NHS prism subsidy

**yzf-r1** · 09-27-2002, 05:22 PM

I would like to gauge some opinions on the following scenario.

You refract a person and decide to prescribe them say 2 doiptres of prism, and for COSMETIC reasons, you split it equally between the two eyes. This patient happens to qualify for NHS help, so now the NHS is paying not 1 lot of prism subsidy, but 2 because the prism happens to be in both eyes.

Does this not amount to defrauding the NHS?

Surely, the NHS should only have to pay for 2 lots of prism subsidy if prism is CLINICALLY necessary in both eyes e.g. as a result of what you see on FD.

I know i will probably get alot of flack for this, but i dont think it is right for the NHS to pay when the predominant aim is cosmesis

Your views please.

Yahya

PS: Before you suggest that the above scenario relates myself, may i add that i do not qualify for NHS support.

**John R** · 09-28-2002, 02:37 AM

yzf-r1 said:
Does this not amount to defrauding the NHS?

Since you will end up with the same amount of prism, i think not.
I dont know how the NHS subsidy works, but i know how we charge for prism.

Care to enlighten us more on how the subsidy's work, like who pays the bills and what sort of rembursements they give.

**yzf-r1** · 09-28-2002, 06:40 AM

John R said:
Care to enlighten us more on how the subsidy's work, like who pays the bills and what sort of rembursements they give.

If you qualify for NHS help towards your specs, the NHS will pay specified amounts (voucher values). The voucher values can be found on the AOP's website
here

If you also see on the same page in the second table, it gives you the values for what the NHS will pay, (in addition to the amount in the first table) for supplements such as clinically necessary prism or tint.

I think there has to be a way for the optometrist to state that prism was split for cosmetic reasons, so that the patient, despite having a prism in 2 eyes, gets an NHS subsidy only once.

**John R** · 09-28-2002, 08:32 AM

yzf-r1 said:
PS: Before you suggest that the above scenario relates myself, may i add that i do not qualify for NHS support.

Hey dont worry about that as i qualify for
free specs....
Just goes to show how well payed some of us are.

**sarahr** · 09-28-2002, 09:01 AM

I'm going to play devils advocate now! If yuo see a px with R Prosthesis, but clinically neccessary tint in the other eye, can you claim for 2 tints?;)

Seriously I see your point. I would think for a larger amount of prism it could almost be deemed clinically neccessary to split, due to wearability rather than cosmesis. What is the actual definition of clinically neccessary? You could say that whatever the results in the test, to split the prism is no more extravagant than giving a balance lens for cosmetics when a plano would be cheaper.

**yzf-r1** · 09-28-2002, 04:16 PM

sarahr said:
I'm going to play devils advocate now.

You're always playing devils advocate:D :D :D
he he he

**sarahr** · 09-28-2002, 06:19 PM

RUMBLED! Bah-humbug...now then, where's my next victim?

**yzf-r1** · 09-29-2002, 07:12 AM

Back to the topic if the thread:finger:

sarahr said:
If yuo see a px with R Prosthesis, but clinically neccessary tint in the other eye, can you claim for 2 tints?;)

I think the scenario you have raised is a tricky one (having said that, it could not have come from anyone other than you;) )

I suppose in this case it could be claimed that is is clinically necessary to have tint in both eyes in a similar way as a tinted CL is used to hide an unsightly eye???

**sarahr** · 09-29-2002, 09:39 AM

yzf-r1 said:
Back to the topic if the thread:finger:

I suppose in this case it could be claimed that is is clinically necessary to have tint in both eyes in a similar way as a tinted CL is used to hide an unsightly eye???

No, lets say it's the most beuatifully handpainted eye you could ever see and matches perfectly the other eye.:bbg: :shiner: hee hee hee

Back to the topic again though, my LHA does work closely with the practitioners and allow for professional judgement, I'm yet to be turned down for any request which can be explained to the LHA PRIOR to dispensing and then notated on the voucher afterwards with a reference name. I think if you feel uncomfortable about a sitution with prisms/tints or anything else, a quick call saying "am I right in thinking it's OK for me to claim for prism in both eyes, it won't affect the vision but if I don't, the specs will be ugly and uncomfortable to wear", I think they would probably deem that as clinically neccessary.
:cheers: