a small rant, from the patient side

[Febrifuge]

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As to background, I'm a crusty old non-trad premed, and I'm sure I have all sorts of unconscious bias in small ways. However, I'm way more experienced as a patient than as a student, and I appreciate the whole spectrum of care a person should seek out, to stay in optimal health. I am grateful for good care wherever and from whomever it comes. I have no chip on my shoulder against anyone in any of the health professions.

It just bugs the crap out of me, the way the eye care people I see are so obviously running a business, and helping me care for my eyes is such a small part of that business.

I understand that they sell glasses and contacts. Cool; more power to 'em. I know that office space ain't cheap. I have no objection to the OD insisting that I can't leave until I talk with the lens person and check on the price of my contacts, in case I want to buy them from them. These folks are good at their work and that's what matters.

What bugs me is getting the bill and finding a $45 'contact lens fitting' charge, which insurance will not cover. What bugs me is calling to ask what that's about, and having the office manager tell me that the chart specifically says it was explained to me that this was "elective" and not covered by insurance.

If fitting me for contacts is so f'ing "elective," how come in my 20 or so years of wearing them I've never had this issue come up before? If I've been wearing this same kind and size for the last 5 years with no problems, why is it necessary to check the fit? And most importantly, isn't it exceptionally bad to chart something that didn't happen? (Never mind; I know the answer to that one already.)

Hypothetically, if I write to the office (and cc: the insurance company) telling them I'm not paying, how likely is it they would give in? Obviously they can hurt me more than I can hurt them, and geez, it's only 45 bucks. But for me it's the principle. Explain your bogus charges and allow me to decline an unnecessary exam, or else don't hold me accountable for it.

And of rant; thank you for reading. Thoughts?

 

[ppa93]

As to background, I'm a crusty old non-trad premed, and I'm sure I have all sorts of unconscious bias in small ways. However, I'm way more experienced as a patient than as a student, and I appreciate the whole spectrum of care a person should seek out, to stay in optimal health. I am grateful for good care wherever and from whomever it comes. I have no chip on my shoulder against anyone in any of the health professions.

It just bugs the crap out of me, the way the eye care people I see are so obviously running a business, and helping me care for my eyes is such a small part of that business.

I understand that they sell glasses and contacts. Cool; more power to 'em. I know that office space ain't cheap. I have no objection to the OD insisting that I can't leave until I talk with the lens person and check on the price of my contacts, in case I want to buy them from them. These folks are good at their work and that's what matters.

What bugs me is getting the bill and finding a $45 'contact lens fitting' charge, which insurance will not cover. What bugs me is calling to ask what that's about, and having the office manager tell me that the chart specifically says it was explained to me that this was "elective" and not covered by insurance.

If fitting me for contacts is so f'ing "elective," how come in my 20 or so years of wearing them I've never had this issue come up before? If I've been wearing this same kind and size for the last 5 years with no problems, why is it necessary to check the fit? And most importantly, isn't it exceptionally bad to chart something that didn't happen? (Never mind; I know the answer to that one already.)

Hypothetically, if I write to the office (and cc: the insurance company) telling them I'm not paying, how likely is it they would give in? Obviously they can hurt me more than I can hurt them, and geez, it's only 45 bucks. But for me it's the principle. Explain your bogus charges and allow me to decline an unnecessary exam, or else don't hold me accountable for it.

And of rant; thank you for reading. Thoughts?

Have you ever heard of Copayment for Doctor visit, or Hospital or blah blah? It works the same way for the eyes too. Of course u have to pay some kind of money/ nothing is free regardless of what insurance u have.

 

[f_w]

> I have no objection to the OD insisting that I can't leave until I talk
> with the lens person and check on the price of my contacts, in case
> I want to buy them from them.

States and the Feds have passed laws to explicitly forbid this kind of behaviour. The OD is required to give you your prescription so you are free to buy them in the marketplace.
http://www.ftc.gov/opa/2004/06/contactlens.htm

> Hypothetically, if I write to the office (and cc: the insurance company)
> telling them I'm not paying, how likely is it they would give in?

That likelihood is 100%. If you didn't change the type of your contacts and all you had was a regular eye exam, this is a fraudulent charge. The doc knows exactly that he can't charge you that, but he/she will try anyway. In 99% of cases they will get away with it and people will just comply.

> Obviously they can hurt me more than I can hurt them, and geez,
> it's only 45 bucks.

On the contrary. YOU can hurt them more, for falsifying a medical record and fraudulent billing. If they insist on charging you this unwarranted charge and threaten to go to collections with it, complain to: the better business bureau, the state department of health, the state board of optometry, your insurance company, your states medicare carrier (in my state I would add the attorney generals office. that guy just loves to sue people over this kind of crap)

> Have you ever heard of Copayment for Doctor visit,

This is not copay, this is a charge for a service that was in all likelihood never performed but is thrown into the bill just for the heck of it.

 

[Febrifuge]

Have you ever heard of Copayment for Doctor visit, or Hospital or blah blah? It works the same way for the eyes too. Of course u have to pay some kind of money/ nothing is free regardless of what insurance u have.

Dude, don't be a tool. I'm not saying I'm unwilling to pay anything -- I know what a copay is. I'm saying that IF this is a charge that my ins won't cover, and IF the office knows that, and IF it's optional, then they damn well better give me the option. They instead went ahead and did the thing, plus they charted that it was discussed with me, when in fact it never was.

 

[JennyW]

As to background, I'm a crusty old non-trad premed, and I'm sure I have all sorts of unconscious bias in small ways. However, I'm way more experienced as a patient than as a student, and I appreciate the whole spectrum of care a person should seek out, to stay in optimal health. I am grateful for good care wherever and from whomever it comes. I have no chip on my shoulder against anyone in any of the health professions.

It just bugs the crap out of me, the way the eye care people I see are so obviously running a business, and helping me care for my eyes is such a small part of that business.

I understand that they sell glasses and contacts. Cool; more power to 'em. I know that office space ain't cheap. I have no objection to the OD insisting that I can't leave until I talk with the lens person and check on the price of my contacts, in case I want to buy them from them. These folks are good at their work and that's what matters.

What bugs me is getting the bill and finding a $45 'contact lens fitting' charge, which insurance will not cover. What bugs me is calling to ask what that's about, and having the office manager tell me that the chart specifically says it was explained to me that this was "elective" and not covered by insurance.

If fitting me for contacts is so f'ing "elective," how come in my 20 or so years of wearing them I've never had this issue come up before? If I've been wearing this same kind and size for the last 5 years with no problems, why is it necessary to check the fit? And most importantly, isn't it exceptionally bad to chart something that didn't happen? (Never mind; I know the answer to that one already.)

Hypothetically, if I write to the office (and cc: the insurance company) telling them I'm not paying, how likely is it they would give in? Obviously they can hurt me more than I can hurt them, and geez, it's only 45 bucks. But for me it's the principle. Explain your bogus charges and allow me to decline an unnecessary exam, or else don't hold me accountable for it.

And of rant; thank you for reading. Thoughts?

I can not speak for what this doctor did or did not do, but I will give you my policy.

For contact lens patients, more examination is done than is done on non contact lens patients. In my office, I use a corneal topographer on all contact lens patients, I evert lids, and I use vital dyes to further evaluate the health of the cornea and conjunctiva that I do not normally do in non contact lens patients. As a contact lens patient, you are at higher risk for certain diseases of the cornea. For the additional time and risk incurred, I charge $30 if there is no change in the lens type or parameters and only a change in power. If I have them available, I will provide a pair of lenses to the patient at no charge. (And contrary to what many patients think, I do not get these for free.)

If the lens type is changed, or if there is any condition that requires any sort of followup, OR if I have never seen the patient before, I charge my regular contact lense fitting fee which is $100.

All of my patients understand that the vast majority of contact lens fees are NOT covered by insurance companies. Patients are free to decline the charge, but then I do not write out a prescription for contact lenses.

Jenny

PS: If you think that only eye care providers run their offices as a business, then you have got another coming.

 

[Febrifuge]

This is not copay, this is a charge for a service that was in all likelihood never performed but is thrown into the bill just for the heck of it.

Thanks for the encouragement. For the record, the fit-check was done, and the guy said something like "well, let's just check to make sure these are fitting properly," but no one ever mentioned that this was going to be beyond what my insurance would cover.

And as to the lens thing, the OD I used to see at this office was always very cool about "you're the consumer, you can get your lenses wherever you like." That OD is no longer with the practice, but the Optho I saw was cool about writing out my script for me to take with me... actually, that was likely part of the fit-check thing. Again, no one mentioned it would cost extra.

 

[Febrifuge]

PS: If you think that only eye care providers run their offices as a business, then you have got another coming.

Relax. I work in a hospital. As I said, I understand that there is a business side, and that it's important. My objection is that unlike the up-front way you do it, where charges are explained and understood beforehand, this was something thrown in without explanation. Worse yet, the chart says there was a discussion about it. That's my issue.

 

[JennyW]

Relax. I work in a hospital. As I said, I understand that there is a business side, and that it's important. My objection is that unlike the up-front way you do it, where charges are explained and understood beforehand, this was something thrown in without explanation. Worse yet, the chart says there was a discussion about it. That's my issue.

Was this a new office you went to?

Optometrist?
Ophthalmologist?
Optometrist at an ophthalmology office?
Mall?

Jenny

 

[PLPrincess]

Have you ever heard of Copayment for Doctor visit, or Hospital or blah blah? It works the same way for the eyes too. Of course u have to pay some kind of money/ nothing is free regardless of what insurance u have.

It isn't the copay or the exam fees she's questioning, it is the contact lens portion that's the issue.

As far as I know, a contact lens RX expires after a year, this is why contact lens wearers need a yearly contact lens "re-evaluation" before a valid Rx can be released. I've been told that this is CT law, can anyone find the law to confirm this? I'm not sure about the other states, but that's what the patients in our office are told.

According to the doctor I work for, he does 30-40 different things with a contact lens wearer than he does in a "regular" exam. If that's the case then I don't see why he shouldn't charge for the "re-evaluation", not everyone wears contacts.

Maybe current optometrists can clarify this better for us? My source is just what i've seen at the office I work in.

 

[PLPrincess]

Dude, don't be a tool. I'm not saying I'm unwilling to pay anything -- I know what a copay is. I'm saying that IF this is a charge that my ins won't cover, and IF the office knows that, and IF it's optional, then they damn well better give me the option. They instead went ahead and did the thing, plus they charted that it was discussed with me, when in fact it never was.

I hope no one chews my head of for this, but isn't it the patient's responsibility to know what their benefits are with their insurance?

I've seen offices where the "discussion" of contact lenses consists of "do you wear contacts?" and " do you want to keep wearing contacts?". I'm not saying it's right, but i've seen it happen.

 

[f_w]

> For contact lens patients, more examination is done than is done on
> non contact lens patients. In my office, I use a corneal topographer on
> all contact lens patients, I evert lids, and I use vital dyes to further
> evaluate the health of the cornea and conjunctiva that I do not
> normally do in non contact lens patients.

Great idea, I'll give it a try. If I have a mammogram on a patient with a family history of breast cancer I will go to her and say: 'you know, you are at a higher risk of breat cancer, I will have to look at your films with extra diligence, but its gonna cost you.' I don't think I would get far, not with the patients, and surely not with the state medical board.

The issue here is that a noncovered service was or was not performed, that the medical record on it was falsified and that a charge for this service was entered.

The issue is not whether medical providers should be allowed to engage in enterpreneurial activity.

> If the lens type is changed, or if there is any condition that requires
> any sort of followup, OR if I have never seen the patient before, I
> charge my regular contact lense fitting fee which is $100.

But I hope you have a sign with your pricing scale in the waiting area informing the patient that all services related to contact lenses are not covered and to be paid out of pocket. I sure hope you don't do what febrifuges doc did and tag on some noncovered services without explicit consent from the patient.
I had to go to an OD's office once for a prescription, they were very upfront and transparent about everything. They actually had me sign a copy of their pricing scale for noncovered services during registration. I guess they didn't want to be thrown into one pod with the fraudulent types.

> And as to the lens thing, the OD I used to see at this office was
> always very cool about "you're the consumer, you can get your
> lenses wherever you like." That OD is no longer with the practice,

Big suprise here ! I guess his boss found out that he allowed patients to leave the office without hanging them from their feet and shaking them until the change falls out of their pockets.

 

[JennyW]

It isn't the copay or the exam fees she's questioning, it is the contact lens portion that's the issue.

As far as I know, a contact lens RX expires after a year, this is why contact lens wearers need a yearly contact lens "re-evaluation" before a valid Rx can be released. I've been told that this is CT law, can anyone find the law to confirm this? I'm not sure about the other states, but that's what the patients in our office are told.

According to the doctor I work for, he does 30-40 different things with a contact lens wearer than he does in a "regular" exam. If that's the case then I don't see why he shouldn't charge for the "re-evaluation", not everyone wears contacts.

Maybe current optometrists can clarify this better for us? My source is just what i've seen at the office I work in.

This is a common misconception.

The law says that contact lens Rxs are valid for a MINIMUM of one year unless the patient has a medical condition that would legitimately call for a shorter experiation period.

However, this does mean that the prescriptions automatically expire after one year. As the doctor, it is YOUR decision when prescriptions expire, and I routinely give my patients who are not having problems and who are compliant with their care regime prescriptions that expire in two years.

I'm also skeptical that your employer does 30-40 more things than he does in a regular exam. 5 or 6 maybe. Perhaps you could ask him to provide a list of what these things are.

Jenny

 

[PLPrincess]

This is a common misconception.

The law says that contact lens Rxs are valid for a MINIMUM of one year unless the patient has a medical condition that would legitimately call for a shorter experiation period.

However, this does mean that the prescriptions automatically expire after one year. As the doctor, it is YOUR decision when prescriptions expire, and I routinely give my patients who are not having problems and who are compliant with their care regime prescriptions that expire in two years.

I'm also skeptical that your employer does 30-40 more things than he does in a regular exam. 5 or 6 maybe. Perhaps you could ask him to provide a list of what these things are.

Jenny

He does have a list, i'll see if i can get a hold of it tomorrow. Does the law vary by state? Do you happen to have a copy of it?

 

[Febrifuge]

Whoa, what a fast-blooming thread this turned out to be!

I called back and spoke with a billing manager to clarify, because to me it's the documentation issue much more than the pricing thing. The manager says it's part of the regular pre-appointment spiel (either at the time the appointment is made, at the front desk at time of check-in, or both) to instruct contact lens patients that there might be extra work needed, and which insurance may not cover. Because it's standard practice for that office to do it that way, the providers typically don't get into it, once the patient is in the exam room.

This is good, because it means we aren't talking about my big fear: clinical documentation that would have been false. I can't be 100% sure the folks at the desk did not go over this as they say they did, in at least some half-assed form, and so I'm willing to let it go. I'd feel better knowing the schedule of charges was clearly laid out on a little sign up front, but overall it's not that big a thing to me, because it's a few bucks and the providers themselves seem to have been ethically okay.

I've seen offices where the "discussion" of contact lenses consists of "do you wear contacts?" and " do you want to keep wearing contacts?". I'm not saying it's right, but i've seen it happen.

Yeah, I wonder if it's more like that, actually. In the end though, they charged me for something they definitely did do, and which I find to be of value. So I am willing to pay for it. Given the chance to make an informed choice and knowing insurance wouldn't cover the $45, I might have elected to skip the lens fit-check, but from what I see here, there are good reasons to re-check a lens rx, including the fit.

 

[cpw]

your doctor probably had a form you looked at when you checked in at the front desk explaining his fees. It's VERY rare that insurances cover contact lens fitting costs.

In MOST offices I've worked at if the patients is wearing the same lenses year after year without change it's a 25-30 dollar "Cl office visit" fee. If it's a change in lenses or a person NEW TO YOUR OFFICE it's the standard 80-100 dollar "CL Fitting fee". You are paying for the lens assesment, ocular health check, corneal staining, and in a lot of offices (like jenny's) topography.

Most offices do explain this in their "welcome to the office" form.

Many offices I've worked at the patient is encouraged to browse the optical, but it's totally up to them whether they order or not. Law requires we release contact lens prescriptions to the patient when their prescription is FINALIZED! (not before)

 

[JennyW]

>
The issue here is that a noncovered service was or was not performed, that the medical record on it was falsified and that a charge for this service was entered.

The issue is not whether medical providers should be allowed to engage in enterpreneurial activity.

> If the lens type is changed, or if there is any condition that requires
> any sort of followup, OR if I have never seen the patient before, I
> charge my regular contact lense fitting fee which is $100.

But I hope you have a sign with your pricing scale in the waiting area informing the patient that all services related to contact lenses are not covered and to be paid out of pocket. I sure hope you don't do what febrifuges doc did and tag on some noncovered services without explicit consent from the patient.
I had to go to an OD's office once for a prescription, they were very upfront and transparent about everything. They actually had me sign a copy of their pricing scale for noncovered services during registration. I guess they didn't want to be thrown into one pod with the fraudulent types.

Before we start throwing around the VERY serious accusation of fradulent medical records, lets take a breath.

Perhaps the patient signed an intake form that said some charges might not be covered. Perhaps it was explained and the patient did not realize what they were refering to. Any number of things is possible. The OP is even admitting in another post on this thread that they DID in fact do what they charged her for.

No, I do not have a little sign outlining my fees. My technicians go over what the fees if something is not likely to be covered. Some patients are upset by the prospect that they might have to pay out of pocket for something they are expecting to be covered, but I can never guarantee this. Insurance companies sometimes cover things, sometimes they do not. It is not my responsibility to know what is covered and what is not because that contract is with the insurance company and the patient, not me and the insurance company. Not only that, coverages change continuously. Often times patients don't even realize that they have insurance through a different company. I've had more than a few patients yell at my office manager because we sent them a bill for denies services because they are "no longer insured." The patients will rant and rave and then sheepishly call back with their new insurance information and a story along the lines of "I didn't realize we had switched from Blue Cross to Aetna."

Well, how the hell am I expected to know that? When we ask if you're insurance information is the same, and you say YES, what are we supposed to think?

Jenny

 

[Febrifuge]

I've been going to this same office for at least four years. My insurance has stayed the same that whole time. On this last visit I learned the OD I'd been seeing is no longer there. It had been about 14 months since my last checkup. I've been wearing contacts since I was 13. This was the first time I'd seen this fee on the bill, or at least the first time I had to pay it myself, to the best of my recollection.

When I arrived for my appointment, they handed me a little stack of forms to fill out, just the way a new patient would have to fill things out, and that makes sense as info might change from time to time. When I called today to talk about this whole confusion, I specifically asked the billing manager whether anything I would have signed would show that the (apparently pretty common) issue with contact lens charges and insurance was disclosed to me. She said nothing in that batch would have covered it. Sounds like they might do well to include something like that in the stack.

So, why is this new? Maybe as a returning patient they skipped over the explanation about contact lens charges and how that might or might not be covered by my benefits. Maybe it went by too quickly for me to register. Maybe the other OD checked the fit of my lenses on those previous visits, and didn't charge me. Maybe my insurance company made some obscure change to how my benefits are structured. Who knows?

I've satisfied myself that fraudulent healthcare records are not the problem. I wonder if poor billing records or unreliable patient communication procedures might be it, but I don't think it's serious enough to get agitated about. So now this discussion is past what I should do, and on to you guys. I guess just as a word of advice from a patient who's also a sometime provider (and thus hyper-aware of clinical and billing documentation), it would be nice if OD's and Opthos do whatever's reasonable to get info like that out front, to avoid surprises. Many of you do, and I think that's fantastic.

I'm sure it goes without saying that if there's something that isn't recessary to a complete exam, it shouldn't be done without consent. By extension, I'm saying that if there's something that is necessary, but the practitioner is aware that a lot of insurance won't cover it, I think it's prudent and patient-friendly of the practitioner to make an effort to get that info out there.

Ultimately the patient is responsible for knowing what insurance benefits the patient brings to the visit. But the provider can be a help or a hindrance, in seeing to it that all parties (patient, insurance co, provider) play their roles well. When I'm a patient, I'm on your turf and I'm trusting you to be my guide. I can't reasonably expect you to be an expert in my insurance, but I do count on you to give me what info I need to apply my insurance intelligently.

 

[rpie]

I've been going to this same office for at least four years. My insurance has stayed the same that whole time. On this last visit I learned the OD I'd been seeing is no longer there. It had been about 14 months since my last checkup. I've been wearing contacts since I was 13. This was the first time I'd seen this fee on the bill, or at least the first time I had to pay it myself, to the best of my recollection.

When I arrived for my appointment, they handed me a little stack of forms to fill out, just the way a new patient would have to fill things out, and that makes sense as info might change from time to time. When I called today to talk about this whole confusion, I specifically asked the billing manager whether anything I would have signed would show that the (apparently pretty common) issue with contact lens charges and insurance was disclosed to me. She said nothing in that batch would have covered it. Sounds like they might do well to include something like that in the stack.

So, why is this new? Maybe as a returning patient they skipped over the explanation about contact lens charges and how that might or might not be covered by my benefits. Maybe it went by too quickly for me to register. Maybe the other OD checked the fit of my lenses on those previous visits, and didn't charge me. Maybe my insurance company made some obscure change to how my benefits are structured. Who knows?

I've satisfied myself that fraudulent healthcare records are not the problem. I wonder if poor billing records or unreliable patient communication procedures might be it, but I don't think it's serious enough to get agitated about. So now this discussion is past what I should do, and on to you guys. I guess just as a word of advice from a patient who's also a sometime provider (and thus hyper-aware of clinical and billing documentation), it would be nice if OD's and Opthos do whatever's reasonable to get info like that out front, to avoid surprises. Many of you do, and I think that's fantastic.

I'm sure it goes without saying that if there's something that isn't recessary to a complete exam, it shouldn't be done without consent. By extension, I'm saying that if there's something that is necessary, but the practitioner is aware that a lot of insurance won't cover it, I think it's prudent and patient-friendly of the practitioner to make an effort to get that info out there.

Ultimately the patient is responsible for knowing what insurance benefits the patient brings to the visit. But the provider can be a help or a hindrance, in seeing to it that all parties (patient, insurance co, provider) play their roles well. When I'm a patient, I'm on your turf and I'm trusting you to be my guide. I can't reasonably expect you to be an expert in my insurance, but I do count on you to give me what info I need to apply my insurance intelligently.

Just a comment about the option of having your contact lens Rx checked. I do not think it is wise to give patients the “option” to have the contact lens fit checked, it should be mandatory for everyone wearing contacts. All contact lens patients need to understand that even the best fitting contact lens causes ocular changes over time, symptomatic and asymptomatic. It is up to your doctor to note these changes and address them as indicated. It would be irresponsible if your doctor did not provide the additional contact lens evaluation/fitting services in order to make sure your ocular health is not being compromised by contact lens use.

As a side note, there was a time when OD’s and MD’s would add the evaluation/fitting fee into the price of the contact lens that was purchased in order to avoid the topic of an additional fee. This is now a thing of the past since 1-800 contacts and alternate suppliers have come into the market. Now most doctors will charge the evaluation/fitting fee because the profit on a “box of contacts” is about 2-3 dollars.

 

[Febrifuge]

That might explain it, right there. Thanks!

And it also prompts me to say, as someone always does, that it's possibly the "damn insurance company's fault." 😉