medicaid replacements

[Mizikal]

Do you find yourself replacing glasses for medicaid patients more then your nonmedicaid patients? I was thinking for the longest time that maybe if we (my employer) offered better quality frames for medicaid patients then maybe we would see less replacements. I however don't think this is the case now. I am thinking now if we supplied them with higher quality frames they would be lost or broken in more unique was. It does not matter how good a frame is if it is not taken care of properly.The real problem is that they see them as free and they know they get so many pairs for "free" and since something is free it is of no value.

That is the sum of my experience with medicaid glasses and kids but I was wondering if others had the same experience.

[Jubilee]

We have had less issues with this the past couple of years compared to others. We are no longer warranting medicaid glasses unless they purchase a separate warranty. Warranty upgrade includes polycarbonate lenses since Indiana won't cover them unless they have a surgical history or monocular. Otherwise any replacement will be billed to insurance and will reset their benefits. Replacement w/o warranty requireswwritten documentation on why replacement was necessary and they must be currently eligible for medicaid. We make sure they understand that they won't be eligible for any mats when they have next exam.

[Slim]

In Illinois, they send a package of frames to display. So we dont have a choice here...
But to answer some of your question, By far I waste more time on those frames, fixing, gluing, screws, modifying frame to fit lenses right... etc...
Just last week we made it an office policy to NOT order replacements for medicaid patients. After doing the math we just loose too much money. We love to help but there has to be a line. So if it cant be fixed to a wearable state in 5 min or less, we can order them a new frame for 30 bucks.

[BigGuy]

I don't take straight Medicaid but in my area we have several Medicaid managed care plans that go through the state and our local BC/BS insurer. There is no cost at all to the patient for eyewear they choose from the covered selections. Most of these plans allow for free replacements also. As my Grandpa used to say, "if you give someone something for nothing, that's what it's worth." Many of these patients call to say their glasses are lost or broken and ask for the free replacements. Sometimes as often as 4 or 5 times a year. Why take care of something if you can get it replaced for free, right? Our tax dollars at work.

[becc971]

We stopped doing the glasses for this reason. it is a quality issue as well as a care issue. In maine they get 2 pair a year, so if they needed a replacement then we would do their second pair. after that it was out of their pocket. you could do a prior authorization, but it usually took months to hear back and it was still usually a no.