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Real Deal

When a Student Extern Disrupts an Office’s Established Procedures, How Can an Owner/OD Regain Control?

An optometry student extern is causing problems for a practice. How can the owner rein her in?

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DR. ABERDEEN’S practice was set in the outskirts of Dover, Delaware. The majority of patients had vision care plans and wore contact lenses, and several months ago she’d written to her alma mater offering to become a preceptor. The externship director listed Dr. Aberdeen’s office as a contact lens rotation, and soon a list was sent with student names and dates.

ABOUT REAL DEAL
  • Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.
  • ABOUT THE AUTHOR
  • NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at info@meredithoptical.com
  • The first extern, Emily, was happy to be accepted as this meant she could commute from her grandparents’ home 30 minutes south of the office. Dr. Aberdeen spent a great deal of time preparing for her extern, including establishing a work station, a series of enrichment assignments, and a customized office policy manual. Dr. Aberdeen also held a 10-minute huddle with her staff to explain the unique role of an extern within the office. While Dr. Aberdeen didn’t directly manage or supervise the staff, she would be overseeing all externs personally.

    Emily’s first day was spent shadowing Dr. Aberdeen in patient care. As this was Emily’s first externship, she was excited and projected confidence and charisma. Dr. Aberdeen was flummoxed. She had expected Emily to remain silent while shadowing her, speaking only if asked a question. Instead, her extern was engaging family members in idle chit-chat during the exams, or offering unsolicited treatment plans.

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    The last patient of the day was a very nice man Dr. Aberdeen had seen for at least 10 years. During the slit lamp exam, she invited Emily to quickly look into the ‘scope over her shoulder, where the beginnings of a nuclear sclerotic cataract were in focus.

    “Cataract,” Emily confidently announced to the room, as though she were on a quiz show. The patient sat back quickly.

    “I have a cataract?!” he exclaimed, looking frightened. Dr. Aberdeen did her best to back-peddle and educate the patient about his pre-cataract, a conversation she hadn’t planned to have for another six months.

    Despite regular coaching, her extern continued to put her educational exuberance ahead of Dr. Aberdeen’s relationships with her patients. Monovision patients were advised that they were wearing ‘old technology’ and should consider multifocal lenses; those with prescribed prism were given lectures on the virtues of vision therapy; and dry eye patients were encouraged to ask for punctal plugs, a procedure Dr. Aberdeen didn’t feel confident performing.

    A breaking point came when Dr. Aberdeen learned Emily had been criticizing some of her policies to the technicians. “These vision care plans are supposed to include dilation and the full contact lens fitting,” she said with authority. “It’s not right to charge for follow up visits, you can get in trouble for that.” One of the techs brought the information to the office manager, who circled around to Dr. Aberdeen. She felt offended, and in an attempt to mitigate some of her stress she found herself assigning Emily to more workups and fewer complete exams. This prompted more complaining, including comments about ‘free labor.’

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    Just before Emily’s midterm grades were due, Dr. Aberdeen sent an email to the director of the externship program. “I can appreciate how engaged Emily is in patient care and the profession,” she wrote, “but this is my business. I don’t think she’s fully appreciated that. Her clinical skills are sound, but I had expected to spend more time teaching and less time cajoling.”

     

    The Big Questions

    • What would you change to improve the remainder of Emily’s rotation with Dr. Aberdeen?
    • If you were the program director, how would you respond to Dr. Aberdeen’s email?
    • Where is the line between educator and business owner, and how can a preceptor find it?
     

    Expanded Real Deal Responses

    Gary S. Muskegon, MI

    If I had a patient with a 10-year history of pre-cataracts, I would have told him nine years ago, confirming each year that they are still way off in the future and not to worry. Lots of monovision patients? This is a wakeup call! Don’t be a dinosaur. If you know what the managed care rules are, then educate the intern who only has ivory tower learning. If you are violating the plan rules, either drop the plan or change before the plan calls you on the carpet. The intern must be addressed by the doctor as to what is expected and to not jump in or override the doctor’s decisions. If the Don Quixote-like jousting with the way the practice is run doesn’t stop, the intern will damage her future prospects of being employed anywhere.

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    Robert M. Edina MN

    The first mistake Dr. A made with Emily was assuming she would act in a certain manner without setting expectations. To improve the balance of her time there, Dr. A should tell Emily exactly what she expects and what behavior is unacceptable i.e. gossiping with the staff, etc. This insight will help Emily in her career. As the program director, I would have a conversation with Emily about the importance of listening to Dr. A and discussing patient issues in private and not in front of staff. I would also let her know the externship is a privilege and should not be taken for granted. There is not a line between business owner and teacher. There is much to learn from both. She should take full advantage of a great opportunity.

    David G. Beckley, WV

    She should have told the extern to shut up and not engage in any direct communications with the patients about diagnosis and treatment or any criticism of the doctor’s office policies. The extern was there to learn, not manage. When the extern enters the real world things don’t always happen like in the school clinic. Very rude.

    Chani M. Highland Park, NJ

    I wouldn’t have waited so long to sit down with Emily and tell her exactly what was expected of her. I would have nipped this in the bud on day one in a more aggressive manner. If I was the program director, I would call Emily in and tell her that her grade was in trouble unless she shapes up. As a preceptor and business owner, expectations, as well as written guidelines, should be discussed and dispersed. In order to salvage the rest of the rotation, I would sit down with Emily and have a really candid discussion about how to turn it around and make sure the staff knows that it is being dealt with so that simmering resentment does not ensue.

     

    What’s the Brain Squad?

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

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    Real Deal

    A Sublease Eye Doc Didn’t Work Out

    Should the optician/owner pursue their non-compete?

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

    ABOUT REAL DEAL

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

    ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

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

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

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

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

    The Big Questions

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

    Expanded Real Deal Responses

    Andy H.
    Jacksboro, TN

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

    Chris G.
    Inver Grove Heights, MN

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

    Bill K.
    Houston, Tx

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

    Anna T.
    Claremont, CA

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

    Rigo L.
    Indio, CA

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

    Darrell L.
    Goodlettsville, TN

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

    Frank U.
    Bakersfield, CA

    No lawyer; lesson learned, find another doctor.

    Wilfredo M.
    Philadelphia, PA

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

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

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

    What’s the Brain Squad?

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

    Continue Reading

    Real Deal

    A Compensated Lens Design Tripped Up This Eye Doc

    The patient wants his glasses and exam refunded.

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

    ABOUT REAL DEAL

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

    ABOUT THE AUTHOR

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

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

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

    “I just can’t drive in them!”

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

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

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

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

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

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

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

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

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

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

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

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

    The Big Questions

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

    Expanded Real Deal Responses

    Rachael D.
    Burlingame, CA

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

    Manuel L.
    Midland, TX

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

    Taylor K.
    Ellington, CT

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

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

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

    Yen N.Dallas, TX

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

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

    Leisa L.
    Newport Beach, CA

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

    Yvette R.
    Cincinnati, OH

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

    Bob S.
    Pinellas Park, FL

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

    Charley A.
    Hurst, TX

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

    Rigo L.
    Indio, CA

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

    Maureen G.
    Oak Park, IL

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

    Andrews, MD
    Hurst, TX

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

    Stewart G.
    San Francisco, CA

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

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

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

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

    Judy C.
    Virginia Beach, VA

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

    Rick R.
    Girard, PA

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

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

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

    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

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

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

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

    ABOUT REAL DEAL

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

    ABOUT THE AUTHOR

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

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

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

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

    Bonnie looked in the mirror and grimaced.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    The Big Questions

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

    Expanded Real Deal Responses

    Mina K.
    Brooklyn, NY

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

    Kenneth P.
    Oklahoma City, OK

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

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    Leonard H.
    Downers Grove, IL

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

    Rigo L.
    Indio, CA

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

    Cory O.
    Key West, FL

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

    Judith W.
    Orange, CA

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

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    Richard K.
    Castle Rock, CO

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

    Martha D.
    Wheatfield, IN

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

    AJ S.
    Houston, TX

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

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