doctors changing rx

[PAM H]

Today we had a patient come in for a new routine exam for contact lens. She has been coming to our office since 1994(the type of patient you want to keep). She's been wearing soft spherical monovision contact lenses prescribe by our doctor since 1994. Today she was seen by another doctor on our staff, her autorefractor reading were +1.75 -25 and +2.00 -.25. The doctor
dilates($10.00 fee) and prescribes a +2.00 and +4.00 -1.25(monovison), charging her for a toric eye examination $75.00 (normally a routine fee of $60.00 for a spherical exam). Is this justified or are there doctor needing to make an extra few bucks to make end meet the bdget for the month? Just curious. I'm furious the she did this to a good patient and customer. Any comment will be helpful. I need to take this to our lead doctor on
staff I think this is outragous.
Thanks for hearing me out I need to vent on this one. It wasn't the first time this has happened with this doctor.
Thanks

[stephanie]

Hi Pam, yes I pretty much agree with you on this one. I think it is ridiculous to run off any pt let alone the good ones. Your doctor needs to stick with customary fees. I would definately talk to the head doctor and find out his/her opinion on the matter and hopefully the situation can be resolved.

Good luck to you,

Steph

[slate83]

I too agree with your observations on this situation.

I would like to add something to this thread... Is it normal for a patient's rx to change every single year they come in?

I have a patient that has been coming to us for years. She has seen one of our doctors that is conservative when it comes to rxing. She has seen one of our newer doctors the past 3 times she has been in and he has changed her rx everytime. She says that she can't see well with the new rx she just got and is questioning why her rx is being changed everytime she comes in now.

She is not the only one who is complaining. This is becoming a routine thing.

I had another patient who was seeing 20/25 with his old rx. The doctor refracted him, but was not able to improve his acuities at all. He told him that he wanted to changed his prescription. We dispensed his new glasses to him and immediately the patient said he couldn't see. I let the doc recheck him. The doc changed the rx back to the original rx. Unfortunately, the patient's old pair of glasses were in great shape with no scratches on the lenses. Now he has a new pair of $500 glasses that he really didn't need.

Sorry guys, can't figure out what makes people so greedy. I'm afraid these types of situations are gonna drive our practice in the ground.

[chip anderson]

Now you are beginning to see some of the real reason behind the "One year limit on Rx's". We have a lot of jake~leg O.D.'s here that charge up to $ 85.00 extra for a "contact lens exam" and there is nothing they get in a "contact lens exam" that they don't (or shouldn't) get in a routine eye exam, beyond the words "O.K. for Contact Lenses" on the Rx.

Soon, we will have addittional charges, for dilation, flouresein, tonometry, wearing a lab coat, shoes shined, and an extra special charge if the doctor is sober .

Chip

[Matthew]

Hello

Did you talk to the doctor? Not sure if I read it or not but is the Doc in your office or from a different location. I have a great relationship with local docs including one in my office. A little communication goes a long way with stuff like this.

[chip anderson]

Dear Slate83:

You have just stated one of the best and most typical cases for the precriber having no economic ties to the one who fills the Rx.

I have seen "Doctors" who would Precribe a .12 cylinder in a pair of welding goggles. Reason, they sell for a lot more than non-Rx welding goggles. Could I be convinced that the patient "needed" the .12 cylinder, NO!

Chip

[Alan W]

Last year I caught a forum of optometrists which I wish I had never seen. The discussion was based around this question:

If the patient doesn't see any better with the new glasses should they get a refund?

Response from about 8 posters:

Credit towards future purchases on the specs, no refunds on the exam.
Why?
Because patients pay for the service of investigating for need. Need was defined as the smallest increment of useable change. Useabale does not mean acceptable. Further, fees are immune from satisfaction according to the experts.

So, why should we expect any other consideration for change criteria and why should we expect any doctor to treat his fees as a reasonable exchange for services. If they did, they would have to make patients happy under a variety of circumstances, instead of expecting them to become happy by the presence of a professional in the same room.

I agree that communications should be deployed under the above circumstances, but we also need to be aware that the doc ain't gonna be your friend no mo!

Caveat Emtor (sp?)

[PAM H]

Thank you for the response. I spoke with our lead doctor today
about the situation. He's confused as why she did that type of RX
change himself (I know he would not do that himself). He's going to speak with her on her next scheduled day to work. Hopefully
things will change. Wish me luck, I'd like to she her gone.
Thanks again,
Pam

[NC-OD]

Hello Pam (and others)

I just read your original post and I must be missing something. You told us her autorefraction (which may or may not be similiar to her actual refraction) but not what she was actually wearing before the change. Was is a big change? Did the patient have a legitimate complaint (not seeing well)?

If the patient had astigmatism previously, the original doctor may have not corrected for it for a number of reasons. This patient may have complained about poor vision in the left eye.

And yes, there IS more involved in a contact lens exam (or there should be). It's called an evaluation and fitting fee because one size does not fit all. Keratometry readings are taken more closely, the CL's are chosen based on physiology of the eye (ie. dry eye, steep/flat cornea ect.) . They are inserted and evaluated for fit, comfort and vision. Changes are made if necessary. More time and expertise = More $$

So I would say more is involved in contact lens exam. And a toric contact, being somewhat more difficult to fit and stablize and more likely to take additional time, should have a higher fee.

So I don't am not defending this doctor but only saying there may me more here than meets the eye (pun intended).:D

I do disagree with an extra fee for dilation. Many doctors do this and am completely against it. I do not want someone to choose not to get dilated (and get a through exam) just because they don't want to pay an extra $10 (or whatever). I simply structure my fees to always include dilation and if they chose, for whatever reason not to, thats fine.

[PAM H]

Hi NC OD,
This patient has been wearing disposable monvision since 1994. She's been getting her annual exam every with slight changes in her RX(also was seen by 3 other doctor in our office in that time, without any significant changes. She came in for her annual exam, was see by another doctor on staff(who works 3 days a week at our office). My point is she"s never worn a toric lenses before. She's 65 yrs. old. Sure lets give her a -1.25 cyl
and tell her to get use to it?
Sounds like a define refund to me plus a waste of time for the patient. Being a optician I hate when a doctor does that.
Thanks
Pam

[NC-OD]

Hello Pam H

Wow, a 65 year old contact lens wearer! I probably agree with you. If it ain't broke, I certainly wouldn't fix it. If she was happy with her vision and was just in for an annual exam then I most likely woudn't have changed her. But I was wondering if the patient DID have any vision complaints that would justify a change if rx. You didn't mention any??

And by monovision, do you mean only one contact lens in one eye or a contact in both the OD and OS (with one being more plus for near)?

Either way there is either more to the patients story (like whining that she cant see) or you have an questionalbe move by the doctor who should not have changed her rx. ?? Hard to say from far away.

Good luck with it.

[Dannyboy]

Is it possible the doc felt that adding that cylinder in the contact lens was necessary to improve the near vision? Frankly, if it was my patient, I would have tried first a spherical lens specially for near (yes even a 1.25). Yep. an overkill for monovision.

In monovision usually the dominant eye is fitted for distance, our eyes are more sensitive to cylidrical correction need mainly at distance. Near vision in the non dominant eye can be corrected usually with a spherical lens if the cylinder (in my opinion) is less than 2 diopters. It all has to do with a principle call the circle of least confusion and the spherical equivalent. One way to resolve the above is to actually have the patient compare and see which one she likes (toric or sph). Now as far as charges, if the fitter spend the time trying to accomplish something (maybe your patient was unhappy with her present lenses) a charge is justified.

Dannyboy:)

[Texas Ranger]

Pam, As an Optician, could I ask what the lady's "glasses" rx is? Is it our position to question the motivation of the prescribing doctor? Instead of going over her head to her boss, could you have discussed the technical merit of the situation for your personal professional edification, and so that you could better answer the clients questions regarding her new lenses? Could she be right? If, not, why not? I can see why there would be more fees for contact fitting than a refraction for glasses, there is a lot more involved. Doctors used to roll these extra fees into the cost of the contacts, until the mail order guys got in to it; now they get the extra fitting fees. I think that's very fair. So, why else do you want to "see her gone?" jus' curious.

[marblez]

Chip

I am alittle confused. When a patient in your office receives a contact lens exam, the only thing on the rx is "good for contact lenses"?

As a contact lens fitter and living in Florida, that would not be a contact lens Rx.


help me understand;)

Christina

[Dannyboy]

Christina, when one works as an optician and decides to fit contact lenses usually an ok for contact lenses is needed. In Florida opticians can fill, fit, adapt and dispense any contact lens under the supervision of a doctor.

If a Florida optician wishes to do it independenly only soft contact lenses can be done. Hard or extended under supervision (does not mean that it has to be under the same roof as the MD)

See the laws and rules athttp://www.doh.state.fl.us/mqa/optic...01do_home.html
also as for interest see the attorney general information
http://legal.firn.edu/consumer/tips/tipeye.html

In this case:
A prescription is usually the refractive information with or without Ks. The optician takes ks and uses the slit lamp to arrive at the parameters such as diameter, bc appropiateness, compensated vertex power of refractive Rx etc..

I think what he means is that some ODs charge extra to look at the cornea in more detail to make sure that a contact lens is not contraindicated. The Od will then write a refractive Rx with the notation ok for contact lenses. I dont remember which state he is in.

Dannyboy

:p

[Dannyboy]

I forgot to mention that Florida licensed opticians must take "the contact lens course" and then apply for board certification to do soft contact lenses independently.

Dannyboy