should patient pay for restyle?

[Mizikal]

This doesn't happen all the time but from time to time I have patients and their parents picking out frames that are not going to work for them. Sometimes its a preteen wanting the big hipster look other times it parents wanting their 4 year old in oversized glasses. I will explain to the parent or patient why the frame will not work and make notes in the order saying so. Frame to big or plastic frame did not sitting on nose. I will also comment in the notes that I recommended against this frame. Then a few weeks after they have the glasses and experience all the problems I said they would have they are under the impression I will restyle them. This is usually a medicaid case were they get 2 replacements a year. I then explain that they cover replacements and that doesn't mean they get to pick out a new pair of glasses. I always tell them at the time the order is placed that these will be the glasses they have for a year and I will not be able to order them a new pair.



Why do they think I will eat the cost of the glasses or that medicaid will? If they used their own judgement shouldn't they be responsible for their choice? Would you restyle a patient for something like this ? Am I being unreasonable?

[Barry Santini]

Technically, yes. But your competition often will not.

That's what you are up against.

B

[BP3]

I call it the "teenager fallacy", meaning they ignore all my advice until it's too late and then they expect us to fix it.

And people wonder why I don't want kids.

[SeaU2020]

You COULD make a very special "waiver" that , hopefully you will need to use only sparingly....it will give them a chance to pause on the decision anyway.

[Paul Smith LDO]

1) you've done your due diligence; documentation and physically pointed out potential issues with said frame
2) cover your ***
3) have an established protocol set in place for situations just like this
4) use said protocol judiciously; as there will always be exceptions
5) patients never want to hear those four words, "I told you so"
6) in the end we all have to compromise

[Jubilee]

Are you billing Medicaid for those replacements?

If it is a situation where we are supplying replacements for glasses, and we are billing the insurance, I don't see why we can't switch the frame. My costs will be the same regardless, and my reimbursement the same.. so why not make them happy?

If it is warranty service, and thus no monies being exchanged, I would work it on a case by case basis. I usually either do my medicaid lenses in house, or I route them to a lab that will allow frame changes. Most of our Medicaid frames come from the same vendor and we keep a large qty on hand. Depending upon the case, I will recut the lens to make it work in the smaller frame (and letting people know that the lenses maybe thicker than necessary since they were originally manufactured for the larger frame. For children I have done some temple conversions, and if the frames are really over/under sized allow a "one time courtesy" remake. Sometimes I will charge the patient a minimal fee that is inline with our state reimbursement rates for the new frame and/or lenses. Cover my costs, keep the patient happy, and keep the family's business there.

[iD]

What I've found is depending on the insurance and lab they will let me switch out frames as a non-adjust to frames.

[Hayde]

In the case of a completely mismatched, ill-fitted zyl, I'd simply rather not sell a disaster waiting to happen. When the patient picks up on that vibe when I theatrically run through the litany of foreseeable problems, they usually take my advise to heart and broaden their search or politely leave altogether to shop elsewhere. The latter case is fine...if the competition wants to invite those sorts of remakes, then they can have them.

If the patient is in love with a bad frame and insists on buying them, then I tell them before the sale that since we anticipate problems and the selection is against advise, the purchase of them won't be refundable. Notes on the emr software to that effect. Be sure to notate the fact on the receipt as well.

Unanticipated cosmetic restyles (completely unrelated to lens aesthetics) I have similar distaste for. I never pressure people to buy and often encourage them to sleep on it if I detect any lack of enthusiasm. I think a policy of x% 'restocking' (plus any greater price difference of the frame) is appropriate to dissuade the fickle from shopping with me. Again, I'm more than happy to give them to the competition. A business model built around 'close the sale!' & 17% remakes is their perfect home. If I really like the patient and can believe they'll only pull this once--then I may wave it...once. (That's much easier to do for a long-time patient rather than a brand new one.)

If there's a functional problem with a frame or how the lenses turned out in them, of course I rush to restyle. If I didn't anticipate the problem, then the error was mine, not the patient's. Even if it was unforeseeable, I'll take the hit for the bad luck. The patient will still look on it as a black mark on my business regardless of the cause--so I still have to hustle to 'catch up' in their eyes.

[optical24/7]

You can thank LC for this asinine policy that's now expected by consumers.

[scriptfiller]

optical 24/7

No one is made to follow, that's a choice.

In the case mentioned by the OP, I would do it once but be clear in the future not again. Document so others in the practice are aware.

[CCGREEN]

Since we are on such a subject.
What do others do when a patient comes in a makes a choice for frame and lenses, they put good faith money down ( in my office we require 1/2) but they call back late that evening/next day and are having buyers remorse and wants to cancel the job?

The first thing that pops into my mind is, has the lab started to surface the job yet?
If they have, were do you go from there?
If they have not, where do you go from there?

[DanLiv]

Regarding OP, how much do you want to keep the patient? Given it's Medicaid to begin with your margin is low there's only so much service you should include. If it's worth the effort to you to please and keep the pt and potentially deal with the same issue with them in the future ("But you did it for me last time!"), by all means be generous. But if you have better things to do maybe let them live with their poor decision and they will either be more careful with you next time, or take their Medicaid business to someone else. I have come down on both sides with pts in the past; some I have refused because of poor attitude, or my belief the problems will only escalate is I capitulate, others I have bent over backward for in efforts to provide them impossibly good service which they will not receive from many of my competitors. It's one among many perks of not working for a corporation that we do not have inflexible policies to which we are chained.

Since we are on such a subject.
What do others do when a patient comes in a makes a choice for frame and lenses, they put good faith money down ( in my office we require 1/2) but they call back late that evening/next day and are having buyers remorse and wants to cancel the job?

Our office policy states cancellations can be refunded 100% on the same day. Jobs are started by beginning of next day's business and cancellations thereafter are subject to refund policy, same as if they took them and brought them back. I will check with the lab and if no work has been done yet I can be lenient and allow a full refund, but I am generally not sympathetic to buyer's remorse. I will happily frame restyle, lens redesign, Rx change, etc. if those are the issues, but if the wife chews hubby out because he spent too much money without her consent, that is not a problem I will work too hard to fix.

[EyeManDan]

bingo

[Mizikal]

Danliv hit the hammer on the head. The reason I don't is simply time. It is the one thing I never have enough of. I am very hands on when it comes to selecting a frame . When they come in I will spend whatever amount of time is needed to make the frame selection. I Just don't have time for a repeat performance. I am not as strict as my original post seemed though. I don't have anything set in stone. Usually by telling them that they will have the frame for the year makes them realize they need to make a better choice and not " order and see if they like it". I will always have the parent who doesn't want their two year in mirraflex so I usually let them switch.

[SeaU2020]

You can thank LC for this asinine policy that's now expected by consumers.

+1