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Real Deal

Real Deal: The Case of the Blank Check




A mother sends her 19-year-old alone to his eye exam.
She’s not pleased when she sees the bill.

This article originally appeared in the June 2015 edition of INVISION.

Real Deal the Case of the Blank Check

In the middle of a busy afternoon, the staff and doctors of Mercury Optometry in downtown Carson City, NV were running at full tilt. One patient, 19-year-old Mike Copley, arrived for his annual eye exam. The paraoptometric technician brought Mike into an exam room and began her standard script.


“Are you interested in contact lenses today?” asked the tech.

“Sure,” he said. “I want to get contact lenses for when I play sports. But I still want glasses, too. I’ve worn them since I was a kid.”

“Great,” replied the tech. She reviewed his chart for insurance and found no vision benefits, then said, “Your contact lens fitting is going to be a separate fee apart from your insurance. Depending on your prescription, it will be in the $100 to $300 range; the doctor will give you a better estimate once the exam begins.”

“OK,” Mike said. The tech noted Mike was over 18, and followed office policy by offering a baseline Optomap for $50, to which Mike again gave his consent.

Half an hour later, Mike’s eye exam was complete and he was in the optical showroom selecting glasses. The optician made specific recommendations for Mike’s -3.00 OU prescription, including high index lenses and Transitions. Mike also opted to purchase prescription sunglasses. He sat with a technician to practice insertion and removal techniques and then approached reception to check out. The receptionist made a contact lens follow-up appointment and reviewed what Mike owed. He pulled a signed-and-dated check out of his wallet and filled in the amount he’d been told; as he handed the check across the desk he said simply, “It’s my mom’s, she couldn’t be here.”



Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual eyecare businesses and people.


Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at


Two days later, just as the office was opening for the day, Mike’s mother called, obviously upset. Bethany, the receptionist on duty, took the call.

“Frankly, I’m livid. I sent my son for an eye exam. Our insurance co-pay is $10,” Mrs. Copley said sternly.

Bethany worked quickly at her computer to pull up Mike’s information in the office’s EHR program. She noted that he was one member of a family of five who had started coming to Mercury Optometry two years ago.

“Yes! I did not get a chance to work with Mike but I do see record of his exam,” she confirmed.

“So why did you charge him $1,150?!” she asked.

“Did Mike bring you the itemized receipt we gave him? I’d be happy to provide you with another copy,” Bethany said.

“Yes, I got the receipt,” Mrs. Copley said. “Not that I’d even know what half these things mean. But Mike told me your people did unnecessary tests. He’s only 19 years old. What are you thinking?”

Bethany checked Mike’s ledger and saw the entry for an Optomap. “We offer that test to all patients over the age of 18, but we do explain it is optional —”

Mrs. Copley interrupted Bethany. “Why did the doctor give him contact lenses and sunglasses?” she demanded. “I sent him there to get an exam and new glasses, nothing else.” Bethany stammered and struggled with what to say, but Mrs. Copley didn’t wait for an answer. “You people took advantage of my son. I’m not paying for this. I’ll pay for my co-pay but cancel everything else. I’m taking my family to a different doctor from now on. This is ridiculous.”

Bethany was stumped, and could only offer to return Mrs. Copley’s call after speaking to the practice manager.

T H E    B I G    Q U E S T I O N S

1. Does Mrs. Copley have the right to cancel her son’s orders, including refusing to pay for services after they were performed?

2. Is it unreasonable for Mrs. Copley to expect the practice to treat her son like a dependent, even if he is 19 years old?

3. What would you do to save the relationship and keep the Copley family in the practice?

R E A L    D E A L    R E S P O N S E S


The son is technically an adult, though obviously not viewed as one in the home. There is no way of knowing that in the medical or retail world, though, unless he’s accompanied by his mother. If his mother chose to pay for his materials and exams, her beef is actually with the son. I personally wouldn’t cancel anything. I would explain that as an adult, he had the power to make these orders and pay for them. And really … are these the type of clients we’re struggling to keep as patients?


Do what the mother wanted and send an apology letter with a discount for any member of the family who returns to the practice.


The mom is in the wrong for wanting not to pay for services that have already been rendered, but she has every right to be very upset. The office’s first mistake was accepting a check that didn’t belong to the patient. The employee could have been helping this person commit fraud. So the damage is done. At this point, the first thing is to tell the mother, “That is horrible! Let me take care of this for you.” When someone is paying a bill for someone else, then it’s their choice what they want to pay for that person. We are servicepeople and we need to look for ways to always make a patient happy.


The patient’s mother has a right to be angry. Not that the practice took advantage of the son, but with a little more questioning they would have figured out that the patient was not paying it on his own. A 19-year-old is technically an adult, but it’s all about asking questions. Of course they want contacts and sunglasses and everything else! I would offer to charge her for the exam and throw in his contact fitting. If that would make her happy, I would see if she would still be interested in doing the glasses. Taking a hit for the rest of the exam is worth doing to keep that family in my practice.


I have a 20-year-old son who would absolutely say yes to everything recommended to him — especially cool sunglasses. That’s why he wouldn’t go to an eye place with my credit card. I would charge for the eye exam and glasses and refund the rest. You’re going have to be nicey-nice and apologetic about the refund if you want to see the family again, and your chances are 50-50 at best.


In a case like this, we always call the parent. Just because they are 18 doesn’t mean they can spend like it’s theirs. It avoids problems later.


Mrs. Copley has the right to cancel the optical order if she is the responsible party. When the patient checked in, it should have been verified and established whether he was a dependent. If this was our patient, we would call her and explain that we understand why she would be upset. We would remind her that an individual 18 or over has the legal right to make decisions which is possibly why we allowed him to make those healthcare choices. We would likely offer her a 20 percent discount on the glasses order, waive the testing fee and contact lens fit fee and offer him six months contact lenses free. Retention of a satisfied patient is worth more in the long run.


I would have suggested that the office manager handle this from the beginning and would charge her only for what she wanted her son to have to save the family’s business.


Mrs. Copley does not have the right to any information from the clinic without her son’s consent. If she pressed the information issue further, I would ask her to ask her son to drop by and sign a records release form so that the clinic is indemnified against any privacy issues. There is room for negotiation here. I would call her back and apologize to her for the misunderstanding. The important thing in this negotiation is not to place blame on her or her son. I would not attempt to tell her how this could have been avoided as she does not wish to hear that. I would immediately offer to refund the charge for the Optomap. If there were no contacts dispensed at the visit I would credit back the fees for the fitting. She should be advised that with the refund of the fitting fee there would not be a contact lens RX as the fit was not confirmed with a recheck. Should the sunglasses be complete I would offer to refund a portion of retail price. I would then apologize again and thank her for her patronage and tell her you look forward to their next visit.

DR. G.R. M.

I’m not sure that Mrs. Copley has the right to cancel the order, but she certainly can refuse to pay. With the check not yet cleared, she has the advantage. Legally he is of age, but there is a huge range of maturity in 19-year-olds. When a young adult comes in with a check from Mom, it is prudent to inquire whether he is authorized to make final decisions.


Any time we get a situation like this, whether a check or credit card, it’s pretty obvious that there’s some type of dependency, regardless of the age of the patient. We always ask the credit card or checking account owner for permission before proceeding, by calling it a “courtesy call to Mom” to let her know what’s going on. There are enough surprises in this business without setting yourself up for a costly one.


I would have “held” the order for the glasses and the CL instruction until getting a confirmation from Mom that it was OK. I’d ask her to send a note or call the office if she is not going to be present for a dependent’s visit. That way we know what the parent has in mind.



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