding what the person with the disability is saying) and expressively (i.e., having the skill needed to convey information back to that person) using any necessary specialized vocabulary.” I take this to mean that it is sufficient that the OD already has a tried and true method of communicating with the deaf. Being armed with this information would drastically change the tone of the conversation with the patient’s father.Adele P. Jacksonville, FLThe patient’s health insurance may cover the cost of the interpreter. It did so for me and it was a Medicaid HMO.Casimiro G., MD Los Angeles, CAI would not have gotten an interpreter and referred him to another practice, since this is too much of a financial burden for my small practice. If I had been able to communicate with this patient using my system for the deaf for the refraction, then the parent should be happy with my effort and not insist on a certified ASL translator, unless he provides one.Lynette M. Loveland, COInteresting that the dad was so pushy. It seems to me that the office went out of their way to work with them, incurring a cost that is not going to be covered by anyone. At this point, it seems that referring the patient elsewhere would be mutually beneficial. The dad is not being reasonable; at the same time, I am sure he struggles in his own situation. For the office to recommend a facility that is better equipped to meet their needs, as well as some accountability on dad’s part in terms of “this is not working for our office” seems more than reasonable and best for both parties. The reality is that not every office is a perfect fit for every patient.Advertisement Gail R S. Chesapeake, VAThey should inform the customer they needed 48 hours in advance notice to cancel the appointment since prior accommodations were made for his son’s visit and that a penalty will occur if they cancel short notice of $150.00 or half $75.00.Yes, because the accommodations were made there would not be a second time cause the patient will be informed.Yes, it was fair because they tried to accommodate the patient and could not accommodate him any longer because the father is not being reasonable.Jen Arlington, TXI think they should have checked with his medical insurance to see if an interpreter is covered for the office visit. Also check the guidelines of the act. The patient should incur a no-show fee. It is ethical for Dr. Simms to refer the patient out.David F. Colorado Springs, COWe see a lot of deaf patients. I simply ask that they have a referral from an agency that is willing to help. Here in Colorado Springs there are many willing to help. 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.Related Topics:INVISION February '18Online ExtraReal Deal click to Comment(Comment)Up NextHow Would You Rate This Practice’s Handling of an Angry Early Bird?Don't MissWhen a Student Extern Disrupts an Office’s Established Procedures, How Can an Owner/OD Regain Control? Natalie Taylor Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com. Advertisement SPONSORED VIDEOSPONSORED BY WALMAN OPTICALPeople Want to Buy Premium ProductsWalman Optical Presents—Industry Myths Busted! It’s up to every ECP to explain that “premium” doesn’t mean expensive—it means “customized to your needs.”You may like Ever Feel Like Your Billing Policy Is Backfiring? Get ‘Em Young ECPs Share their Best-Selling Collections for MarchPromoted Headlines Safilo’s “American Eyes” Video Celebrates Elasta and Emozioni starringECPs Peter Tacia and Heidi DancerSafilo Hoya: The Right Lenses for Sun ProtectionHoya Nano Vista—The Quintessential Line for KidsAlternative and Plan B EyewearReal DealEver Feel Like Your Billing Policy Is Backfiring? This practice does. How can it get back on track? Published 4 days agoon May 15, 2019By Natalie Taylor IN FOCUS VISION CARE, a private practice in Olive Branch, MS, was adding a new billing manager to the office. Sean had four years of experience submitting optometry claims and 12 years billing for a physical therapist; this would be his first position as a supervisor. Erin was office manager and spent a lot of time training Sean during his first few weeks. After lunch on his third day, Erin brought Sean to the conference table and spread out several documents.ABOUT REAL DEALReal 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 AUTHORNATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at email@example.com“I’ve delayed going over Medicare but I think it’s time,” Erin began. “We made a decision that doesn’t really seem to be panning out for us, so you and I need to work with the doctors to edit our protocol.”Sean was intrigued. “I’ve always known Medicare to be straight-forward. What’s happening?”Erin pulled one of the documents toward Sean: an EHR-generated pie chart. “As I mentioned earlier, 44% of our comprehensive exams in the last five years have been Medicare exams. Eighteen months ago we saw a major increase in Replacement plans.”Sean nodded. “Right, patients on Medicare can buy a hardware benefit. I’ve seen this advertised on television.”“Well, the plans these patients pay for also include a well-visit.”“The doctor I used to work for always sent the exam to Medicare. I understand these plans to be for optometrists to ‘identify – don’t treat.’ Elderly patients usually have a medical diagnosis and require actual care.”“I agree with you. Their comprehensive exams are, on average, too complex to bill to these kinds of plans — not to mention the significant difference in reimbursement!”“So what’s the issue?” Sean asked.“Several patients complained, first to our doctors and then to me, that they wanted to use the services they had purchased. Most of the patients I spoke to were in their early 60s and relatively new to Medicare. One patient even went to our local newspaper and got a reporter involved. ‘Potentially deceptive practices.’ We were pushed into the spotlight.” She sighed, pulling the newspaper clipping out of the pile towards Sean. “We did what we thought was best at the time: the doctors only do a refraction and the minimum level required for the Replacement plan, delay all patient counseling and education, then schedule a comprehensive visit using Medicare for a few weeks later.”Sean nodded. “That sounds reasonable. The patient uses both plans and I imagine at the second exam you skip the refraction and only collect the 20% co-insurance?”“Yes, but the problem is most patients are no-showing to those exams, or canceling last minute and never rescheduling. We’re now seeing these initial patients pass the 12-month mark and call to book again. One doctor believes as long as we document carefully and have a signed consent that each patient understands the difference between the well-visit and a comprehensive exam, it’s the patient’s right to select their level of care. The other doctor told me she plans to refuse well-visits for patients who skipped their Medicare-level exams last year, because she doesn’t think a piece of paper will protect us from the consequences of subpar health care.”Sean drummed his fingers on the table. “I think I need to do a little research before bringing my professional recommendation to the doctors,” he said.The Big QuestionsHow would you have solved this dilemma if it was your practice criticized in a newspaper?If your parent/grandparent was a patient at this practice and wanted to use a Medicare Replacement plan, which doctor would you side with?Would your own protocol be affected if your Medicare base was only 10%? How about 80%?Real Deal ResponsesJohn M.Victoria, TXI recommend the practice stop participating in the Medicare advantage plan and see patients that have regular Medicare.Nina C.North Chesterfield, VAThis is hard. I would like to do the wellness on the vision plan, but Medicare patients have more complex ocular situations than most. We have a large Medicare group. Most will not return for the Medicare exam and liability is such that I cannot give a “lesser vision exam.” We tell patients when making the appointment and again on checking in that we are Medicare providers and will be filing Medicare. We will be collecting refraction fees unless the patient has a vision plan that coordinates benefits to cover refraction. We can use their material benefit towards glasses or CLs. Those who disagree never make an appointment or leave. If the optometrist was to forsake filing Medicare, we would soon be dropped as physician providers.Rigo L.Indio, CANewspaper! Who reads a newspaper nowadays? Anyways, it could have been worse with social media or TV. Patients with Medicare usually require extra time and visits and they think Medicare works the same everywhere. I have seen offices take Replacement plans with Medicare only if they have a vision insurance plan and refer out for medical exam or not take Medicare at all if it’s a Replacement plan. Well visits don’t do much for a patient and most of the time they need comprehensive exams or medical during an office visit. That being said, I would change protocol for the Medicare patients to only see them for comprehensive or office visits. I make that clear when the appointment is made. Having a good relationship with MDs and co-managing patients works best.Maureen G.Oak Park, ILI see the problem as one of a lack of educating the patient. Our office sees maybe 10 percent Medicare patients, but the doctor takes time to explain so the patient understands the importance of the medical visit. We have few if any patients that do not schedule a medical visit. And it has to be the doctors doing the explaining, not a manager or technician. Patients will listen to a doctor more than anyone else.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 ReadingReal DealA Sublease Eye Doc Didn’t Work Out Should the optician/owner pursue their non-compete? Published 1 month agoon April 8, 2019By Natalie Taylor 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 DEALReal 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 AUTHORNATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at firstname.lastname@example.orgThe 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 QuestionsIn 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 ResponsesAndy H. Jacksboro, TNThis 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, MNFirst, 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, TxBad 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, CAFirst 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, CAOhh, 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, TNThe 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, CANo lawyer; lesson learned, find another doctor.Wilfredo M. Philadelphia, PAUnless 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 ReadingReal DealA Compensated Lens Design Tripped Up This Eye Doc The patient wants his glasses and exam refunded. Published 3 months agoon February 21, 2019By Natalie Taylor 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 DEALReal 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 AUTHORNATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at email@example.comDr. 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 QuestionsDr. 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 ResponsesRachael D. Burlingame, CAI 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, TXDr. 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, CT1. 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, TXDigital 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, CABefore 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, OHAdjustment 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, FLBoth 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, TXCut 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, CALet 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, ILDr. 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, TXCut 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, CA1 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, VAI 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, PA1. 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.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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