Doctor's remakes

[TRISH]

I am totally dependent on outside RX's. How should I handle Dr.'s changes? Do I charge the patient for the remake or just continue to absorb the errors? This is getting out of hand and very costly. I'm ok if it is a progressive lens with in the 60-90 days non adapt policy. I have a couple of particular doctors that I cringe every time I fill their RX's. How do you handle these situations? I've thought of putting up a sign saying not responsible for Dr's changes in prescriptions they will be remade at 50% of cost/charge. Your thoughts would greatly be appreciated.

[AngeHamm]

What is your lab's policy? Most labs will replace lenses at no charge at least once within 30 or 60 days for a Doctor's change.

[Barry Santini]

Me too.

[OptifiedNikki]

Trish, I totally understand you. I cringe myself when I fill outside Rx's too.

What I would recommend and what I started doing was telling all my clients even the ones that get the prescriptions from us (because I have to be consistent in how I conduct business) the following:

Progressive lenses:
To not be charged .... 7-14 days to adapt to the lenses (of which they normally do) 30 days to return the lenses for any necessary changes if applicable (why 30 days ... because by telling them 30 days they will be more than likely to come in before the 60 - 90 day non-adapt policy period runs out. I told a patient the exact length of the policy period, they came back a year later complaining about the errors. who knew? lol)

They will be charged ... After the policy period 50% or cost whichever is higher and clearly explain to the patient that being that lenses are custom-made as prescribed and can not be changed once the order has been completed, any adjustments made are considered a new order aka a new lens aka a new transaction aka a new price. But, we are more than happy to help you in the best way possible because we want you to be satisfied with our service. although this is not our Rx (or is our Rx but you waited to return too long pass the warranty period), we will share the cost with you. Re-iterate that you gain little to nothing from this transaction.

Bi-focal lenses are changed at no cost only when patient wants Sv and couldn't adapt to lenses

Single lenses are changed at no cost depending from distance to near only within the first week, otherwise redone at a discounted rate

Single lenses to bi-focals will be charged whatever the U&C fees are. If you explained it and they declined that's their issue not yours.

I hope this helps.

[Uncle Fester]

If it's an office that regularly sends rx's my way and is infrequent I eat it. My lab significantly discounts. Cost of doing business.

That's a pretty short progressive non adopt time but to each their own.

[Paul Smith LDO]

I have several OD's in my neck of the woods who do not have a dispensary and regularly send their patients to me. Although it is gratifying that they have confidence in my ability as an optician it is also discerning how some of their prescriptions are consistently off. I have learned that trial framing can be an opticians best friend, if I come up with something different I call the prescribing Dr and inform them of my findings, some will readjust the Rx and fax it back to me. It might be a good idea to build a strong relationship with the Dr's in your area.

[Craig]

We trial frame as many as possible and we do normally charge 1/2 off for changes; sometimes I will do 70% off.
We normalyy do charge for any re-makes and it is normally not a big deal with the patients, sometimes we get push-back and we have to deal with it at the time but overall it works for us. I am on net pricing and do not get any credit for re-do's of any type!

I hate the fact that MD's and tech's can even do an exam without consequences.

[Craig]

Me too.

What?

[9520g]

We avoid all of this. Not so much because of the remakes but because when something is wrong they are quick to point the finger at the optician and not the doctor. Our office policy is that we do not take outside rx's.

[harry888]

I've had couple diabetics seem to think I should change their outside Rx change monthly at no charge./

My policy with outside Rx: One remake due to dr's change within 30 days at no charge. After that 50%. Then later grumbling that we hope the Rx was the only thing the Dr got wrong.

No matter how good you are at spinning dials, 2-5% of Rxs come back.

Harry

[rbaker]

I've had couple diabetics seem to think I should change their outside Rx change monthly at no charge./

My policy with outside Rx: One remake due to dr's change within 30 days at no charge. After that 50%. Then later grumbling that we hope the Rx was the only thing the Dr got wrong.

No matter how good you are at spinning dials, 2-5% of Rxs come back.

Harry

Hence the 250% mark-up on lenses.

[wmcdonald]

We avoid all of this. Not so much because of the remakes but because when something is wrong they are quick to point the finger at the optician and not the doctor. Our office policy is that we do not take outside rx's.

Interesting........that is how Opticians have made a living for many years.

[revein]

Do private practices have enough volume to be able to disregard outside Rxs?

[TRISH]

Thanks everyone for your in put. I don't have a trail frame. Where can I get one? I don't have a doctor I have a dispensary and finishing lab. I don't want to have to refuse any prescription.

[wmcdonald]

If you do not know how to use a trail frame appropriately, and most Opticians unfortunately have little understanding of optics even at a rudimentary level (thanks to the poor education and training required), you should not be using it. Know that in some states it is expressly prohibited, and considered practicing Optometry. Don't get in trouble based on recommendations here.

Unfortunately, this decline in the field is what other professions in the industry and the chains want from us......sales clerks, and we have allowed it to happen! We dumb down with each generation and some do not even realize it is happening. In your state of Miss., for example, there are some good, solid Opticians. I do not know your background, but the only requirement there to use the title is a pulse, unfortunately. Work to improve that if you are serious about this profession.

If there is a doc who is consistently off, then it would be sound business to inform patients who come in with his/her Rx not to take them any longer. Soon, they will lose patients as the word travels, or clean up their act.

[Paul Smith LDO]

If you do not know how to use a trail frame appropriately, and most Opticians unfortunately have little understanding of optics even at a rudimentary level (thanks to the poor education and training required), you should not be using it. Know that in some states it is expressly prohibited, and considered practicing Optometry. Don't get in trouble based on recommendations here.

Unfortunately, this decline in the field is what other professions in the industry and the chains want from us......sales clerks, and we have allowed it to happen! We dumb down with each generation and some do not even realize it is happening. In your state of Miss., for example, there are some good, solid Opticians. I do not know your background, but the only requirement there to use the title is a pulse, unfortunately. Work to improve that if you are serious about this profession.

If there is a doc who is consistently off, then it would be sound business to inform patients who come in with his/her Rx not to take them any longer. Soon, they will lose patients as the word travels, or clean up their act.

Trailing framing is utilizing your very basic skills of lensometry, it's not rocket science. If you can neutralize lenses in a focimeter, you can trail frame a patient. If you can't, learn some damn skills or get out of this industry. It's not refracting, it's at the very core of opticianry. You are simply showing the patient the RX that the OD or the OMD came up with prior to spending money on lenses.

[kaypaula]

Do private practices have enough volume to be able to disregard outside Rxs?

We get VERY few outside Rx in our practice but I will gladly take them! We have one MD and two OD. That keeps us busy.

[wmcdonald]

Trailing framing is utilizing your very basic skills of lensometry, it's not rocket science. If you can neutralize lenses in a focimeter, you can trail frame a patient. If you can't, learn some damn skills or get out of this industry. It's not refracting, it's at the very core of opticianry. You are simply showing the patient the RX that the OD or the OMD came up with prior to spending money on lenses.

I agree we should have the ability, Paul, but it is refraction no matter how you wasn't to view it. In the early days that is all there was, so to say it is not is incorrect. In some states, like Tennessee for example, Opticians cannot even LEARN about refraction. I have lectured in every state in America, and am familiar with the 22 state laws, and know that your state has a fairly good law. Others do not. Some are expressly prohibited to perform such acts, because it is the domain of the OD. In states with no license requirement, it can still be a questionable practice from a legal standpoint, and many there have very limited skills.....the very reason I fight so hard to improve things. I am afraid at this point it may be too late, but only time will tell.

[CME4SPECS]

I believe that if I put a trial frame on someone and made changes to what was prescribed, I'd be refracting and in the state of CA, that is illegal.

[Paul Smith LDO]

I agree we should have the ability, Paul, but it is refraction no matter how you wasn't to view it. In the early days that is all there was, so to say it is not is incorrect. In some states, like Tennessee for example, Opticians cannot even LEARN about refraction. I have lectured in every state in America, and am familiar with the 22 state laws, and know that your state has a fairly good law. Others do not. Some are expressly prohibited to perform such acts, because it is the domain of the OD. In states with no license requirement, it can still be a questionable practice from a legal standpoint, and many there have very limited skills.....the very reason I fight so hard to improve things. I am afraid at this point it may be too late, but only time will tell.

I am not advocating trial framing for refraction purposes. I am simply stating the use of trialing framing as a means to demonstrate the RX written by an OD or an OMD whom one has had a plethora of redo issues, as a means of providing said patient with visual information. It is no more refraction than dispensing the written lens RX. You mock it up and ask the patient how their vision is, we do that when dispensing. The example that I gave was based on my experiences in my area. I stand by the use of the trial framing and for anyone who works at a dispensary only business should know how it works and have one available to them. As to CME4SPECS adjusting the lenses and power on a trial frame does not constitute changing nor rewriting an RX, it is showing the patient what the RX may look like. Perhaps your definition of trial framing should be reviewed. The use of trial framing is equally beneficial to both the patient and optician, it is an additional tool; no more than a set of metric socket wrentchs are to an auto mechanic. I am advocating better opticianry not prescribing Rx's.

[wmcdonald]

I am not advocating trial framing for refraction purposes. I am simply stating the use of trialing framing as a means to demonstrate the RX written by an OD or an OMD whom one has had a plethora of redo issues, as a means of providing said patient with visual information. It is no more refraction than dispensing the written lens RX. You mock it up and ask the patient how their vision is, we do that when dispensing. The example that I gave was based on my experiences in my area. I stand by the use of the trial framing and for anyone who works at a dispensary only business should know how it works and have one available to them. As to CME4SPECS adjusting the lenses and power on a trial frame does not constitute changing nor rewriting an RX, it is showing the patient what the RX may look like. Perhaps your definition of trial framing should be reviewed. The use of trial framing is equally beneficial to both the patient and optician, it is an additional tool; no more than a set of metric socket wrentchs are to an auto mechanic. I am advocating better opticianry not prescribing Rx's.

Again.....and let me write more clearly. I am not talking about Washington. In my experience teaching refraction to Opticians all across America, in China, and South America, I have a broad understanding of what we can and cannot do. I am familiar with EVERY Opticianry law in this nation, and you are asking form trouble in some states, as I am sure the ODs here will probably advise. I want us to use over-refraction and all of the skills available to complete a manual refraction, and I am sure you are great at what you do, but in some states, Opticians CANNOT do what you are advising them to do. It is against the law. Last comment on this simple issue. Take it or leave it, it is the truth, no matter what you do in your business.

[fjpod]

Prescribers will never become good at prescribing unless they eat their own glass.

It doesn't matter what the auto-refractor says, or the retinoscopy, or the manifest refraction...what matters is that you listen to what your patient is complaining about, consider his/her habitual state, age, health and a few other factors....then you get close to the right Rx.

But the memory of eating glass really drives the process.

[CME4SPECS]

I am pretty certain that if the opticianry cops came around and saw me switching lenses back and forth in a trial frame...I'd have a problem!

[kaypaula]

I am pretty certain that if the opticianry cops came around and saw me switching lenses back and forth in a trial frame...I'd have a problem!

Are you not allowed to fit CL in California? If so, wouldn't you check the refraction and/or tweak it when necessary? That may require trial framing as well, as well as trial CL! Well, don't do what you're not comfortable with but I agree that you are not prescribing by trial framing.
P

[Barry Santini]

I don't think it is fair to characterize most remakes as "dr." remakes. I've seen enough to know it is NOT always the Rx...but rather the rest of the eyewear recipe that can enter into it.

I maintain that 15%, at a minimum, of all eyewear you make will have to be re-visited for *some* reason.

B