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How Would You Rate This Practice’s Handling of an Angry Early Bird?

A patient denied before-hours service takes matters into her own hands.

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SPARKLE CITY OPTOMETRY normally opened its doors at 8am. Receptionist Heather, a night owl, found she could only manage this by grabbing breakfast at the coffee shop next door and scarffing it down at the front desk. One morning, Heather looked up from her sandwich to see a woman peering in the window. Heather jumped a little, and the woman waved impatiently and pointed at the door. Heather suppressed an eye-roll and moseyed over, keeping her hand on the deadbolt as she leaned her face through the door crack. “Good morning, ma’am, we will be opening in 10 minutes!” said Heather cheerfully.

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
  • “I know that, but I need to get my contact lens order and I really need to get to work as soon as possible!” she said.

    “Our staff are still arriving and getting the office ready. I will unlock the door at 8am and we can make that happen,” said Heather, stepping back.

    “Wait!” the woman exclaimed. “Can’t you just get them for me? I paid already; you just need to hand them to me!” 
    “It’ll just be 10 minutes,” continued Heather. “There is a coffee shop next door while you’re waiting?” she said, flashing her best smile at the scowling woman. She grabbed her food off the desk and marched back to an empty exam room, far from any windows.
    By 8am the lights and equipment were on and Heather’s coworker unlocked the front door. The woman made a beeline to reception and coolly gave her name to Heather, who had the boxes of lenses ready.
    “My eyes are actually bothering me, too,” said the woman. “I think it’s allergies. Can Dr. Wylam see me now?”
    Heather grabbed the schedule and studied it, while the woman scanned her name tag. “Yes, I think we can do that! I am going to need to pull your insurance, but I can do that while you’re in with him,” she said. “You have a $30 copay. I’ll take that and a technician will bring you back.”
    A few moments later, Dr. Wylam stepped into the exam room, already operating on autopilot. “Good to see you. My notes say you’re having some allergy issues. Let’s take a look at your eyes, chin up here, look at my ear, blink…”

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    The patient suddenly pulled her head out of the chin rest and shook her head. “Actually, I need to speak to you about your receptionist Heather,” she announced. “She was here at 7:50am and came to the front door but refused to give me my contact lenses. I’m making myself late for work but I couldn’t leave without talking to you. I’ve never been treated so rudely!”

    The doctor was shocked. “I’m so sorry that happened,” he said.

    “I’m sure you are, but I want to know what you’re going to do about it,” she said, clasping her hands.

    “Well I’m sure there will be a conversation, and…”

    “I think you should fire her,” the patient said bluntly.

    “I’m not going to do that,” said Dr. Wylam without hesitation. “We have an internal system for handling staff issues.”

    “Then you’re losing five patients: me, my husband, my son and my parents,” she said. “Now, I really need to go to work.”

    Dr. Wylam said goodbye to her and summoned Heather to hear her side of the story.

    There was no punishment or follow up, but a few weeks later Dr. Wylam received a voicemail from the patient, livid that the visit had been submitted to her insurance. She threatened to report fraud if he didn’t cancel the claim and reimburse her for the $30 copay.

     

    The Big Questions

    • Did Heather treat the patient badly, or is she blameless?
    • Should this exam have been submitted to insurance? Why or why not?
    • Is there anything Dr. Wylam can do or say to salvage the situation?
     

    Expanded Real Deal Responses

    Greg H. Minneapolis, MN

    Bill her insurance. Do not refund her a penny. Your open hours are your open hours…not 10 minutes prior. Let them walk; there are more fish in the sea. Chances are she’ll be back. Too bad for your staff. Sadly, the doctor’s hands become tied whenever a patient makes ridiculous demands, and reprimanding a staff member in front of a patient to assuage the patient’s overly ruffled feathers is a dangerous precedent to set. He was right to defend Heather at that point, but a follow-up apology letter with a gift card afterwards might have helped. PS: What office is still “getting ready” 10 minutes before opening?!!

    Lewis K. Milan, TN

    Heather should have gone and gotten the lady’s contact lenses. Insisting on firing her was unreasonable. We are there to serve our patients and anything reasonable that we can do to improve our services is indicated.

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    Danielle S. Fort Worth, TX

    The question you should ask yourself is, “If I were the patient, what would I want?” The staff member wasn’t in the wrong, but the manager/doctor was. Your staff doesn’t make the decision when to come in, so therefore you should mandate that enough staff members get there 10-15 minutes before 8am to unlock the door, get the office ready, and avoid problems like this. It’s a simple solution and far more convenient for the patient. In addition, the staff should be trained to go above and beyond for your patients. Don’t leave good behavior up to fate! The charges are a little tougher. If you schedule an appointment with a doctor, you should expect to be billed. The time you took on the schedule is time they lost on other patients with real issues and trouble. However, common courtesy shows the doctor could make the choice to waive the fee, due to the circumstances of the false visit. There isn’t one right answer!

    Tim O. Richmond, VA

    Not to be too hard on Heather, but she should come to work prepared for the day and ready to work once clocked in. Creating a customer experience will reinforce strong lasting relationships. Heather should have taken care of the customer immediately and not put her off. This would have eliminated the additional issues. Given the actual events, the customer charges should have been voided and no claim sent to the insurance company. It was bad enough that they lost the family’s business; you do not want to do more damage and risk an online review that could deter other customers from doing business at the office. The doctor’s response to the request for Heather to be fired was perfect. I would suggest the doctor go above and beyond once all the event details are known to keep the customer. Except for firing Heather!

    Sheri H. Creighton, NE

    If Heather did not wish to be bothered before 8 o’clock, she should not have been sitting and eating her breakfast in full view of the windows. Was she clocked in? If she was, she is at work and should have assisted the woman. If not, she should be eating in a break room. Should the appointment be billed? Yes, the patient stated that she was having eye issues. She should simply have asked to speak to the doctor about a personnel matter. The only way for the doctor to defuse the issue was to apologize to the woman in person and explain the insurance issue versus the personnel issue. He should speak to his staff about using the break room. If you are clocked in you are considered to be at work and should assist patients even if it isn’t the stroke of 8 o’clock.

    Staci V. Sun City, AZ

    While it sounds like the patient was a bit over the top and demanding, I think it could have been handled a bit differently. It sounds like Heather was pleasant and tried her best to delay the woman, but it would not have been the worst if she helped the woman a few minutes early, unless store policy prohibits it or she herself was not qualified to dispense the lenses. While it was underhanded of the woman to make an appointment under false pretenses and she should have been up front about why she wanted to speak with the doctor, the visit should not have been billed to insurance. As for as the woman’s demand that Heather be fired, she was out of line, and the doctor did well in his response.

    Stewart G. San Francisco, CA

    1. No, the patient was not treated badly. There are many offices where rules are to start business at official opening time, not before. In some cases, premises insurance will not cover accidents during non-business hours. The employee was very polite. However, I would tell staff that they cannot eat in full view of the public. And if the patient had to get to work, why did she waste time creating that ruse right then and there?
    2. I wouldn’t have, because the non-medical nature of the visit became apparent at the time the patient spoke to the doctor.
    3. He shouldn’t bother. If the patient is offering their business predicated on removing an employee who did nothing wrong, that’s a patient you do not want in your practice. The doctor’s appreciation of their staff in these instances will go a long way to maintaining the office environment and increasing business.

    Sondra M. Wichita, KS

    Our policy states that we MUST have two people in the office before the doors are opened just to avoid this possibility. This gives an eyewitness to any unhappy occurrence and helps in controlling flow of the office. The only fault I see is that Heather made herself vulnerable by being visible. Office hours are office hours and clearly stated, if we make an exception for one, we must make exception for all. That’s bad practice as patients will think they can come and go at their convenience and not stated open hours. Insurance is justifiably filed. She stated her complaint and took the doctor’s time. The doctor stood up for his staff, that makes for a great work environment when staff know they won’t be penalized for upholding stated business guidelines. However, there should be policy in place regarding eating outside of designated areas.

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    Kenneth P. Oklahoma City, OK

    The practice took a chance on losing a patient or patients for a 10-minute issue. This sounds like an internal problem that needs to be handled quickly. Poor handling will cost the practice patients, reputation, and money. The office manager or the doctor needs to impress on the staff that they are in a customer service profession, and this was a big fail. Heather shouldn’t be fired. Nothing should have been filed. A nice gift card should be sent for the patient’s trouble. With all the competition out there, why would you risk losing this patient and her family for 10 minutes?

    Katie A. Nashville, TN

    Heather did not have to give the patient her contacts, but it would have been beneficial to the practice if she had. And that should always be the consideration taken by employees — to go the extra mile — especially with the competition from online companies and the unfortunate expectation of instant gratification becoming more prevalent. Our office realizes customer service is our best defense against online sales, so we try to put forth extra effort any way we can, even if it means staying over a little later to give a patient their glasses or working through the occasional lunch break.

    Daniel M. New York, NY

    She should have handed her the contacts. Nothing can fix this. No exam should be submitted. Copay should be taken in advance.

    Scott L. Greenville, SC

    Heather was not rude but she did handle the situation incorrectly. She took the time to open the door so it would not have hurt to get the patients’ contacts. She had them ready when the patient came in, so she could have just given them to her. Not a firing offense but punishable for sure. The exam should not have been submitted because the doctor did not actually look at her eyes. I would give her the $30 back and ask her not to return.

    Dennis I. Monroe, CT

    Unfortunately, Heather triggered a chain of events making a bad situation worse. Customer service is always the first priority. Customer service is what sets eyecare practices apart. Heather should have allowed the patient in and dispensed her contact lenses to her. The patient was already expecting a hassle, being late for work, and Heather just fueled the fire. There is no justification for the doctor billing the insurance company unless he actually gave the patient a diagnosis and a treatment. Since that wasn’t done, the office staff should immediately contact the patient and rectify the situation. There is a whole lot of room for staff education in this scenario and the doctor needs to adhere to appropriate exam protocols.

    Angel M. Cynthiana, KY

    Heather’s breakfast was not more important than patient relations. It would only have taken a moment to pull up the patient’s records and dispense the contact lenses. No type of examination or medical consultation was given, so she should not have been charged, or the visit filed. That was just throwing fat into the fire and I agree that it seems fraudulent.

    Monica T. Charlottesville, VA

    It is very frustrating when you come in early to try and get something done prior to opening, however since the contacts where paid for — I would have left her outside and gotten her contact lenses. It should not have been billed to insurance but very tempted to charge for the doctor’s time since she lied. I would refund the money and make notes in case she decided to return. I would also contact the insurance company and let them know to avoid getting in trouble with them. She doesn’t respect other people’s time and could have reached out to the doctor in a different manner. My doctors always shared emails or letters that needed to be addressed. If you want your staff to have the time prior to opening to be undisputed then I would put up a screen on the door so patients cannot see in or have a back desk they can work at — if she was just eating — she should stay in back to avoid this in the future.

    Olga C. Yuma, AZ 

    Heather shouldn’t have let it get that far. If she had let her in and dispensed the contacts in the first place the other issues wouldn’t have arisen. Sometimes staff has to use their best judgement with patient satisfaction.

    Rick R. Girard, PA

    1. Heather is 100% to blame. If she would have eaten breakfast somewhere besides in full view of a potential situation like the one that happened, all of this could have been avoided. No, instead she adds fuel to the fire by not giving the customer the contacts, which would have taken minutes at the most and, again, avoided the situation all together.
    2. No, since the exam was never really performed. Granted she mentioned allergies and that in itself could constitute a reason to file, but losing five patients and then getting accused of insurance doesn’t seem worth the hassle.
    3. I doubt it. He waited too long. Seems like Heather takes the cue from her boss.

    Chani M. Highland Park, NJ

    Heather didn’t treat the patient badly per se, but she did make some serious mistakes. If the office is closed, don’t sit near the front window where patients can see you. This would have made the issue a non-event. Once she was spotted AND went over AND listened to her request she should have sucked it up and handed her the contacts, they were paid for anyway. Then she should have told herself never to sit up front again when the office is closed. The encounter with the doctor should not have been billed, I understand she took time with the doctor but how do you legally code this encounter? Not cool. Refund the copay as well. Tough call as to how to salvage the situation. I would hand write a letter of apology/explanation to the patient, telling her how much I value her patronage etc. etc. and that Heather was duly admonished. The patient was definitely not 100% right either, but that’s not the point here, the point is the interaction occurred.

    Robert M. Edina, MN

    Heather should have gotten the patient her lenses and thanked her for her business. This problem escalated when she decided taking two minutes to deliver the lenses could have made the patient happy. Heather could have made a much better decision. You could make the argument for billing insurance, however better judgement could have saved even more pain and distress. Dr. Wylam should retract the insurance bill and refund the patients co-pay since no service was performed or treatment plan developed. He should write the patient a sincere apology for the incident and outline what steps have been taken to prevent its reoccurence. He could include a gift card or an offer of free plano sunwear. He should then follow-up with a phone call inviting her back to the practice.

    Lisa T. Mountain View, CA

    She wasn’t rude, but wasn’t friendly about it. The exam didn’t seem to be an exam after all, so the patient should have been charged for doctor’s time, but not billed for any services. The doctor can assure the patient that her concerns are heard and that his staff was following opening procedures. Maybe he can evaluate this procedure in the future. Apologize for the inconvenience.

    David G. Beckley, WV

    Yes, I believe the insurance should be billed, the patient agreed to see the doctor. There is not much that can be done in my opinion. Pull the shades. I am sure the patient isn’t going to pay Heather for her 10 minutes off the clock. Also, for security reasons the door should be unlocked when the office is fully staffed.

    Barbara S. Ohio

    Heather should have let the patient in, this is usually an isolated incident and for the client to have seen the employee in the window and even addressed by her made matters worse. The time it took Heather to go to the door and let the woman know she could come back and the ensuing actions, she could have just got the woman her contact lenses which were already paid for. No, the exam should not have been submitted because clearly, the woman, right or wrong was using his time to make a complaint, however, had Heather let the woman in in the first place, this would not have happened. Dr. Wylam could calmly have let the woman know, he will train his staff to let patients know in the future, if they have extenuating needs to pick up product outside of store hours, that they need to call in advance the previous day.

    Amy P. Corona, CA

    Heather should not have been sitting at the front desk eating in view of the front doors. I understand that they were closed but she should have been somewhere that she was not able to be seen by patients. Personally, for myself I would have given the patient her contact lenses but then again, I also deliver contacts to patients that are unable to make it to my office before I close and they are on my way home. I do not feel the exam should have been submitted to the insurance because it sounds as if an exam was not performed. I would not fire Heather but I would definitely have a talk with her. I always try to treat my patients the way I would like to be treated. It does no harm to go out of your way once in a while. I don’t think there is much that can be done to salvage this situation.

    Judy C. Virginia Beach, VA

    Lesson 1: Don’t eat breakfast, or any other meal, in view of patients. 
    Lesson 2: Establish an office policy concerning allowing anyone in outside of operating hours and develop a “script” to use.
    Lesson 3: Refund the copay. Cancel the claim. This patient will never let it go if you don’t. Document everything.

    Ben R. Rockford, MI

    1. No Heather did not treat the patient badly but at the same time once you open the door for a patient you are kind of out of luck. If I had opened the door, I would have taken care of her. That said I would have made a “just a minute” gesture and disappeared out of sight if it was that important that I not open the door a few minutes early. 
    2. Depends. Did the doctor find something diagnosable if so then yes the patient used doctor’s time that he could have been using for a patient who had an actual concern.
    3. No this patient is someone who is just looking for a reason to make everyone as miserable as she is.

     

    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.
  • 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.

    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 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.

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    Real Deal

    What Would You Do If You Were This Office Manager Who Caught Her Doctor and Optician in a Sneaky Sun Swap?

    Rx lenses are made but they never get dispensed so that a plano sun gets covered by insurance.

    mm

    Published

    on

    WEST VIRGINIA’S BALFORD Vision Center had recently hired their first practice manager, Ellen. She moved to town specifically for the opportunity, bringing nearly 20 years’ experience. The small staff was eager to impress, yet anxious at the prospect of Ellen exposing various flaws and inadequacies.

    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

    One day Ellen was covering the lab while optician Leslie took her lunch break. A patient arrived for an eyewear dispense, and Ellen reviewed his tray: a sporty, wrapped frame with G-15 polarized lenses. Ellen also found a baggie containing an additional set of heavy, clear lenses.

    She checked both pairs in the lensometer and popped back out to see the patient.

    “Sir, I just need another moment. Your glasses are here but I need to insert your prescription lenses into the frame,” she said with a smile.

    “No, no, I don’t want the prescription,” he replied. “The other person said she was going to give me the plain lenses so I’d have sunglasses to wear over my contact lenses.”

    Ellen cocked her head to one side. “Strange. I wonder why she made you lenses,” she said quietly. “Well, I will go get your sunglasses for you!”

    Ellen spent some time adjusting the man’s frame and once more confirmed he didn’t want his prescription lenses. As he stepped out, Leslie walked in.

    “Hey!” said Ellen amiably. “Can I ask you about that guy’s order?”

    “Sure, what’s up?”

    Ellen grabbed his tray and started rifling through it. “Why did you order prescription lenses, but not dispense them? He told me he just wanted the demo sunglass lenses.”

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    “He wanted to use his vision plan,” explained Leslie.

    “Oh,” said Ellen, and paused. “I guess I don’t understand.”

    “Well, they don’t allow patients to buy plano sunglasses, so I just order a pair of lenses that are completely covered or just have the minimum copay, then swap the lenses out when they come back from the lab and throw them away,” she said matter-of-factly. “If they have a co-pay, we deduct that from the frame copay so they aren’t paying anything extra. Patients are fine with waiting, as long as they can use their plan.”

    Ellen nodded slowly. “Is that what the doctor wants, or is that your own workaround?”

    “Yeah, Dr. Balford told me to do it that way,” said Leslie.

    Ellen sat down with the practice owner a few hours later to explain the situation and her concerns.

    “We can’t order lenses with no intention of dispensing them,” explained Ellen.

    Dr. Balford shook his head. “I don’t remember ever discussing this,” he confessed. “But it seems silly not to be able to give the demo lenses to a patient — it should be considered a part of the frame purchase!”

    “If we get audited, there’s a risk our contract will get canceled,” warned Ellen.

    “That’s a big ‘if,’ Ellen.”

    “You have also encouraged an employee to commit insurance fraud. I reviewed our records for the last 12 months and I see 20 instances of Leslie processing fake lens orders,” she said. “We need to take action of some kind.”

    Dr. Balford shrugged his shoulders. “I feel like this is a gray area — I’m not convinced we should change anything.”

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    The Big Questions

    • Do you agree with Dr. Balford that demo lenses should be included as part of the frame purchase?
    • How do you protect the business if it gets audited by the vision plan in question?
    • If you were in Ellen’s position and Dr. Balford elected to continue this policy, what would you do?
    Jess G.
    Leesville, LA

    Patients are responsible for any eyewear purchase that is not covered by their allowance plan. If they don’t need prescription eyewear, they should re-evaluate the money they are spending on their monthly vision plan premium compared to what they would pay out of pocket for an eye exam and plano sunglasses and ask themselves: “Is this vision plan really saving me any money?”

    Cory S.
    Las Vegas, NV

    As frustrating as it may seem, most vision plan contracts prohibit this type of activity. The intent is to defraud a vision plan. If there is a plano sunwear option it will be stated in the benefit. You will not only lose your contract, but also face heavy fines, penalties and possibly legal action. Something similar would be for a patient to “give” their frame to a friend or family member. This also constitutes fraud. Better have your ducks in a row to show you were not complicit in the scheme.

    Caitlin W.
    Montrose, CO

    I would not be comfortable with the situation at all. Letting patients know that is insurance fraud would be my first step. Also, most companies will write out the policy, which I would show to the patient and explain why it is not something we are willing to do at our practice.

    Missy D.
    Spokane Valley, WA

    We always let the patient know what their insurance benefits are. If their prescription is valid for lens coverage but the patient just wants plano sunglass lenses, we explain that we will need to fill the lens prescription to utilize their lens benefit and we dispense the eyewear with the prescription lenses mounted in the sunglass. We give the patient the stock plano/demo sunglass lenses and let them know if they don’t like the prescription in the sunglass after giving them a try we can mount the plano/demo lenses back in. We’ve used their benefit according to their plan, explained coverage to the patient but also allowed the patient to keep all parts purchased. The original stock plano/demo lenses were part of the frame the patient is purchasing (even if they are using their insurance coverage), so they should be allowed to keep them. It becomes up to the patient after that, what they do with those lenses.

    Pat R.
    Irving, TX

    According to both VSP and EyeMed this is fraud. We don’t do it where I work. We have patients try and we tell them no. However, as long as the patient is really getting prescription lenses they will actually use, I don’t mind giving the plano lenses to them for future use if they can no longer use the Rx lenses.

    Judy M.
    Pittsfield, MA

    I would give demo lenses with a sunglass frame. I would not order Rx lenses knowing the patient is not going to use them at all. I do agree with the doctor to give the demos to the patient as long as they have ordered Rx lenses that they will use. The reason I give demo lenses is if in the future the customer wants contact lenses or to let someone else have the sunglasses, they have the demos. If the business gets audited, they will have to face the consequences. If I were Ellen and the doctor wanted to continue this practice, I would look for another job.

    Judy C.
    Virginia Beach, VA

    The doctor and optician may consider it a gray area, but the vision care plan will not. Fraud is fraud, no matter how well intentioned. Another big “if” is the patient seeing another, different practice and expecting the same “help.” One complaint to his vision care plan about perceived unfairness will surely trigger an audit and will definitely expose other discrepancies for as many years as are investigated. Regardless of the doctor’s actions, the office manager should document both her findings and her conversations about the issue with the doctor. Whether the office manager stays or leaves is a personal choice, but she must understand that her professional reputation will be at risk if and when an audit is done. In addition, she may be liable for hiding the fraudulent claims.

    Jennifer L.
    Dansville, NY

    You have to abide by the contract you commit to with the insurance company. If they do not allow plano eyewear you must not make a revision so they can get plano eyewear. I also believe that when you sell a plano pair of sunglasses then Rx them, that person bought the demos with it — give them to them. If they decide later to swap out the Rx lenses for the planos then do it. It’s ridiculous to nit-pick some of these things but you have to honor the legal contract you agree to. Explain the situation to the patient, how illegal activity can shut down your business, and how important it is for you to be legit. Tell them you can’t control what they do when they leave the office or in the future, but what happens in your office is always above board and transparent. Your reputation and integrity are top priority.

    Leisa L.
    Newport Beach California

    Where a patient uses their insurance plan for sunglasses and the frame has plano lenses mounted the lenses are part of the frame purchase and should be at least offered to the patient when dispensing the completed glasses. If the patient also wears contact lenses and decides to use the plano lenses that is their choice. If a pair of lenses are cut for the patient that are not actually the patient’s Rx, that is a completely different situation. It should not be considered insurance fraud when making the proper Rx for sunglasses. There are other ways to handle the sunglass sales. Recommend two different pairs, one for wearing over the contact lenses and a second Rx pair without the contacts. In fact, there have been several sunglass frames made with pop-out lens ability just for this purpose. The Porsche Carrera and a Cazal come to mind immediately.

    Rigo L.
    Indio, CA

    Wow, this is a tough one, depending on how you see it or how you work the insurance. Where insurances don’t pay much, in a small private office where we want to make some money off insurances, why not? On the other hand, I have worked in a larger practice with multiple locations where this was out of the question. I don’t see a fraud issue as long as the patient has the minimum Rx, they understand what we are doing and the lenses get dispensed. Where it becomes a very dark gray area is when you are trying to save the patient money and you bill the insurance for a different frame and not dispense the lenses. Even though the patient has an Rx you are basically lying to the insurance company and this can be a big issue. In Ellen’s case she sounds like, and I could be wrong, an old school optician. There is nothing wrong with that as long you are good with, and open to, change.

    Stewart G.
    San Francisco, CA

    1) VSP guidelines state that the demo lenses are not to be given to the patient. So, the answer is no.
    2) You can’t protect the business. The business has committed insurance fraud. And VSP guidelines are such now that they can go back years and request you pay them back for all those orders plus interest plus penalties AND you can get kicked off the roster.
    3) Ellen may need to put what she said in writing to protect herself, or start looking for a new position in a different office.

    Pablo M.
    Alpharetta, GA

    1. No, we do not hand out the clear demo lenses, so why do the color ones? It is supposed to be an Rx job for insurance purposes, right?
    2. How do you protect the business if it gets audited by the vision plan in question? Turn witness for the prosecution, your honor…
    3. I would try to explain to the good doctor why this is all a bad idea all around, and if the doctor decides to keep doing it, it will be without my help. I deal too much with insurance as it is to get involved in these kinds of messes.

    M. Pastor
    Phoenix, AZ

    In this scenario, Ellen is completely correct! The doctor/owner is a complete idiot and should not be in business if he is willing to commit insurance fraud! Ellen, find a new job with an ethical practice!!

    Donna
    Mission, British Columbia

    I would never do this; it’s insurance fraud. My credentials and reputation are worth way more. I would never protect or work at a place that allows it.

    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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