Is there a bettter way to handle this???

[scograd]

A patient came in with a "contact lens stuck in her eye." Last exam was 2004. Our receptionist informs her there is a $35 exam fee (yeah, I know it's too low!). Patient says she won't pay the fee and wants to talk to the doctor. I tell her that there is a fee for professional services. Since we don't do any medical billing, we try to make it competetive with most insurance co-pays. She wants me to look at her eye and tell what's wrong. I tell her that there are very specific examination tests that need to be performed. Because of that, there is an exam fee. Patient wants to talk to my husband (the other O.D./ owner). She waits for him to come out with his next patient. While I'm in with my patient, I hear arguing between her and my staff. I leave my exam room to tell my staff not to discuss anything with her further. Finally, my husband comes out to tell her that there is a professional fee for services rendered. She then takes out her CLs, throws them away...puts on eye makeup!!!!, then proceeds to start bawling and asks what she should do now...are we going to send her home blind? She wants a pair of trial CLs now!!! My husband writes out her previous SpRx and recommends to have glasses made next door. The patient refused to take the Rx and left.....
So...I told my staff that next time something like that happens, if the patient becomes agitated to simply say, "It looks as though we are not going to be able to come to any agreement, we would be more than happy to call the 2 nearest practices (on the 2nd floor) to see if they have any appointments available immediatly. Is that the best solution??? I hate turning away red eyes, but why should I take that kind of liability for even less than $35?? If we had billed medical, it would be well over $100 exam fee for a foreign body removal!!

[drk]

How can you better handle a nut job?

Difficult question...

[bren_03825]

A hard one, but, each situation demands that you do what you can and send on what you can't. That patient needed to see that no matter what, your a professional, and she would be getting of severely less cost wise than normal.

[Fezz]

I'm thinking some MMA moves!

A nice arm bar or a kamora would be great. A full nelson would "snap" her out of it! Maybe a few slaps in the face followed by a splash of water would help!


Seriously, once someone raises there voice, or tries to argue with my staff or myself....there done, out of there, see-ya! End of discussion. I would personally escort them out, or call the police and have them show the way out!

[chip anderson]

How did she take them out if they were "stuck in her eye?"
When I have a patient of mine come in with one "stuck in the eye" as per a rigid lens stuck on the sclera, I remove it, clean it an put it back on.
I do the same if the patient is not mine and just walks in the door.
Now if they want more, I have them make an appointment. Or if not my patient I have them see thier eye doctor and get an Rx and make an appointment.

I do not charge anything in either case for removing, cleaning and re-insertion.

If they have difficulty inserting or removing, I schedule an appointment for that, usually without charge. But then I am old an poor.

Chip

[Johns]

Last Monday, for the first time ever, I had to call the police to escort a lady out. Unfortunately, she heard me call and left before they got here.

I had a roomful of pts. and the cop said, "Is everything under control?"

I looked at an old guy (about 90 yrs old) sitting there and said,"Yes officer, unless this guy starts to get out of hand!"

The whole office started laughing and eveyone was a good sport about it.


It sounds like Scograd's office/OD handled everything pretty well.

[obxeyeguy]

So...I told my staff that next time something like that happens, if the patient becomes agitated to simply say, "It looks as though we are not going to be able to come to any agreement, we would be more than happy to call the 2 nearest practices (on the 2nd floor) to see if they have any appointments available immediatly. Is that the best solution??? I hate turning away red eyes, but why should I take that kind of liability for even less than $35?? If we had billed medical, it would be well over $100 exam fee for a foreign body removal!!

Typical cl patient, never happy, don't ever want to pay. I think you did fine.

[Fezz]

Typical cl patient, never happy, don't ever want to pay. I think you did fine.

:cheers::cheers:

[Robert Martellaro]

How did she take them out if they were "stuck in her eye?"
When I have a patient of mine come in with one "stuck in the eye" as per a rigid lens stuck on the sclera, I remove it, clean it an put it back on.
I do the same if the patient is not mine and just walks in the door.
Now if they want more, I have them make an appointment. Or if not my patient I have them see thier eye doctor and get an Rx and make an appointment.

I do not charge anything in either case for removing, cleaning and re-insertion.

If they have difficulty inserting or removing, I schedule an appointment for that, usually without charge. But then I am old an poor.

Chip

Chip,

I must be aging faster than you because your posts keep making more sense as of late.

Regards

[dweinstein]

I would have given her the option of going to the emergency room, waiting a few hours to be seen by a med student, then another hour for an ophthalmology resident to come down and remove the lens in about 10 seconds and slap her with a bill for hundreds of dollars... or pay the $35 fee and get a thorough examination on the spot.

[obxeyeguy]

When I have a patient of mine come in with one "stuck in the eye" as per a rigid lens stuck on the sclera, I remove it, clean it an put it back on.
I do the same if the patient is not mine and just walks in the door.

Chip, I kow that you know what you are doing, but, do you slit lamp them? What if there is a corneal problem, such as a slight abrassion, that some how turns into an ulcer?? Do you wan't to take the responibility for that? My god, he /she only wanted $35 bucks. This is the total problem with us that have been around for a while, we give it away. Its wrong. we need to stop and start chargeing for our services. No more free ride. Where else do you go and get professional services for free? No where(eccept optical community).
I kike you am an optician, not a dr., and by the way, have not fit a cl in many yrs( thankfully ). Its just that the older I get, the less I want to give away my expertise for free. I wholeheartedly agree with sco on this.
Contact lens patients are a pain, will aways be a pain, and ther is very little money in it if any.

[ShuString]

Good thing it wasn't WalMart ,they would have gave her a gift card...

[DrNeyecare]

My contact lens fitting fees are the highest around. Why? because I hate contact lens patients. I rather the OD across the street see them with his lower fees. I rather dedicate my time to patients that would spend money on glasses, than those that abuse their eyes and take their RX to Costco or online vendors. Sure, I lose CL patients this way, and possible Sun RX sales, but I also save myself alot of unncessary stress...

[MarySue]

I don't understand this? Did the patient ask yor fee for helping her? If not - if you could have seen her, you should have - and then handed her an invoice due immeadiately after the exam.

I don't know of anyone who thinks medical services are free. If you had first done the job before asking for the money - maybe she would have seen the value.

To this client, it appears that they thought it was simple. I say wow them with your prowess and expertise, and overwhelm them with your very low price of $35 for that fantastic experience.

[Fezz]

I don't know of anyone who thinks medical services are free. If you had first done the job before asking for the money - maybe she would have seen the value.

You should pay a visit to the States! You would be truly horrified at the lack of common sense, respect, and personal and financial responsibility that most patients possess.

[DocInChina]

I don't know of anyone who thinks medical services are free.

Correct. The patient thinks that their buying contacts or glasses from you when Clinton was president covers them for all future services rendered.

I say wow them with your prowess and expertise, and overwhelm them with your very low price of $35 for that fantastic experience.

I will refrain from any innuendos and leave it to Fezz or Harry to reply to the above statement.

[Fezz]

I will refrain from any innuendos and leave it to Fezz or Harry to reply to the above statement.

Who, what, where, when? How? ;)

[KStraker]

She probably bought one box of Acuvue 2's in 04 and is still wearing them! This seems like the classic case of a primadonna who is too cute to wear glasses. People like this wear the crap out their contacts and then wonder why they always have eye problems. We have several of them.

I'm with Fezz, a nice throat chop would have shut her up quick.

[obxeyeguy]

To this client, it appears that they thought it was simple. I say wow them with your prowess and expertise, and overwhelm them with your very low price of $35 for that fantastic experience.

Absolutely, every cl patient comes in always wanting to pay for everything. Seriously, I think not. This patients last visit was 04, Read between the lines, non-compliant!! How often do you replace your cl's?? Oh, I wear them till they bother me.

Why? because I hate contact lens patients

What else can I say on this, it says it all.

[DocInChina]

I'm with Fezz, a nice throat chop would have shut her up quick.

Interesting observation. Fezz is becoming our alter ego. :cheers:

[chip anderson]

Actually when we had only PMMA lenses and were the only or near the only fitters with thier act together in the state. We gave lifetime service (check ups, polish, PC modification, slit-lamp exam[but not a substitute for physician's annual exam] free. Of course on condition that all service and replacement was purchased from us.
This was very, very successfull but alas now gone are the days. Now that almost anyone can fit soft contacts as well as anyone else, and every M.D., O.D., chain optical, discount house and mail order sells them at below our costs, it just ain't what it used to be.

Chip:cheers:

[Andrew Weiss]

Question: what would the practice's liability be if they showed her to the door without at least offering services? I think scograd and her office handled this very well, and the suggested alternative of offering to refer her to another office would work equally well.

But once the patient has refused to pay for treatment that's been offered for a (in this case extremely) reasonable fee, does the office's liability end?

Yelling at staff, taking out CLs (thereby proving they aren't stuck on her eye) and bawling and demanding free demo lenses -- beyond the pale Out of respect for the office staff and the patients, escort her firmly and irresistibly to the door.

And take a cue from Johns -- treat the whole incident with humor; everyone feels better ;)

[DocInChina]

Reminds me of a CL patient that was examined and fit with toric SCL's. She had oblique astigmatism and required a fair amount of chair time over a period of several weeks. She paid for the examination, fitting and lenses up front which was my standard policy. When both patient and I were satisfied with vision, fit and comfort of the final diagnostics she wanted a refund for the contacts and just wanted to pay for the general eye exam insisting I give her the prescription for the SCL Torics so she could order them online. It was explained that this was not possible and she proceeded to have a screaming fit. The police were called and finally she left. A couple of days later she came back again screaming and demanding a refund and threatening all forms of legal action. When asked to leave she refused whereupon she sat in the waiting area for several hours. When it was near time for us to go home she refused to leave. I walked over and snatched her shopping bags from the floor next to her and threw them out the door. She moved pretty fast then and I locked the door behind her. Ah, the good old days. Why did I move to China?!?! ;)

[HarryChiling]

I'm with Fezz, a nice throat chop would have shut her up quick.

Judo-ptician, just decorate the office like a Muay Thai ring and come out wearing gloves next time. :D

I think this image describes it best:

[Fezz]

Judo-ptician, just decorate the office like a Muay Thai ring and come out wearing gloves next time. :D

I think this image describes it best:

Oddly, my office looks similiar to that! And I do wear "Hi-Ya Karate" Cologne!


Fondly,
Sensei


:D:cheers::D:cheers::D:cheers::D