How I explain *why* I don't accept insurance

[Barry Santini]

In my office, we are all opticians, licensed in NYS (the toughest) and all of us have mucho add'l training and expereince. We have no refracting doctor at all in our office, and we don't accept any insurance (except Medicare after cataract surgery).

I think we're *dinosaurs*!

However, my clients commonly ask what insurance we take, and why we don't.
I tell them there's not enough money in it to make eyewear consistent with the quality we want to deliver, without "trading" them up with options in a, well, *madatory* way. I additionally tell them let's look at the number$$:

Insurance supposedly "gives them a free pair of glasses", worth about $150 to $200. I tell them the numbers don't lie:

What is your "out-of-network" reimbursement for eyewear? And I'll suggest we settle, for arguement's sake on $50.00.

Now, can we all agree that your insurance company, expecially in this day & age, is out to save as much money as it can? Can we agree that they would strive to save pennies on each claim, if they could? (response in generally "yes")

Now if, for example, your insurance company's out-of-network reimbursement would cost them $50 (as above), and they would pay an in-network provider..say...just $1 more, or $51.00.....

...don't you think they would tell all their members that they should go out-of network, and save the insurance company money?

Then I say: Whatever your out-of-network reimbursement dollar amount is, then the in-network payment to your eyecare provider is probably pretty close to that. And there's no way a participator is goin' to give your a "real" $150-$200 pair of glasses for a $50 or so dollar reimbursement...

It just doesn't make any sense! And they buy the arguement...because it's logical, and so often true!

For me, the expansion of seyewear purchases is currently being held hostage by three things:

1. The precipitant of n "eye exam", when only a refraction is necessary
2. Insurance reimbursement, and its annual/biannual allowance timetable
3. Consumer habit that says "I hate eyewear!" If I don't *need* it, then I don't *want* it!

We don't need "Check yearly, See clearly" consumer campaigns...

We need to change Consumers from *need* to *want*, and they best way to tackle point #3, is to address changes or wipe out Points #1 & #2.

Your thoughts, optiboarders? (my flame suit is nearby...)

Barry Santini, ABOM

[JerryR]

I guess another reason you don't take insurance is that you and your associates are NYS Licensed Opticians (as I am), therfore even if you wanted to participate, you couldn't become a provider as an optician.

[Malibu Barbie]

From a consumer's point of view, I would personally rather hear something like:

"Our prices are so competitive that we don't feel it would benefit our customers to accept insurance when you compare the quality of services we provide."

or

"Our prices are so competitive that we've actually seen customers pay more in insurance or discount plans than they would have without these benefits, so that's why we don't encourage it."

Either of these responses would answer my question, or have me so confused that I wouldn't be inclined to ask further questions for fear of being perceived as an idiot. :D Besides, I feel that asking a facitilty why it doesn't accept insurance deserves an equal response in the realm of reasonability.

[orangezero]

For me, the expansion of seyewear purchases is currently being held hostage by three things:

1. The precipitant of n "eye exam", when only a refraction is necessary
2. Insurance reimbursement, and its annual/biannual allowance timetable
3. Consumer habit that says "I hate eyewear!" If I don't *need* it, then I don't *want* it!

We don't need "Check yearly, See clearly" consumer campaigns...

We need to change Consumers from *need* to *want*, and they best way to tackle point #3, is to address changes or wipe out Points #1 & #2.

Your thoughts, optiboarders? (my flame suit is nearby...)

Barry Santini, ABOM[/QUOTE]


I guess I don't read on here enough. Do most opticians really feel refractions should be separated from actual exams?? I talked with several people from Canada this last week, and perhaps they are biased, but all of them felt refracting opticians in B.C. was bad for almost everyone involved. Too many people around that dont' know what they are doing. Sure there are people who feel otherwise.

However, I do think its always a good thing to mention how cruddy vision insurance plans are. I'm thinking of opening up an office, and really would love to have no vision plans, just medical. They really are ripoffs. Its too complicated or boring for most to want to think through.

[Fezz]

Good post Barry.


I work for an OD and we do take some insurances, but not many. We explain to patients that we will not compromise ethics, quality, medical procedure just to be on a provider list. We often are very frank in discussing that this is a business and we have to make $$$$$$ or else we close. PERIOD. We let them know that many of these plans pay less then half of our break even costs for chairtime. We then ask if they would like us to rush thorough the exam, not talk about Aunt Jane and here new goiter, compromise on the care. Obviously, they all say no and open there eyes to our perspective. Thankfully, we have a very good patient base who understand, appreciate and value the services, professionalism, and products that we provide to keep us afloat(so far).


Fezz
:cheers:

[HarryChiling]

1. The precipitant of n "eye exam", when only a refraction is necessary

I totaly agree.

I talked with several people from Canada this last week, and perhaps they are biased, but all of them felt refracting opticians in B.C. was bad for almost everyone involved. Too many people around that dont' know what they are doing.

Their are doctors out there that don't know what they are doing as well and they refract all the time.(opinion) I think that if someone is to be able to refract they should be highly qualified, but refraction has nothing to do with health.

I think that logically opticians should refract, but I don't think optometry will give up refraction because without it what do they do? I have heard that more and more optometry schools are gearing their curriculum more towards the medical aspect and farther from optics. I believe that at some point in my lifetime IF optometrists are able to gain a wider scope of practice it is possible that opticians could gain refractions, but that is a long way from now. While optometry schools are preparing for a wider scope of practice what are we as opticians doing, and how will we convince anyone that we as opticians are ready and cabable of refracting?

I also think that since opticians in BC have fought hard to gain refraction, they deserve the right to not have anyone haphazardly throw out generalitys about incompetence. I take offense to this personally, because I believe they have obviously earned the right to refract in 2 ways.

1) they were able to band together to get legislation passed (a pipe dream here in the US so far, and also the way optometry seperated themselves from opticianry)

-and-

2) were able to intelectually argue their case against many naysayers and prove that they have earned the privledge

I talked with several people from Canada this last week, and perhaps they are biased, but all of them felt refracting opticians in B.C. was bad for almost everyone involved. Too many people around that dont' know what they are doing.

It is a known fact that most optometrists don't want to have opticians refract, and spreading rumors is not considered a valid argument, so to help counter the damage you may have done here we go.

I heard from some people in Canada the other day that the opticians up their are doing refractions a 100 times better than optometrists.

[orangezero]

i see your point. three people saying something doesn't make it so. But, for as many people on here that believe it is a god given right to provide cheap refractions instead of costly eye examinations, there are just as many people who see this as something that is detrimental to our society and professions.

However, it is my feeling that if you believe refraction really is totally separate from the medical aspects of eyecare you really don't understand eye care, how the visual system works, or the medical/legal aspects of what is being proposed. My history is a little rough, but the main losses of optometric lawsuit cases are examples of optometrists acting as "refracting optometrists" and failing to do simple testing such as tonometry. Do we really want our society and legal system to go through that again?

There are many reasons people come to me to "see." Many times (despite the fact that I currently work at a retail establishment, and thus have a skewed patient base) the assessement is not one of simply changing the Rx, but rather addressing other health related issues, rarely but sometimes life threatening. Or perhaps visual performance related. Are "refracting opticians" going to know how to treat these conditions as well?

One of the problems is that optometry seems to have abandoned refraction, but thats not truly the case. We do seem to emphasize the medical side of optometry, but there are many reasons for this. I believe its a natural progression, since we perform the vast majority of eye exams and in many rural areas are the only providers of eye care.

I fail to see how opticians should be given refracting priveledges, at least in the US. Dental hygienists don't naturally gain the right to perform dental surgeries just because they've been around as a profession long enough. And they don't seem to clamor to perform dental cleanings without the aid of a dentist. Perhaps not a perfect example, but there are similarities.

I don't think what we do as optometrists is sacred, but there are many valid reasons to couple refraction and eye care. There are also many, many more qualified people that can give better arguments than me, that much I think we can agree on.

I would never send anyone I knew to a simple refractionist, often times for the same reason I wouldn't send them to an ophthalmology office. I don't think most tech refractionists (and their opthalmologists who "teach" them) really understand things such as accommodation, convergence, overminusing, streff's syndrome, etc. Not that I believe ophthalmologists are bad, they are actually trained in other specialties, like cataract surgery, lasik, etc. But to think they get the same training as an optometrist in refraction and the visual system is just plain silly.

Frankly, its scary to read some of the things believed about eye care on this forum. Visual acuity is not god, its one part of the exam. Visual acuity actually tells me very little about how a person performs in real life.

If you really do want to perform limited exams, where do we draw the line? Is it ok to have 20/20 vision in both eyes, but not test visual fields? color vision? Do you want grandma driving down the street with 20/20 vision but can't see anything from the midline to the periphery on the left side? I sure don't.

Optometry has won most of its "medical" battles (ok, its a lot of politics too) from a realization that we can and should be providing primary eye care. There was a need in many areas and patients were put at risk. For example, if someone comes into my practice with an angle closure the best treatment for that patient is something that I can't legally give them. Try telling that to the patient at 6:30pm on friday night. Instead they get to go to the ER where most times the docs on call are scared to have to even touch an eye ball and end up giving them drops that should be out of production (not being mean, they are more heavily educated than me on most things, but they don't spend day in and day out dealing with eyes so lack the confidence and knowhow). Not an efficient use of medical dollars in my opinion.


Sorry this is so long, and off topic. trying to deflect some of the perceived rebutals. I do think this a good discussion.

Something that always comes up in a topic such as this is that "everything boils down to money". Truth be told, if i wanted money I wouldn't be providing eye care. (there are so many things I love about eye care and are the reasons I became an optometrist: optics, health, medicine, helping people, small business, technology) I think most in the know about the current eye care "system" can agree with that. There's no money here, perhaps a long time ago, but not now. I can speak for myself at least and say there are certainly bad examples of every profession. However, I really hope the majority of opticians don't believe they should have refracting rights simply because of the opinion that "refraction has nothing to do with the medical aspects of eye care." We as health providers have a lot bigger problems than I thought if that's really the case, or perhaps we will have a much easier time shooting this thinking down. half full or empty I suppose.



anyway, on topic again...

[dcdwn]

It is sad that O.D. had cheapen there prof. They got into incurrence the person who started V.S.P. IS AN O.D. Before O.D.,S would refract now they refract,dispenes, take all INCURRENCES ,TREAT EYE PROBLEMS,AND IF SOME OF THEM COULD CUT ON THE EYE THEY SURE WOULD . NO ROOM FOR USE POOR RE
FRACTING OPTICIANS OR OMDS . WE HAVE BEEN REPLASED BY ODS. So I LIKE THE FACT THAT BERRY IS INDPENDENT OF INCURRENCE. HIS PATIENT SHOULD BE PROUD TO GO TO A GREAT PLACE TO PURCHASE THEIR EYEWEAR KNOWNING THAT THEY ARENT GETTING SCREWED BY INC,VISION INC, OR MEDICAL FILING BY AN O.D

DON PRICE ABO- NCLE
REGISTERED OPTICIAN OF TEXAS

[Barry Santini]

I do think that a refraction is an important and necessary element of a compelet eye-health exam...but...

refraction of and by itself *is not* a medical procedure in the manner that it should be forever tied to a complete eye exam SOLEY!

In my areas, (poorly-trained) techs are performing refractions, and doing it more poorly than you would believe. The consequences of this are that they (the techs) are finding out that their *corrective parameters" (?!) are not satisfactory for their patients, so...together with the patient disconnect for "paying" for a refraction as a $30-$45 co-pay, these techs are performing (?) quick acuity tests, and asking the patient if *they* feel they see "OK", and if the answer is affirmative...NO REFRACTION is performed.

So much for keeping refraction tied to the complete eye-exam in the interests of patient eye health.

Regarding OD's?MD's dispensing...I have no problem, as long as their "recommendations" are just that...written out on a spearate piece of paper with the title "Recommendations"...AND NOT WRITTEN ON ANY PAPER WITH A MEDICAL IMPRIMATUR. Writing out Transitions, Poly, UV, AR and the like, on an Rx is uneithical leveraging of their trust as a medical professional...especially when the profit from these recommendations. Their is absolutely NO WAY you are going to reduce or prevent conflicts of interest in this regard.

As far as OD eye exams/refractions....if they are properly done, they the fee for these should reflect it, and not need to be subsidized by "capturing" as many "Rxs" in their office as they can.

2 cents?

Barry Santini, ABOM

[HarryChiling]

When I go to my primary care physician, sometimes he shines a light in my eye and will document that the eyes look OK. That doesn't mean that I am all good and don't have to go to an optometrists and get an eye exam, and if I do have anything that my primary doctor sees wrong then he will refer me to an ophthalmologist. So yes I agree with you that OD's give better refractions than MD's, I also think that OD's might be suprised that some opticians would give better refractions than the OD's.

Refraction \Re*frac"tion\ (r?*fr?k"sh?n), n. [F. r['e]fraction.]
1. The act of refracting, or the state of being refracted.

2. The change in the direction of ray of light, heat, or the
like, when it enters obliquely a medium of a different
density from that through which it has previously moved.

Refraction out of the rarer medium into the denser,
is made towards the perpendicular. --Sir I.
Newton.

3. (Astron.)
(a) The change in the direction of a ray of light, and,
consequently, in the apparent position of a heavenly
body from which it emanates, arising from its passage
through the earth's atmosphere; -- hence distinguished
as atmospheric refraction, or astronomical refraction.
(b) The correction which is to be deducted from the
apparent altitude of a heavenly body on account of
atmospheric refraction, in order to obtain the true
altitude.

Optometry \Op*tom"e*try\, n.
1. (Med.) Measurement of the range of vision, esp. by means
of the optometer.

2. As defined (with minor variations) in the statutes of
various States of the United States:
(a) ``The employment of subjective and objective
mechanical means to determine the accomodative and
refractive states of the eye and the scope of its
function in general.''
(b) ``The employment of any means, other than the use of
drugs, for the measurement of the powers of vision and
adaptation of lenses for the aid thereof.

This is a websters definition of refraction (although old), and nowhere in their do I see anything about health. My point is not that the health of the eye should not be a concern, but that if you are concerned with the health go to a medical doctor if you want a refraction go to an optometrist. Why is it OK for optometrists to widen their scope of practice into medicine and prescribing drugs and it isn't OK for opticians to widen their scope of practice?

It is sad that O.D. had cheapen there prof. They got into incurrence the person who started V.S.P. IS AN O.D. Before O.D.,S would refract now they refract,dispenes, take all INCURRENCES ,TREAT EYE PROBLEMS,AND IF SOME OF THEM COULD CUT ON THE EYE THEY SURE WOULD . NO ROOM FOR USE POOR RE
FRACTING OPTICIANS OR OMDS

He has a cryptic but good point that OD's have their hands now in insurance, dispensing, refracting, contacts, and in one state even lasik. What makes OD's believe that they are this skilled that they can do everything?

As an optician, I shouldn't have the right to refract as a natural progresion of our field, but naturaly lasik should be performed by OD's and drugs prescribed. Oh and by the way in Maryland when they recently passed the bill for OD's to prescribe certain steroid drops the training was a 2 hour lecture that you would have to sit through and some of the OD's didn't even sit through the whole thing.

However, I really hope the majority of opticians don't believe they should have refracting rights simply because of the opinion that "refraction has nothing to do with the medical aspects of eye care." We as health providers have a lot bigger problems than I thought if that's really the case, or perhaps we will have a much easier time shooting this thinking down. half full or empty I suppose.

It's funny how they become we so quickly. I honestly think that opticians should never and I mean never take the advice of optometry when it comes to how we should think about our future in the health care system. I say this because optometry has never had opticianrys best interests in mind.

This thread will probably continue like so many others on this topic, so let me sum it up.

• Optometry believes that refracting without a complete eye exam is horrible.
• Opthalmology believes that refracting can adequately be done by techs they train.
• Opticianry believes that one day maybe someone will throw us a bone.

[Barry Santini]

Besides, I feel that asking a facitilty why it doesn't accept insurance deserves an equal response in the realm of reasonability.

I do too. I gave/give them the Truth!!

Barry

[orangezero]

I'm not sure Webster's dictionary is the best place to look up what I do on a day to day basis, or for what I was trained to do.

But if we must look at those, why don't the opticians that want to refract simply go to school and become optometrists??

[dcdwn]

I did go to school . I WAS TAUGHT HOW TO REFRACT BY TRAIL LENS. ALSO HOW TO MAKE EYEGLASSES FROM SCRATCH , AND CONTACT. BY THE WAY I WILL BE HELPPING TEACH REFRACTING TO RESIDNET DOCTORS. I ALSO WORK FOR A YOUNG O.D. AND I DO TELL HIM SOME PROBLEM AREAS IN HIS REFACTING. IAM CURRENTLY BEING TAUGHT HOW TO MAKE ARTIFICAL EYES. AND THE PERSON WHO IS TEACHING ME HAS BEEN DOING EYES FOR OVER FORTY FIVE YEARS. HE IS VERY RESPECTED BY MANY MEDICAL DOCTORS. AND I THINK THAT YOU HAVE WENT TO OPTOMTRY SCHOOL YOU ARE NO BETTER THAN I . YOUR NOT A MEDICAL DOCTOR ,FOR THAT TAKES TWELVE YEARS OF SCHOOL. YOU JUST WENT TO SCHOOL TO REFRACT AND I WILL BET THAT SOME OPTICIAN TAUGHT YOU A CLASS OR TWO AT SCHOOL. OH BY THE WAY I AM VERY HAPPY THAT OPTICIANS IN CANADA ARE REFRACTING. I HAVE HEARD THAT THEY ARE REAL GREAT REFRACTIONIST BETTER THAN SOME O.D. I HOPE THAT THEY KEEP ON REFRACTING.


Don Price , ABO , NCLE
Texas Department of Health- Registered Optician
ROATx .

[Johns]

"Why don't you use your insurance and get the glasses your insurance company wants you to have, and then come back here and we'll make you a few pair that you'll really want!"

[wmcdonald]

I'm not sure Webster's dictionary is the best place to look up what I do on a day to day basis, or for what I was trained to do.

But if we must look at those, why don't the opticians that want to refract simply go to school and become optometrists??

That is the same old tired argument MDs used when ODs wanted to "do drugs". This is simply hypocritical and not accurate. Refraction can be taught, and is in many Opticianry Colleges. I only wish ODs and Opticians could one day come together and stop all this he said, she said and take care of patients!

[drk]

IF (big IF) you all knew what you were talking about (which you don't) you'd realize that the "refracting" that you're talking about (whatever the heck that is) cannot be done as a stand-alone service.

I'll explain this, once more, and only once more:

When a patient comes into your office with a complaint of blurry vision, for example, you have to find the cause. This is called a "chief complaint". You have to take a case history to investigate the cause. You have to understand what kinds of "blur" complaints are refractive, and what kinds of "blur" complaints are medical.

What if the patient is having some kind of transient ischemic attack, presents to a "refracting" optician, who finds a half diopter of cylinder change and a ten degree axis change, "diagnoses" (which is a medical decision-making process) a change in refractive error, and "prescribes" (again, a medical decision) a change in spectacle Rx? Delay in treatment. Whose to blame?

The government is to blame, in that one, for allowing such a ridiculous state of affairs to exist. In the U.S., at least, we don't have health care rationing to the degree that we are willing to step down the level of eye care that is being provided.

Yes, an optician can be a smart person. Yes, an optician can be well-educated and experienced. Yes, some O.D.s are dumb as a box of rocks. But there are some minimum standards that separate the professions, and they are HUGE, boys and girls.

Refracting: difficult. Life and death? No. Could an optician do that? Sure.

Examining eyes: very difficult, sometimes, and a big responsibility to boot. Grandma. Little Timmy.

NOW I ASK, ONE MORE TIME: HOW ARE YOU GOING TO SEPARATE THE TWO? How are you going to provide "refractions" (and I won't even begin to broach the subject on how to be more than a simple auto-refractor level "refractionist, but believe me, as your experience should tell you, it 'aint that easy), again, how are you going to provide "refractions" without performing some semblance of an eye exam?

How you gonna make sure that cheapskate mom doesn't take innocent Timmy to Walmart for their "$19.99 Refraction Friday" special, and miss his amblyopia? Do you want that for the people of this country? (Heck, for another $20 they could at least see a commercial O.D., for what that's worth.) Do you think we should have ANY control of healthcare at all, or should "caveat emptor" be the law of the land concerning eye care?

If you like the "caveat emptor" concept in your field, would you like that to happen for dentistry and medicine, too? Should we toss out all the regulatory efforts that the people of the states have enacted? I didn't think so. We need regulation.

Now, lets see you take this quest to the states: "Please allow a new and lesser level of eye care because
1.) there aren't enough optometrists and ophthalmologists, and there is a dearth of access to care available
2.) you can't get a cheap enough "full" eye exam, and people are economically suffering
3.) we want to refract, because that makes us somehow better than what we have been, traditionally."

For heaven's sake, from the perspective of the U.S. citizen, what is the point of a "refracting optician"?

I am not a hater of Opticianry. I am a hater of ignorant hubris.

[JerryR]

DRK..........That was a great post!!!!!!!!!!

[Barry Santini]

IF (big IF) you all knew what you were talking about (which you don't) you'd realize that the "refracting" that you're talking about (whatever the heck that is) cannot be done as a stand-alone service.

I'll explain this, once more, and only once more:

For heaven's sake, from the perspective of the U.S. citizen, what is the point of a "refracting optician"?

I am not a hater of Opticianry. I am a hater of ignorant hubris.

OK! I think you might be leaning to socialism (which is an ok, alternative path....)

Aren't you just this much from advocating (mandating) eye exams as a matter of public health?

Using your reasoning, all OTC meds should be removed from sale, and anytime a citizen feels ill, etc., they must be examined by a physician to preclude any hidden disease or other significant health conditions.

I'm still listening, but *only* one more time...

And I don't like especially being called ignorant... soryy if I am offended by your big brush!

Barry Santini, ABOM

[Bicentric_CR_39]

Cheers!!!!
Well spoken!!!
My hat is off to you...
:cheers:

[drk]

There is a balance, Barry.

You may note that OTC meds do occasionally cause harm, too. You understand how OTC readers work. The point is that we are pretty balanced in the US. If you want to compare the US to the far east, we're regulated. If you want to compare to Europe, we're unregulated.

Optometry doesn't set the state board rules, nor does opticianry. Their purposes are to protect the people from us professionals. In this case, I would agree that people need to be protected from a lower level of service than a basic eye examination, meaning "refraction", and I think that just about every lawmaker would agree.

So why not spend time doing something productive, like raising your across-the-board professional standards, instead of swinging for the fences?

[Barry Santini]

There is a balance, Barry.

You may note that OTC meds do occasionally cause harm, too. You understand how OTC readers work. The point is that we are pretty balanced in the US.

I for one, do NOT think we're balanced in the US. Since anyone that can obtain "healthy vision" from purchasing appropriate OTC readers is *satisfied* that their vision is now fine...they generally do not seek an eye exxam...with all the possible deliterious effects you mentioned above. For me, it's either: OTC readers and refractions anywhere...or *madatory eye exams (with expiration dates...yikes!). Anything in between in facicious.

...and I think that just about every lawmaker would agree.

If the cost to the healthcare system for comprehensive exams to *everyone* is factored in, i think we're moere bankrupt (if that's possible?) than we are now.

I enjoy discussing this with all of you. Please continue!

Barry Santini,
ABOM

[Barry Santini]

Listen, guys...I'm still learning how to post... I misposted one of my reply's into DRK's statement...


sorry!

barry

[drk]

Hey, I'd be for removing OTC readers, but since they pre-existed today's laws, the burden of proof would be to show how much damage they caused. OTC readers don't have direct substantially negative conseqences.

That's balance.

Now, if you want to provide vision care as an optician, the burden of proof for you is to show how the status quo is hurting people. And you can't make that case.

So I win. HAHAHAHA!

[optical24/7]

There is a balance, Barry.


Optometry doesn't set the state board rules, nor does opticianry. Their purposes are to protect the people from us professionals.

Then drk, I assume you agree that Dr's should not be allowed to own eyeglass dispensaries, the same way an MD can not own a pharmacy, possible conflict of interest.

[Barry Santini]

Now, if you want to provide vision care as an optician, the burden of proof for you is to show how the status quo is hurting people. And you can't make that case.
So I win. HAHAHAHA!

...give me time... (heh heh heh!)

barry