Optometry visit

SDN Members don't see this ad. (About Ads)

Hey all,

I went to see an optometrist for an eye exam. I went to Lenscrafters wearing contacts that I had from my last 6 months supply. I went in to get a new 6 month supply. So, anyways, I was wondering do you guys do retinal imaging on all patients even if you are like me who is in his mid 30s with no medical history? Anyways, I was never told I had to pay out of pocket for this. I got a partial refund after I told the optometrist I was never told I was going to be charged.

So I got my eye exam and found out I was charged a contact fitting fee of 54 dollars. I was never fitted for any NEW contacts. After the eye exam, I think the optometrist made sure the contacts which I came into the store fitted me and not newly purchased contacts (which I thought should have been the case). I got my bill from the eye insurance company and there was the charge of contact fitting and followup. Today, I just picked up my contacts and was never "followed up" as to whether these newly purchased contacts "fit" me. So I was upset as to how can I be charged a contact fitting fee on old contacts I went into the store with and not newly purchased contacts.

Yes I understand that there is a contact fitting fee. I just dont understand how you can charge me on my old pair of contacts. Can someone clarify this for me?

How much did you pay out of pocket?

Originally Posted by Unty

So I got my eye exam and found out I was charged a contact fitting fee of 54 dollars. I was never fitted for any NEW contacts. After the eye exam, I think the optometrist made sure the contacts which I came into the store fitted me and not newly purchased contacts (which I thought should have been the case). I got my bill from the eye insurance company and there was the charge of contact fitting and followup.

Was this your first visit to this optometrist? The answer to this question would change my opinion of how much the contact lens fitting should cost.

Did the optometrist look at the contact lenses on your eye? Did the optometrist discuss contact lens options with you (or at least if you were happy in your current lenses)? Did the optometrist use clinical judgement to decide if your previous fit was still adequate/appropriate? Did the optometrist consider test results that would not be done on a non-contact lens wearer (keratometry, fluorescein stain, etc)?

The answer to the above is likely "yes".

Do you feel you should have to pay for these things? If not, why not?

To answer your question from my opinion..

the retinal photo thing is a complete scam.As medically necessary as taking a photo of your face to compare to 10 years from now to see if skin cancer develops. If you have no retinal pathology there is no need for retinal photos period..A 30 yr old with no pathology needs a retinal photo as much as I need a photo of my penis to compare to in case I develop penile cancer..This just pisses me off..

You might have been charged a new contact refitting fee if the contacts you brought in were not a new fit since they have to recheck everything...not everyone does things that way.. (I don't for example) but some people do.

Sounds like this optometrist was trying to maximize his profit from the photos thing..

Originally Posted by mclem222

To answer your question from my opinion..

the retinal photo thing is a complete scam.As medically necessary as taking a photo of your face to compare to 10 years from now to see if skin cancer develops. If you have no retinal pathology there is no need for retinal photos period..A 30 yr old with no pathology needs a retinal photo as much as I need a photo of my penis to compare to in case I develop penile cancer..This just pisses me off..

You might have been charged a new contact refitting fee if the contacts you brought in were not a new fit since they have to recheck everything...not everyone does things that way.. (I don't for example) but some people do.

Sounds like this optometrist was trying to maximize his profit from the photos thing..

I am a physician and I confronted the optometrist about the retinal imaging. The little I know about retinal pathology, I do know that unless you have hypertension, diabetes or macular degeneration you most likely do not have retinal pathology and therefore do not need imaging. I asked if this was clinically indicated in a patient my age with no medical history and if he did this on all patients. He stated he does it on children as well. Well, unless you have retinoblastoma I can understand but again I dont think this is clinically indicated in all children. I just hope this guy is not ripping off other customers. In addition, he went over the images with me after the pictures were developed and mentioned macular degeneration. I lost respect for him after that. Seriously, macular degeneration in a 35 year old. You have got to be kidding me.

Instead of telling me that the retinal imaging was not indicated (which I think he ethically should have done) he did not. Therefore I am not ever going back to this moron. I just hope he isnt screwing over other patients and giving them some lame excuse to do the retinal imaging. That machine was set next to all the other devices and if you weren't told you were going to be charged, you wouldve just gotten the test because you thought it was part of the exam. Patients dont know right from wrong and I can see this guy milking these poor ppl.

I personally do not feel that I should have been charged the contact lens fitting fee on the contacts I came in with (of course they are fitting me correctly Ive been wearing them for the last six months!!!). If he charged me for the new set of contacts I received, then yes I can understand the charge because these are newly purchased contacts and he would like to see if they fit you correctly.

Originally Posted by mclem222

A 30 yr old with no pathology needs a retinal photo as much as I need a photo of my penis to compare to in case I develop penile cancer..This just pisses me off..

Originally Posted by Unty

I personally do not feel that I should have been charged the contact lens fitting fee on the contacts I came in with (of course they are fitting me correctly Ive been wearing them for the last six months!!!). If he charged me for the new set of contacts I received, then yes I can understand the charge because these are newly purchased contacts and he would like to see if they fit you correctly.

The retinal photo aside, as you would be hard pressed to find many optometrists who feel it a necessary procedure, if you had a contact lens evaluation of any kind you will be charged. I know that you were not fit into a new lens but there was still clinical decision making involved (again, given that this was a new optometrist to you) and the optometrist can expect to be reimbursed for that. The level of reimbursement should be less than that of a new lens/new patient, although many ODs do not make that distinction.

It is important to note that I've seen enough patients in ill fitting contact lenses to know that the fact that you've worn them for 6 months matters very little. In the future, given that you are a physician, just write your own contact lens Rx and be done with it. You can then charge yourself whatever your contact lens clinical decision making is worth.

Originally Posted by Unty

I personally do not feel that I should have been charged the contact lens fitting fee on the contacts I came in with (of course they are fitting me correctly Ive been wearing them for the last six months!!!). If he charged me for the new set of contacts I received, then yes I can understand the charge because these are newly purchased contacts and he would like to see if they fit you correctly.

Totally agree on the retinal imaging. Sadly, Optos (which I'm sure was what you were photographed with) cameras are being used to increase revenue for OD and OMD offices all over the US. The leases aren't cheap so they're heavily marketed to patients at annual checkups and most of the time, patients pay out of pocket. Macular pigment testing is the same deal. I've been in offices that test macular pigments on 20 year olds at 50 bucks a pop - totally ridiculous, but not at all uncommon.

Here's where I take issue with what you're saying. You absolutely should have been charged for the contact lens fee. At $54, you're paying less than many, if not most, private offices would charge for a normal, no-changes CL evaluation. I charge $79 to look at CLs even if I do nothing to them. What you're paying for is the expertise required to evaluate the lens fit and the prescription, not the time it takes to do so.

If I come see you for a general physical and you order routine blood work which comes back normal, I don't say "Hey, I don't want to pay for that blood work since I had no complaints and you didn't have to do anything to treat me as a result of any of the results, it was all normal." I have to pay for that blood work because it took expertise to draw the blood, have the lab work done, and it took a lot of previous knowledge for you to sit there and read over and interpret the results. It might take you 20 seconds to read the results of the blood work or an xray, but you're not paid for that 20 seconds, you're paid for the expertise and training it takes to read and interpret that information. That training took years to develop, even though it only takes you a minute or two to use it in a given situation.

Doing a quick CL check is no different. The consequences of blowing off a CL eval can result in permanent vision loss for the patient and a giant lawsuit for the OD. It is not at all uncommon for patients to come in for a "CL check" wearing lenses that were not prescribed, ordered online without an Rx, or bought in a beauty shop. If I were to sign off on those lenses because the patient reported no problems, I'd be liable for any problems that resulted from problems with the fit. If the patient ends up with a penetrating keratoplasty due to severe stromal scarring that results from complications from a tight-fitting lens (which is not necessarily uncomfortable), it's my name on the Rx and I'm going to be holding the grenade when it goes off.

I don't know why an OD looking at CLs on a patient is considered any different than any other doctor doing a well-check on any other patient. Personally, I think it probably has to do with the fact that optometrists are notorious for giving away services for a variety of reasons, depending on the setting. Just keep in mind that, just like in your practice, what patients are paying for is expertise and assumption of risk, not time.

Totally agree with Jason. My boss charges $85 per fitting.

Very nice and informative post Jason K. A departure from your usual doom and gloom. I applaud thee.

I believe this guy and many other ophthalmologists/optometrists do the retinal photography on every patient because:
A) It goes around insurance since it is direct cash pay
B) Most patients might not have anything but its sure easier to have a tech do a photo than to do a DFE yourself
C) For patients that do have something and you don't catch it you have a pending lawsuit usually and photographs are a great way of preserving the pathology

So they might take the easy road.

Should they do it? Well, right now anything that gets around insurance is sought after.

Originally Posted by shnurek

very nice and informative post jason k. A departure from your usual doom and gloom. I applaud thee.

I believe this guy and many other ophthalmologists/optometrists do the retinal photography on every patient because:
A) it goes around insurance since it is direct cash pay...that is completely unethical. Its basically using our knowledge to rip off people. The only thing worse i have heard is a colleague in town has people sign a waiver "refusing" a complete exam if they don"t do the photos. Totally unethical. Just because something makes us money does not mean we should use it everytime. We are just scammers then.you wonder why people are viewing doctors with less respect these days.

b) most patients might not have anything but its sure easier to have a tech do a photo than to do a dfe yourself. WHAT!! if one goes into the field of healing (optometry, chiro, medicne) and wants to do things because they are "easier" and not necessary, they deserve to lose their license to practice. If a dfe is that hard, someone shouldnt of graduated from optometry school. Why not order a fluorescein, oct or xray on everyone? ITS EASIER FOR A DOC TO XRAY EVERY PATIENT THAN LISTEN TO THEIR HEART, WHY NOT DO SO? INSTEAD OF DOING A SKIN CANCER CHECK LETS JUST PHOTO YOUR WHOLE BODY. IT EASIER RIGHT? NONSENSE

c) for patients that do have something and you don't catch it you have a pending lawsuit usually and photographs are a great way of preserving the pathology

see above. Retinal photos or imaging only document the findings that are seen on exam. They are not meant to "pick up" things. That sounds like optos rep speak. If you are using retinal photos to "pick up" stuff you can"t see, you are incompetent. I know, it sounds rough to say but is true. People are not going to want to hear it but it is the truth. GUESS WHAT..HERE IS SOMETHING THAT IS UNBELIEVABLE. DID YOU KNOW THAT AS RECENT AS 10 Years ago, no one had stuff like this around. And you know what? THERE were not 30 year olds with missed pathology running around. If you are going to miss something on a DFE, you are going to miss it on a photo. IF the DFE is that hard for you, I don't know where the hell you have been for the four years of optometry school.

Again, we are doctors not car salesman. We are not here to scam the system or maximize our profits. if insurance or medicare reimburses low that is one thing, but to try to rip off people and somehow justify it because we don"t get paid well etc.. Is wrong. shrunek you are early in your career. Eliminate that mentality before it gets you audited or put in jail.
i have seen several colleagues try to bend the rules or game the system and rationalize that they aren"t getting what they used to so it is ok, or that insurances are screwing them over or they need to document for "liability purposes". There was a guy who used to do that in Philly. He would photo everyone's eyelid to look for skin cancer and then compare it to later. He thought he was real smart and tried to convince other ODs to do it too. That is less easy to do once you are caught and saying it from inside the wall of a prison cell.

Should they do it? Well, right now anything that gets around insurance is sought after.

those people need to be in prison. They are ruining our reputation as doctors and are trying to scam the public.

One last thing which will be very unpopular here though it is true. My brother is an OMD and I know a ton of OMDs and ODs.. This phenomenon is seen much more in the OD community. It may reflect that we are not as busy, get less from glasses and contacts or getting screwed from vision insurance.. In fact, I only know of one OMD who owns an optos and uses it only for screenings. Sorry..had to be honest about this.

Did he actually say you have macular degeneration? Refer to you retinal specialist?
Although rare, at 40-45 years of age, there are people who can have drusen in the macular or around the macula area. Cholesterol might or might not be related.


In one of the external clinics, as a ODIV many years ago, I saw drusen 1 spot or two? on a teenager and my clinical preceptor at that time wasn't sure but sure looked like it we had ophthalmology come in and take a look. This was about 20 yrs ago.

Highly doubt you have mac deg.

Originally Posted by mclem222

those people need to be in prison. They are ruining our reputation as doctors and are trying to scam the public.

I agree, but let's not forget that ODs likely "learned" this from other areas of medicine. I've been to neurology followups in which cranial nerve assessments were done on me for no other reason than to code up a level for the office visit. Suffice it to say that there was no need to do a CN eval at every visit to this guy, but he did one every time. He probably figures, "Hey, this guy's insured - doesn't cost him anything." This kind of stuff happens all over and I think it's going to get worse as reimbursements get cut further and further. I'm acquainted with an ophthalmologist who, when the NFL analysis codes were slashed in half, said "Doesn't bother me one bit, I'll just do it twice as often."

Originally Posted by mclem222

One last thing which will be very unpopular here though it is true. My brother is an OMD and I know a ton of OMDs and ODs.. This phenomenon is seen much more in the OD community. It may reflect that we are not as busy, get less from glasses and contacts or getting screwed from vision insurance.. In fact, I only know of one OMD who owns an optos and uses it only for screenings. Sorry..had to be honest about this.

In my area, I see it in both types of offices, but I have no doubt that the Optos/Q-eye thing goes on in OD offices a lot more frequently than ophthalmology offices. They've got other ways to keep the lights on besides telling 23 year old black patients that they need screening photos and macular pigment testing to watch out for the dreaded macular degeneration. It's kind of funny how the "age-related" portion gets dropped from the disease when it's described to patients in those situations.

Unfortunately, as the noose gets tighter and tighter with revenue shrinking, EMR nonsense slowing things down, and costs rising, this kind of "creative" cash-flow enhancement will be more and more commonplace in all doctor offices. I think the lower you go on the totem pole (in terms of revenue), the more you'll see it going on.

Originally Posted by Jason K

Totally agree on the retinal imaging. Sadly, Optos (which I'm sure was what you were photographed with) cameras are being used to increase revenue for OD and OMD offices all over the US. The leases aren't cheap so they're heavily marketed to patients at annual checkups and most of the time, patients pay out of pocket. Macular pigment testing is the same deal. I've been in offices that test macular pigments on 20 year olds at 50 bucks a pop - totally ridiculous, but not at all uncommon.

Here's where I take issue with what you're saying. You absolutely should have been charged for the contact lens fee. At $54, you're paying less than many, if not most, private offices would charge for a normal, no-changes CL evaluation. I charge $79 to look at CLs even if I do nothing to them. What you're paying for is the expertise required to evaluate the lens fit and the prescription, not the time it takes to do so.

If I come see you for a general physical and you order routine blood work which comes back normal, I don't say "Hey, I don't want to pay for that blood work since I had no complaints and you didn't have to do anything to treat me as a result of any of the results, it was all normal." I have to pay for that blood work because it took expertise to draw the blood, have the lab work done, and it took a lot of previous knowledge for you to sit there and read over and interpret the results. It might take you 20 seconds to read the results of the blood work or an xray, but you're not paid for that 20 seconds, you're paid for the expertise and training it takes to read and interpret that information. That training took years to develop, even though it only takes you a minute or two to use it in a given situation.

Doing a quick CL check is no different. The consequences of blowing off a CL eval can result in permanent vision loss for the patient and a giant lawsuit for the OD. It is not at all uncommon for patients to come in for a "CL check" wearing lenses that were not prescribed, ordered online without an Rx, or bought in a beauty shop. If I were to sign off on those lenses because the patient reported no problems, I'd be liable for any problems that resulted from problems with the fit. If the patient ends up with a penetrating keratoplasty due to severe stromal scarring that results from complications from a tight-fitting lens (which is not necessarily uncomfortable), it's my name on the Rx and I'm going to be holding the grenade when it goes off.

I don't know why an OD looking at CLs on a patient is considered any different than any other doctor doing a well-check on any other patient. Personally, I think it probably has to do with the fact that optometrists are notorious for giving away services for a variety of reasons, depending on the setting. Just keep in mind that, just like in your practice, what patients are paying for is expertise and assumption of risk, not time.

Excellent post and I agree 100%. Retinal screening photos are not necessary unless you have pathology to document to monitor at your next visit. Retinal screening photos are almost never covered by your vision plan, so you would have to pay out of pocket. Yes, it absolutely should have been disclosed to you in your paperwork you filled out. If not, I would be quite upset as well.

There are many OD's out there that will offer you to pay for a retinal screening photo instead of having your dilated fundus exam (DFE), which is complete BS if you ask me. The OD will make money off of the photo, and won't have to "waste" time doing a DFE and be able to see more patients... but that screening photo does not capture your entire retina, therefore it is NOT a replacement for a dilated fundus exam.

There are many other conditions besides HTN and DM that can cause unsymptomatic and symptomatic retinal pathology (such as a choroidal melanoma). You may have had macular drusen, but more than likely not macular degeneration based ONLY on statistics. Is it normal to have some drusen, somewhat, but not so much in a 30 year old and I would want it documented with a fundus photo, but that would have been billed to your medical carrier... in my office.

You were charged for a contact lens evaluation. Contact lens evaluation = contact lens fitting. It's really the same verbage, even though it does cause some confusion. You better believe you will be charged for me to evaluate your habitual contact lenses to make sure they are "fitting" your eyes, you are seeing well through them, and to make sure the lenses themselves are in good shape (i.e. you are caring for them appropriately). Many offices have a tiered fee structure based on the complexity of your contact lens evaluation. For example, to evaluate your habitual lenses and re-new your Rx could be $50. To select a new lens for your needs, evaluate the "fit", and perform a 2 week follow up could be $170... and if you need a custom lens it could be $300, etc.

I shadowed an OD that never dilated. Only used the Optomap. I was a little unsure of the practice, thoughts?

The guy was a bit off his rocker. Took 55 pills a day and pitched the same vitamins to every patient.

Originally Posted by thecgrblue

I shadowed an OD that never dilated. Only used the Optomap. I was a little unsure of the practice, thoughts?

The guy was a bit off his rocker. Took 55 pills a day and pitched the same vitamins to every patient.

You will not be able to image the entire fundus with OPTOS. It is not a replacement for a dilated fundus exam.

Originally Posted by Jibslider

You will not be able to image the entire fundus with OPTOS. It is not a replacement for a dilated fundus exam.

Bingo.

Originally Posted by hello07

Did he actually say you have macular degeneration? Refer to you retinal specialist?
Although rare, at 40-45 years of age, there are people who can have drusen in the macular or around the macula area. Cholesterol might or might not be related.


In one of the external clinics, as a ODIV many years ago, I saw drusen 1 spot or two? on a teenager and my clinical preceptor at that time wasn't sure but sure looked like it we had ophthalmology come in and take a look. This was about 20 yrs ago.

Highly doubt you have mac deg.

Correct. Drusen is not macular degeneration. I've seen plenty of young folks with a few scattered drusen. Are they at a higher risk for AMD? Probably not. There are some uncommon retinal pathologies that can resemble AMD that occur in younger patients (e.g., pattern dystrophies, malattia leventinese, Stargardt's, resolved central serous choroidopathy), but if you're under 60, you're unlikely to actually have AMD.

And then we wonder why OMDs think we are idiots?...wtf..That guy should lose his license.

Originally Posted by Unty

I am a physician and I confronted the optometrist about the retinal imaging. The little I know about retinal pathology, I do know that unless you have hypertension, diabetes or macular degeneration you most likely do not have retinal pathology and therefore do not need imaging.

Wrong! How do you know what you have without being tested? You would be surprised at how many retinal pathologies can present in a perfectly healthy individual. The imaging is mainly done on people who view having their pupils dilated an inconvenience; people like you.

Originally Posted by Unty

I lost respect for him after that. Seriously, macular degeneration in a 35 year old. You have got to be kidding me.

He may have said "possible macular degeneraion". Regardless, it seems you are not as healthy as you made yourself out to be. But coming from a "physician" we do not expect any less. You should be more appreciative of the care and explanations the optometrist gave you; instead of questioning a few extra tests that actually showed some pathology. Seems like the moron was the one in the exam chair....

Originally Posted by Unty

I personally do not feel that I should have been charged the contact lens fitting fee on the contacts I came in with (of course they are fitting me correctly Ive been wearing them for the last six months!!!). If he charged me for the new set of contacts I received, then yes I can understand the charge because these are newly purchased contacts and he would like to see if they fit you correctly.

Personally, he gave you a pretty nice discount if you ask me. So next time just ask him for a free trial pair of contacts and STFU with all the whining

Exactly, you are a physician. Why are you bitching about an extra fee for retinal imaging like it is going to sink you economically for the next 5 years? He even gave you a partial discount because of your whining. There is only one line talking about how this might affect the other patients while the rest of your post is focused on you yourself and how you had to pay fees that you don't like paying because you might be cheap.

Exactly the point...because he is a physician he doesnt like other physicians ripping off people and certainly not ripping off him. Just like when my dad when to get a PVD checked by a retina guy in NYC and the guy did an ultrasound and OCT. I called him and chewed his ass out for trying to milk the system.

Originally Posted by Meibomian SxN

Wrong! How do you know what you have without being tested? You would be surprised at how many retinal pathologies can present in a perfectly healthy individual. The imaging is mainly done on people who view having their pupils dilated an inconvenience; people like you.


He may have said "possible macular degeneraion". Regardless, it seems you are not as healthy as you made yourself out to be. But coming from a "physician" we do not expect any less. You should be more appreciative of the care and explanations the optometrist gave you; instead of questioning a few extra tests that actually showed some pathology. Seems like the moron was the one in the exam chair....



Personally, he gave you a pretty nice discount if you ask me. So next time just ask him for a free trial pair of contacts and STFU with all the whining

Why is it that when someone identifies themselves as an MD your whole tone and logic changes? I know you don't like MDs or whatever but geez don't make it so obvious. The inferiority complex can be seen by everyone on the board.

For one, imaging is for documentation NOT for picking up sh9(*(T that you couldnt see. The optos doesn't cover the whole retina. If you cant see on a DFE what an optos map picks up I can't help you. People who are diabetic, hyptertensive or have ARMD get more imaging because they tend to have more pathology. Stuff is found like hemorrages, CSME or a CNV and then it needs to be imaged etc.. Imaging totally healthy people just in the hopes that it will pick up something is a LIE. I will go on record to say that if you are saying this you are lying. You are lying to yourself and more so to the patient mostly likely to make a buck. This is like when my dad told me about PRP laser, when it used to be paid per session. Docs were rationalizing why it was better for the patient to have many treatment sessions. People used to do PRP 7-8 sessions to get the whole retina. Then they changed it to getting paid for prp for the whole treatment and people started saying it was all of a sudden better for the patient to get it all done in one session. Its amazing what people will convince themselves if it suits them financially.

About this stupid concept of imaging everyone to "try an find something". Stick with that mentality, they why don't they put this imaging system in an internist office. He can image everyone, bill for it and have it read by some "eye imaging" doctor or technician. Who needs an eye provider for retinal problems then? Double that with the autorefactor that is being developed RIGHT now for the iphone and all you need is a imaging slit lamp and a something to check pressure and goodbye entire profession of optometry. All because some OD genius somewhere thought, Hmmm I can make an extra 10K a year by trying to convince healthy people that this non-indicated test is somehow necessary. My dad is an ophthalmologist and he taught me that if you do imaging on a patient for anything (photos, Fluorescein) and it picks up something that you shouldve seen, you should be embarrassed. These MFers are probably happy and think "Great I can bill insurance for this now Yay!" Hmm doesn't take away from the profession does it? Sickening...

Second, the guy threw out the words macular degeneration he didn't say that this guy had it. Sort of like throwing out the word glaucoma when someone doesn't want to have their pressure checked. Just throw out some fear factor to intimidate. Unfortunately he underestimated this guys knowledge level of eye stuff. Chances are he didn't know he was an MD.

Doctors (MDs, ODs, Chiros) do all sorts of unethical stuff all the time. It isn't a surprise. No one is saying that only ODs do it. Because of our retail background, we tend to be more visible because 50% of the population comes to see us. How many people will run into a crooked urologist? But if you are a crooked OD, chances are a lot of people will see you and the word gets out there fast. When people rape and milk the system, they are causing reimbursements to go down, stealing from patients, taxpayers and fellow doctors. That guy is probably causing me, meibomian sx, shruken, etc to get lower reimbursements because he is billing unncessary stuff. He not only rips off that doctor, other patients, you, me, our parents, patients, neighbors. Those people are more likely to try to bend the rules and when they do, I hope they get caught and raped in prison.

Originally Posted by Unty

Hey all,

I went to see an optometrist for an eye exam. I went to Lenscrafters wearing contacts that I had from my last 6 months supply. I went in to get a new 6 month supply. So, anyways, I was wondering do you guys do retinal imaging on all patients even if you are like me who is in his mid 30s with no medical history? Anyways, I was never told I had to pay out of pocket for this. I got a partial refund after I told the optometrist I was never told I was going to be charged.

So I got my eye exam and found out I was charged a contact fitting fee of 54 dollars. I was never fitted for any NEW contacts. After the eye exam, I think the optometrist made sure the contacts which I came into the store fitted me and not newly purchased contacts (which I thought should have been the case). I got my bill from the eye insurance company and there was the charge of contact fitting and followup. Today, I just picked up my contacts and was never "followed up" as to whether these newly purchased contacts "fit" me. So I was upset as to how can I be charged a contact fitting fee on old contacts I went into the store with and not newly purchased contacts.

Yes I understand that there is a contact fitting fee. I just dont understand how you can charge me on my old pair of contacts. Can someone clarify this for me?

Try Costco next time if you really need to save money, I had a good experience there. Lenscrafters is a total scam, and I can say that cause I worked there. They don't even tell people you get a huge discount if you have AAA.

Originally Posted by mclem222

Why is it that when someone identifies themselves as an MD your whole tone and logic changes? I know you don't like MDs or whatever but geez don't make it so obvious. The inferiority complex can be seen by everyone on the board.

It has nothing to do with me "not liking MDs". That's like me saying: Why are you licking his boots because he and your daddy are a physician? Pal, EVERYONE has someone in their family who is a doctor nowadays. And trust, I am sure your dad is not the founder of any ophthalmic devices etc, so put your trump cards away; you're embarrassing him.

In my opinion, it had more to do with the way he expressed that "he's a physician" yet he knowingly signed up for some extra tests, and then whines about it afterwards? It just made his claim of being an MD look pathetic.

Originally Posted by mclem222

For one, imaging is for documentation NOT for picking up sh9(*(T that you couldnt see. The optos doesn't cover the whole retina.

Do you even HAVE an Optos in office; because I do? Do you perform DFEs on 100% of your patients? And of those, do you reach out to ora in every quadrant and on every patient? I never said it was a substitute, but don't act like its the equivalent of a kodak camera or a gimmick. Some may present the option as deceiving but it is an alternative to those who do not want the inconvenience of a DFE. Simple as that. It sure is better than an undilated 90D.

Originally Posted by mclem222

Imaging totally healthy people just in the hopes that it will pick up something is a LIE. I will go on record to say that if you are saying this you are lying. You are lying to yourself and more so to the patient mostly likely to make a buck.

Agreed, but again it was an optional test that the "physician" knowingly consented to. So why whine if it was "normal"? The "physician" could've just declined and opted for a dilation.

Originally Posted by mclem222

Its amazing what people will convince themselves if it suits them financially.

Tell your dad that did he ever think that doctors are struggling to make ends meet because of reimbursement cuts, etc? Most doctors do not like screwing their patients, but we did not undertake this profession in health care to be paupers.

Originally Posted by mclem222

About this stupid concept of imaging everyone to "try an find something". Stick with that mentality, they why don't they put this imaging system in an internist office.

This program is already underway. Its called retinal telecenters. They have photos taken and sent to an outside site to be analyzed by a retina doc.

Originally Posted by mclem222

Second, the guy threw out the words macular degeneration he didn't say that this guy had it. Sort of like throwing out the word glaucoma when someone doesn't want to have their pressure checked. Just throw out some fear factor to intimidate. Unfortunately he underestimated this guys knowledge level of eye stuff. Chances are he didn't know he was an MD.

Underestimated? The physician knowingly consented to an extra test and then whined about it. Seems like you're knowledge is just as equivalent to his....

Why is it a crime to educate someone on a finding of drusen. You did not witness his exam. Patient's lie ALL the time. For all I know, the OD could've had a talk about macular drusen vs dry AMD vs window defect vs RPE drop out. Probably blew right over the "physician's" head; just like it did you.

I see nothing wrong in offering optional testing that insurance does not cover. Nothing unethical with that. The OD clearly stated this is optional. I believe the physician is more bitter because he has retinal drusen that was diagnosed by an OD.

Originally Posted by Meibomian SxN

It has nothing to do with me "not liking MDs". That's like me saying: Why are you licking his boots because he and your daddy are a physician? Pal, EVERYONE has someone in their family who is a doctor nowadays. And trust, I am sure your dad is not the founder of any ophthalmic devices etc, so put your trump cards away; you're embarrassing him.

In my opinion, it had more to do with the way he expressed that "he's a physician" yet he knowingly signed up for some extra tests, and then whines about it afterwards? It just made his claim of being an MD look pathetic.

How did he know they were unnecessary? He isn't an optometrist or ophthalmologist. How would any non eye person know that?


Do you even HAVE an Optos in office; because I do? Do you perform DFEs on 100% of your patients? And of those, do you reach out to ora in every quadrant and on every patient? I never said it was a substitute, but don't act like its the equivalent of a kodak camera or a gimmick. Some may present the option as deceiving but it is an alternative to those who do not want the inconvenience of a DFE.


When was is it ever ok to do an imaging test as a replacement or some type of substitute for a DFE? When did that happen because I missed it. I do DFEs on yearly exams for people. When retinal specialists or comprehensive ophthalmologists start doing optos on people instead of dilating them, I'll get one.. It is a freakin gimmick. Its a a retinal photo through an undilated pupil. So what? It doesn't pick up anymore than an exam. I tell people when they come in if they don't want a DFE its like going to the heart doctor and saying "make sure my heart is fine but don't use the stethescope". I see 40 people a day roughly and I get maybe 1-2 people a month who give me a hard time about it. Do you have an article to show an optos is somehow a replacement for a dfe? I would love to see something peer reviewed. Not some crap from that company. I went to a COPE lecture Optos had.. The whole lecture was about how you could upcode patients if you do the testing and how fast it could pay for itself. It made me want to vomit. COPE lecture my ass...it was a sales pitch.


Agreed, but again it was an optional test that the "physician" knowingly consented to. So why whine if it was "normal"? The "physician" could've just declined and opted for a dilation.


At what point was he told it was optional. That was the ENTIRE point of his original post.


Underestimated? The physician knowingly consented to an extra test and then whined about it. Seems like you're knowledge is just as equivalent to his....
[/B]

Again the point of his whole post was that he was never told it was an extra test. Seems like your knowledge is the equivalent to well...your knowledge.


Why is it a crime to educate someone on a finding of drusen. You did not witness his exam. Patient's lie ALL the time. For all I know, the OD could've had a talk about macular drusen vs dry AMD vs window defect vs RPE drop out. Probably blew right over the "physician's" head; just like it did you. I see nothing wrong in offering optional testing that insurance does not cover. Nothing unethical with that. The OD clearly stated this is optional. I believe the physician is more bitter because he has retinal drusen that was diagnosed by an OD.

Number one..where did the optometrist say it was optional. (common point in my response). Number two..he threw out the word macular degeneration...he didn't tell him he had drusen. It was clearly to try to scare him..comeon man we see that all the time. Number three..the whole point is that it isnt unethical to offer optional testing if you describe it as just that "optional". When you try to sell it or add it on like a car salesman does rustproofing or "transfer fees" etc and the a patient is going to get the service and then get billed for it unless they speak up beforehand you and I and everyone on this board knows exactly what it is...a scam.

If you can point out where you got that this guy was told it was optional and then went ahead with it and then subsequently got pissed that he had to pay for it I will apologize wholeheartedly.

If you think that he is lying then your hypothesis is that this doc got on here to ask a question about retinal photos which he was told was optional but logged onto studentdoctor.net and lied about that fact to get an answer to a question for something that didn't even occur. Yeah...makes a lot of sense..

I love how you admit "Most doctors don't like screwing their patients but we didn't become doctors to be paupers" implying that somehow screwing patients over is ok because you aren't earning what you think you deserve... That's really great. This is why as ODs we have to fight so much to convince people we aren't eyeglass salesman. Why? Because we have people here who use techniques similar to what is done when I went to go buy a car last month. No different than a saleman. The moment we started using medicine as a tool to profit and feel ENTITLED to get rich is the moment we stop becoming doctors.

I am sorry you never got into medical school. I am. I can see from your thoughtless response to my post why that happened. I wish you were an MD because its embarrassing that you are part of my profession. I hope you earn more money so you don't need to rip off people.

I will always remember that quote "Most doctors do not like screwing their patients, but we did not undertake this profession in health care to be paupers." I hope you say that in riker's island before your roomate rapes you.. You'll know all about how one gets into a tight space without dilation then...

Originally Posted by mclem222

At what point was he told it was optional. That was the ENTIRE point of his original post.

You kidding me? Everything in healthcare is optional and patients have a right to refuse anything. As a physician he would know that he can refuse any kind of treatment as he desires.

yes..everything is optional...but if you go to your primary care and they start taking your blood pressure you don't stop them and say "hey is this covered?" You assume it is. No one is forcing you to do anything but when you go to get a routine check that is covered by your insurance, you assume that everything they are going to do is covered. You don't think hmmm..maybe when they use the digital thermometer I will be charged an extra fee because it isn't covered by insurance because insurance only covers the mercury thermometer...I have to believe that you know that.

His argument is not that the testing is dangerous or that he didn't want it done, he didn't know it was not covered by insurance. Its not like he didn't want to do it. That isnt the point. I am sure if he wasn't charged he wouldnt have cared about the test.

When I bring my car in for its 3000 mile oil change and maintence, they always call me and tell me if they want to do something and how much extra it costs. They don't just do it and they when I come to pick up the car, have a $500 bill etc.. By having your technician lead you into a room to do a test without being told it is an optional test, is a scam. A patient is going to assume it is routine and part of the exam, not something extra. If most doctors don't do that test routinely it makes it more scammish. How bout I compress everyone's meibomian glands and charge it as a "milking of the meibomian glands" on their yearly visit $100 fee? Oh yeah. I tell them about the $100 after they are all done and checking out.

He should have asked Na, but seriously I agree that is a bit obtuse on the ODs part if he really did not mention that this will be out of pocket. Not illegal but looked down upon. Even when I saw a dentist and he tried to swindle me out of getting an amalgam filling to get a composite filling he told me the costs up front.

Originally Posted by mclem222

How did he know they were unnecessary? He isn't an optometrist or ophthalmologist. How would any non eye person know that?

When was is it ever ok to do an imaging test as a replacement or some type of substitute for a DFE? ...

Whatever, I side with the OD in this case; the "physician" knows better what an eye exam consists of and what it doesn't. He should have been thankful that the OD found the pathology in his eye because it surely didn't grow there overnight.

And sorry, I never applied to med school . Didn't interest me at the time. I guess you weren't that "chip off daddy's block" huh? What was it, low MCAT score? Not a strong rec letter from daddy? Oh well.....

and I never said it was ok to do imaging as a replacement, I said alternative! Learn the difference....

Whatever, I side with the OD in this case; the "physician" knows better what an eye exam consists of and what it doesn't. He should have been thankful that the OD found the pathology in his eye because it surely didn't grow there overnight.

It is obvious you want to believe what you want to believe. If you read his posts, never once did he say the OD told him he had any pathology. He only threw out the word macular degeneration. When did the OD say he had drusen? When did he say that he found pathology or any findings? Yet again, you want to believe what you want to believe. Keep living in your fantasy world as usual.

By the way, I didn't take the MCAT or apply to med school. I wanted to go to optometry school not medical school but I don't have an inferiority complex like you do. What's right is right. Its obvious from this posting (and the other 1000 you have) that you have complete lack of balance and fairness when it comes to MDs. To just say "whatever I just will side with the OD" reflects it. The same way a mother who has a child who is a bad student will just choose to side with her son over a teacher no matter what the evidence shows. What happened did some premed gunner make you do badly in biology and now you are stuck doing optometry and have to hold it against them?

When did the optos become a valid "alternative"? Alternative, replacement is all the same..just semantics...If someone gets an optos picture every year for five years because they refuse dilation it is essentially becomes a replacement for a DFE. If it isn't why are you doing it? Oh wait! I know you response..Here it is below....

"Most doctors do not like screwing their patients, but we did not undertake this profession in health care to be paupers." - Meibomian Sxn

Quote of the year. Keep scamming people with the optos. Hope it brings you the profits you dreamed of.

Children, do I have to put you in time out?

My dentist offered me an "oral cancer screening" for $50 at my last 6 month checkup. It would have consisted of an oral rinse followed by a brief pass with some sort of near-UV lamp. Given the incidence of oral cancer among healthy, non-tobacco users, I'm fairly confident this was a way to pad his bottom line. I politely refused, but I can see how someone who's a chain-smoking Redman user might benefit from it.

Personally, I think the Optos camera is a useful tool for pt education and as a novelty item. Beyond that, I don't think it does much of anything. The resolution is not impressive and the shots, unless taken by someone who's well-trained, often involve some sort of massive lid obstruction. I've used it before and the yield for anything that involves any sort of action on my part is near extremely low. It'll pick up lattice, chrpe, nevi, whatever, but I feel like it's my job to talk a patient into a dilation if they are unwilling to do it. Sometimes, I'm able to just blame in the patient's insurance if all else fails. That said, I can't remember the last time I had a patient downright refuse a dilated retinal exam once I explained the significance of doing it. My yield on dilations is much higher than on optos, but it certainly doesn't pay as much. But if it's offered as an "add on" and not a substitute for dilation and if scare tactics aren't employed to coerce someone into paying the test fee out of pocket, I don't see anything inherently wrong with the test. I just don't think it's very useful clinically, although I know others would disagree.

Like I said, this stuff goes on in all areas of health care and it's going to get more common as costs increase and reimbursements fall. All docs are seeking ways to make up for the fact that their reimbursments are falling every year. It's not pleasant and it reflects poorly on all of us, but it's a reality.

Originally Posted by Jason K

My dentist offered me an "oral cancer screening" for $50 at my last 6 month checkup. It would have consisted of an oral rinse followed by a brief pass with some sort of near-UV lamp. Given the incidence of oral cancer among healthy, non-tobacco users, I'm fairly confident this was a way to pad his bottom line. I politely refused, but I can see how someone who's a chain-smoking Redman user might benefit from it.

Personally, I think the Optos camera is a useful tool for pt education and as a novelty item. Beyond that, I don't think it does much of anything. The resolution is not impressive and the shots, unless taken by someone who's well-trained, often involve some sort of massive lid obstruction. I've used it before and the yield for anything that involves any sort of action on my part is near extremely low. It'll pick up lattice, chrpe, nevi, whatever, but I feel like it's my job to talk a patient into a dilation if they are unwilling to do it. Sometimes, I'm able to just blame in the patient's insurance if all else fails. That said, I can't remember the last time I had a patient downright refuse a dilated retinal exam once I explained the significance of doing it. My yield on dilations is much higher than on optos, but it certainly doesn't pay as much. But if it's offered as an "add on" and not a substitute for dilation and if scare tactics aren't employed to coerce someone into paying the test fee out of pocket, I don't see anything inherently wrong with the test. I just don't think it's very useful clinically, although I know others would disagree.

Like I said, this stuff goes on in all areas of health care and it's going to get more common as costs increase and reimbursements fall. All docs are seeking ways to make up for the fact that their reimbursments are falling every year. It's not pleasant and it reflects poorly on all of us, but it's a reality.

Not to keep drumming on, but to add on to your story, my dentist offers some extra test that determines how much antioxidants are in your body and if its low, he has vitamin supplements in-office for sale. This is not a scam and neither is an Optos exam.

I'm sure he never tells his patient's that "their teeth will fall out if they refuse this extra test" or "buy a different vitamin other than mines and your liver will fail". Just as the OD probably never said "you'll go blind Mr. Physician or Ms Patient if you refuse this EXTRA test."

My question is would the "physician" had been as disgruntled if the exact same situation occurred with an ophthalmologist? And I also wonder how these same critics feel about retina surgeons using the more advanced Optos for imaging?

That's where my problem is, nothing to do with inferiority complex and everything to do with RESPECT.

Originally Posted by Meibomian SxN

Not to keep drumming on, but to add on to your story, my dentist offers some extra test that determines how much antioxidants are in your body and if its low, he has vitamin supplements in-office for sale. This is not a scam and neither is an Optos exam.

I'm sure he never tells his patient's that "their teeth will fall out if they refuse this extra test" or "buy a different vitamin other than mines and your liver will fail". Just as the OD probably never said "you'll go blind Mr. Physician or Ms Patient if you refuse this EXTRA test."

My question is would the "physician" had been as disgruntled if the exact same situation occurred with an ophthalmologist? And I also wonder how these same critics feel about retina surgeons using the more advanced Optos for imaging?

That's where my problem is, nothing to do with inferiority complex and everything to do with RESPECT.

sounds like your dentist is scamming you

Originally Posted by PBEA

sounds like your dentist is scamming you

How could he scam me with an optional test? He stated what it does and I either accept or refuse it. Simple as that. Why the intelligent "physician" did not do the same is beyond me. It just sounded like he had a chip on his shoulder about ODs and then found reason to rant about it.

Originally Posted by PBEA

sounds like your dentist is scamming you

Agreed. Sounds bogus, especially with an obvious conflict of interest in his selling the very supplements for which he is testing. I've had companies try and peddle eye vitamins that I can sell to patients directly out of my clinic (for a profit). It's a rip-off for the patient--no demonstrable benefit over the cheap, generic ones.

Originally Posted by Unty

Hey all,

I went to see an optometrist for an eye exam. I went to Lenscrafters wearing contacts that I had from my last 6 months supply. I went in to get a new 6 month supply. So, anyways, I was wondering do you guys do retinal imaging on all patients even if you are like me who is in his mid 30s with no medical history? Anyways, I was never told I had to pay out of pocket for this. I got a partial refund after I told the optometrist I was never told I was going to be charged.

So I got my eye exam and found out I was charged a contact fitting fee of 54 dollars. I was never fitted for any NEW contacts. After the eye exam, I think the optometrist made sure the contacts which I came into the store fitted me and not newly purchased contacts (which I thought should have been the case). I got my bill from the eye insurance company and there was the charge of contact fitting and followup. Today, I just picked up my contacts and was never "followed up" as to whether these newly purchased contacts "fit" me. So I was upset as to how can I be charged a contact fitting fee on old contacts I went into the store with and not newly purchased contacts.

Yes I understand that there is a contact fitting fee. I just dont understand how you can charge me on my old pair of contacts. Can someone clarify this for me?

This is just a case of misunderstanding about exam fees. Unlike in medicine where patients just have to pay a copay or co-insurance (i:e: 10% or 20% of the bill depending on their insurance plan) and the rest will be covered by their insurance, in optometry (and in dentistry as well), however; vision insurance is a joke. It pays optometrists next to nothing so patients are left with paying most, if not all, the bill out of pocket. The general public, unfortunately, thinks that their so-called "vision insurance," just like their medical insurance, pays for all of their eye care needs.

Because of this, from my experience, in order to reduce or eliminate this confusion and misunderstanding, I have created a sign in form where I detailed out all the charges up-front. Basically there's no "gray" areas in terms of exam fees. I also explained all the tests that we usually perform at my office (ie: DFE) and the charges that apply. Patients can therefore make an informed decision whether they want the test or not by checking the appropriate box and then they have to sign the form signifying that they have understood all the terms presented on the form before I even see them.

In optometry every office does things or charge professional fees differently, therefore it is important to make things easier for the patient.

So in this case, I can understand why the patient is upset b/c he was not informed about the procedure and to be charged for it without even expecting it. He could have refused the test had he knew about it.

In addition (to me this is the most important) I think all optometrists should explain to the patient the difference between vision and medical insurance. The general public is clueless and are confused about the two different types of insurance that optometrists accept. Vision insurance covers for routine eye exam. Their medical insurance covers for all their medical eye problems, that is, if that optometric office accepts medical insurance and does medical billing.

Ever since I created a form that I spell out everything that I think could potentially cause a misunderstanding, I have eliminated much confusion and arguments with patients about their exam fees. Seriously, it is ridiculous to have to argue with patients about their fees and in return they think we are scamming them. Also, if you have everything written down for them to read for themselves when they show up, you don't have to repeat yourself every single time you have a patient seating in your exam chair. This allows you more time to concentrate on patient care and helps things go more smoothly.

Originally Posted by Meibomian SxN

My question is would the "physician" had been as disgruntled if the exact same situation occurred with an ophthalmologist? And I also wonder how these same critics feel about retina surgeons using the more advanced Optos for imaging?

That's where my problem is, nothing to do with inferiority complex and everything to do with RESPECT.

If you are using Optos to document pathology (fundus photo) or for advanced imaging (widefield angiography), I think it's perfectly legitimate. If you're doing it to document "normality" in an undilated patient, you're fooling yourself and the patient. A non-mydriatic camera is no substitute for a DFE...period. Appropriate discussion of Optos should include the fact that you cannot guarantee that potential pathology will not be missed with it. I can usually convince patients to have a DFE, then give Rev-Eyes, if they really hate the dilation.

Originally Posted by mclem222

One last thing which will be very unpopular here though it is true. My brother is an OMD and I know a ton of OMDs and ODs.. This phenomenon is seen much more in the OD community. It may reflect that we are not as busy, get less from glasses and contacts or getting screwed from vision insurance.. In fact, I only know of one OMD who owns an optos and uses it only for screenings. Sorry..had to be honest about this.

I agree. I don't know of any ophthalmologists who take retinal photos as a screening tool.

Originally Posted by NYCBlues

Unlike in medicine where patients just have to pay a copay or co-insurance (i:e: 10% or 20% of the bill depending on their insurance plan) and the rest will be covered by their insurance, in optometry (and in dentistry as well), however; vision insurance is a joke. It pays optometrists next to nothing so patients are left with paying most, if not all, the bill out of pocket. The general public, unfortunately, thinks that their so-called "vision insurance," just like their medical insurance, pays for all of their eye care needs.

Bingo. This is an important point. If you see a physician and you have insurance, almost 100% of the time, you only pay a co-pay. You don't pay for tests. If a test is not covered by insurance the physician's office needs to notify the patient. As patients we have become accustomed to this. Most people don't know that dental or vision insurance may not cover ancillary tests. I think all health care providers have a responsibility to notify patients of any out-of-pocket expenses they may incur ahead of time. That way there are no surprises.

Originally Posted by Meibomian SxN

How could he scam me with an optional test? He stated what it does and I either accept or refuse it. Simple as that. Why the intelligent "physician" did not do the same is beyond me. It just sounded like he had a chip on his shoulder about ODs and then found reason to rant about it.

so if I say to a pt "I have an optional test for you to consider paying for, it is called corneal topography and it produces a digital representation of your cornea and is sometimes helpful in managing corneal disease...it would cost you $50 to perform"

you think that is reasonable?



BTW you are being scammed by your dentist because he is offering dubious testing in an effort to sell you "vitamins". It's called "profit motive".

derrrrrrrrrrrr

Patients depend on us to tell them what is necessary or not. A physician who is not an ophthalmologist has zero clue what is normal or not. My father is an anesthesiologist and got an OCT and B scan done for a PVD. He had no clue whether it was necessary or not. No one other than an ophthalmologist or optometrist would know if it was needed. The concept that the patient can someone decide for themselves because they know which tests are necessary or not is absurd. That is why we go to medical school.

The rationalization for this sort of behavior can be summed up below and is why optometry,dentistry and chiros fights to be respected in medicine. At some point you have to choose to be a doctor, not a profit center...and sorry...as much as you really try to convince yourself....you can't be both.

"Most doctors do not like screwing their patients, but we did not undertake this profession in health care to be paupers." - Meibomian Sxn

How could he be billed for that? If I have somebody with ARMD and perform a macular OCT great. The ICD 9 code will justify the CPT code. If you use the ICD 9 code for PVD and use the CPT for OCT or Bscan that will likely come out of the patient's pocket as it will be rejected by insurance. Did your dad pay for the useless services out of pocket?

Originally Posted by Zorro12

How could he be billed for that? If I have somebody with ARMD and perform a macular OCT great. The ICD 9 code will justify the CPT code. If you use the ICD 9 code for PVD and use the CPT for OCT or Bscan that will likely come out of the patient's pocket as it will be rejected by insurance. Did your dad pay for the useless services out of pocket?

PVD is actually a billable code for B-scan, but not OCT. Have I even done a B-scan on a PVD? No, but I know some do.

Originally Posted by Visionary

......... I can usually convince patients to have a DFE, then give Rev-Eyes, if they really hate the dilation..........

somewhat OT.
whoa, Rev-Eyes is back? I thought they went out of business....? Just curious.

Originally Posted by itek2OD

somewhat OT.
whoa, Rev-Eyes is back? I thought they went out of business....? Just curious.

Hey, a satisfied patient is a return patient, yes?

Oh, and Rev-Eyes is back from the dead as Nu-Rev (different company). Sorry, old habits die hard.