Not charging for CL fitting

**fjpod** · 07-14-2006, 06:14 AM

I think we've had a thread like this before...The optical/eyecare industry is it's own worst enemy. So many CL wearers have no idea that their CLs have to be fit. They have no clue that a CL Rx is different than a spectacle Rx. They have no clue that we have to order or stock diagnostic sets, etc. No clue that we have to ensure they know proper care and handling... I can't tell you how many times a routine exam patient comes in with no CLs, never mentions CLs except when asked in history taking, gets his glasses or an Rx for glasses, then says, "oh yeah, let me have my Rx for CLs too in case I want to order them online."...and then squeals like a stuck pig when he is told he needs more testing and fitting.

I had a -12.00 with a -2.00 cyl the other day, who had nothing but problems, who wasn't wearing his old lenses anymore, and he couldn't understand why I would charge a fitting fee. "He never paid one before."

Why is it so compelling for optical providers to give away CL fitting services for nothing? Does anybody take the patient through a fitting process anymore? What's the point of doing all that work, taking all the risk, for no money? We would never fabricate and fit spectacles for no profit.
Does your plumber unclog your drains for nothing just because he possibly installed a new faucet for you?

I have a lot of optical chain stores around me. I don't know who is in control (usually corporate), but nobody is charging. Some of them say, " a spectacle exam is $40, and a CL exam is $50." That's not charging for a CL fit. Why is any one of us willing to do CL work for 10 bucks, especially when CLs are such a profitless commodity today? We might as well have the FDA declassify them as medical devices and just let patients pick them off the shelves, so we don't have to deal with all the work and responsibility of fitting them. It would save us a lot of time and money.

I still make a good living fitting CLs. I have a graduated fitting fee schedule depending on the complexity of the fit and experience of the wearer. I make it clear to every prospective CL fit that the fitting charge is xx before we even start. If they don't want to pay, I let them walk.

I'd be interested in hearing what others think about this...but please don't go off blaming receptionists for fitting CLs, or bashing one profession or another.

**HarryChiling** · 07-14-2006, 07:03 AM

fjpod,

I think a great way to differentiate yourself is to ecome well at fitting the hard to fit. Fit the presbyopes and RGP's that the chains don't like and most of the time the chains tell these people things like they can't wear CL's. Make your self a reputation for being the best d*mn CL fitter in the state of NY and people will stop complaining about the fitting fees, because the alternative would be the chains telling them they are not a candidate for CL (chain speak for you will not work with an sperical disposable)

**Jubilee** · 07-14-2006, 07:16 AM

What we do in our office is charge for a fitting fee on a graduated scale as well. Then as long as you remain in that same brand (ie Oasys, SSMT, Purevision MF, whatever) we do not charge it again until we change brands again. Then a fitting chargde gets reassessed, thought typically less.

To the people that balk at it, we point out how the majority of the lenses we utilize have rebates available for the fit if they purchase at least a 6 month supply. (AV comfort series, B&L purevision, etc) We also talk to them about how some places charge every year extra for just having cls, and we do not. Those who don't have the rebates are ones who have came to our doctor because he is considered a cl specialist for those difficult to fit cases.. Torics, Hard lenses, monovision, and multifocal CLS. According to a couple of different sources, he has the highest Monovision and Multifocal success rate in the Indy area.

I once had a lady ask "$xx for me to come back for 10 mins on two occasions to check the fit? He only used one set of trials to begin with!" My reply was that she was paying for his expertise. Be happy it didn't take 5 or 6 tries to get it right... which would cost more to her?" She gladly paid up!

Cassandra

**Framebender** · 07-14-2006, 07:56 AM

that some patients lie about never being charged a fitting fee. We hear the same thing alot, but when we call for CL specs and ask the provider 95% say oh yeah, we charge xxx for fitting. I don't know if patients think we're stupid or if they just choose not to remember.

In Colorado cl Rxs are good for 1 year by law. New patients (spherical) pay a fitting fee equal to our exam fee. Previous patients are charged a fitting fee equal to 2/3 of our exam fee. They are charged this every year. If you are a toric fit you pay more, multifocals and RGPs are the same, but more than a soft toric. I am fortunate to have a Doc that is very good with gas perms so alot of OMDs refer kone patients to us. They pay the largest fee of all, but we keep their lens prices as reasonable as we can.

My Dad told me a long time ago that anything you give away is precieved as having no value. I believe that to be true. I will give away a pair of nosepads from time to time, but I would never think of giving away my Docs skill.

**Excel-Lentes** · 07-14-2006, 08:21 AM

The way I figure it if a person feels that it is not important to have a proper contact lens fitting then I probably don't want to do the fitting. As far a the fitting fees are concerned; I feel that what you pay for is what you get. In those places that don't charge for fitting or just add on $10-$20 on top of the exam fee I don't think the patient is getting the best care. I have heard through others (doctors as well as patients) that a fitting consists of putting lenses in the eyes and checking vision. No follow up, just selling boxes of lenses.

It is sad to see this art losing it's value. You can't really blame the consumer as much as the manufacturers the way they advertise on TV and magazines. I will give credit to B&L trying to save face in light of the Moistureloc incident with a TV ad that tries to promote good lens care.

**docandk** · 07-14-2006, 10:15 AM

The law states that if the patient was yours the last time and neither the brand of contacts nor the prescription changed, there is no fitting fee charge (and no fitting, by the way), otherwise, do a fitting and charge a fitting fee.

**rbaker** · 07-14-2006, 11:06 AM

docandk - I wasn't aware that there was a law telling me when to charge or not to charge. Please educate me?

**docandk** · 07-14-2006, 12:28 PM

Originally Posted by rbaker

docandk - I wasn't aware that there was a law telling me when to charge or not to charge. Please educate me?

Oops, I mispoke. Actually, the Fairness to Contact Lens Contact Lens Consumers Act which requires release of contact lens prescriptions defines a contact lens fitting as the "process that begins after the inital eye examination and ends when a successful fit has been achieved or, in the case of a renewal prescription, ends when the prescriber determines that no change in prescription is required, and such term may include - (A) an examination to determine lens specifications; (B) except in the case of a renewal of a prescription; an initial evaluation of the fit of the lens on the eye; and (C) medically necessary follow up examinations."

After this was passed, we stopped doing and charging for contact lens fittings to our previous contact lens patients whose prescriptions and contact lens brand did not change.

**Dave Nelson** · 07-14-2006, 12:31 PM

This is an ongoing debate here in Canada as well. Here in British Columbia, the law requires a fairly extensive fitting procedure, documentation and follow up service, yet many places either charge no fitting fee, or a small one of say $15. This leaves an optician performing a fitting procdure worth about $100 for nothing, or next to nothing, then hoping the client won't simply purchase cl online. As already mentioned, clients then perceive the fitting procedure as worthless, then balk at paying for any contact lens related service, such as re-fits. The most annoying example was a woman who came to see me for a new toric fitting. She lowered her voice, and said "I know about your little secret" she says, "I know what you guys pay for the contacts, and you must be getting rich off them. Don't worry your little secret is safe with me." She paid for a couple boxes of lenses, took 2 HOURS of chair time over a month, and thinks I RIPPED HER OFF?

**fjpod** · 07-14-2006, 07:27 PM

Originally Posted by Framebender

I am fortunate to have a Doc that is very good with gas perms so alot of OMDs refer kone patients to us. They pay the largest fee of all, but we keep their lens prices as reasonable as we can.

.

I've always done keratoconus cases. Lately, however, patients have walked if I don't take their medical insurance. Since keratoconus is considered a medical condition, RGP fitting and supply of lenses is a covered service. So, these cases are no longer as lucrative as they once were, and you have the hassle of "educating" the insurance company that, Yes they do cover the service.

**The Critical Eye** · 07-15-2006, 12:27 PM

Originally Posted by docandk

Oops, I mispoke. Actually, the Fairness to Contact Lens Contact Lens Consumers Act which requires release of contact lens prescriptions defines a contact lens fitting as the "process that begins after the inital eye examination and ends when a successful fit has been achieved or, in the case of a renewal prescription, ends when the prescriber determines that no change in prescription is required, and such term may include - (A) an examination to determine lens specifications; (B) except in the case of a renewal of a prescription; an initial evaluation of the fit of the lens on the eye; and (C) medically necessary follow up examinations."

After this was passed, we stopped doing and charging for contact lens fittings to our previous contact lens patients whose prescriptions and contact lens brand did not change.

Hmmm.... I'm baffled... ! Are you saying that this consumers act supercedes
your associations act and bylaws. Is this not just a guideline ?

To my understanding... a contact lens fit is a never ending ...ongoing process. Even if lens type/design or Rx don't change... there are still things to be checked for. I'm not going to list them ... this should be common knowledge.

**Happylady** · 07-15-2006, 05:25 PM

We always call it a contact lens fitting and evaluation. When we used it refer to it as just a fitting people would say that they already were wearing the same brand of contacts and why do we need to do a fitting. Now that I always add evaluation I rarely get that. It has really made a difference, surprisely.

We charge $45.00 to $125.00 extra for the contact fitting and evaluation depending on on the type of fitting and lens. This includes follow ups for the first 3 months.

**ilanh** · 07-15-2006, 10:13 PM

We charge a graduated fee for fitting ($120-170) depending on complexity. This includes 3 months of unlimited follow-up. Every year when our patients return for their routine exam/refraction we charge $45 for "contact lens evaluation". This fee is charged whether or not a change in prescription is required. If we have to refit with a different brand we charge about $75. Whether a patient has paid the full fitting fee or only a small "contact lens evaluation" fee we will always offer 3 months of free follow-ups.

This may sound steep for some practitioners but we really spend an enormous amount of time with our contact lens patients.