Withhold presciption

[dfung]

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I apologize if this is the wrong forum for this, but is it legal for a CA optometrist to withhold patients' prescriptions? Assume a patient wants an rx copy to buy lenses somewhere else, has no balance and the rx hasn't expired.

 

[KHE]

I apologize if this is the wrong forum for this, but is it legal for a CA optometrist to withhold patients' prescriptions? Assume a patient wants an rx copy to buy lenses somewhere else, has no balance and the rx hasn't expired.

I'm assuming you are referring to contact lenses.

A doctor does not have to release a contact lense prescription until the doctor has completed the fitting process. Different doctors have different protocols for CL fitting, but in general most doctors fit patients in lenses, have them come back in a week or two to assess that the fit is still good after the patient has been wearing them for a number of hours, and that there is no issue with the health of the eye. At this time, most doctors will release a copy of the prescription. A few more cautious docs may require more follow up visits.

It is against the law to withold a prescription after the fitting process is complete.
It is against the law to withold a prescription even if the patient has a balance due
It is against the law to require patients to purchase lenses from the prescribing doctor in any quantity as a condition of releasing the prescription.

I'm guessing from your post that you are having some kind of issue. Maybe you can be more specific as to what the problem is, and what your doctor has said as the reason why s/he won't give you a copy of your prescription.

 

[Ben Chudner]

I'm assuming you are referring to contact lenses.

The same holds true for spectacle prescriptions with the following exception:

"Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;"

I don't know for sure about whether this holds true for contact lenses, but I thought it did.

 

[Ben Chudner]

Eye doctors are required to provide patients with a copy of their ophthalmic lens prescriptions as follows:

Spectacle prescriptions: Release upon completion of exam.
Contact lens prescriptions: Release upon completion of exam or upon completion of the fitting process.

The above was taken from the following website:

http://www.optometry.ca.gov/laws_regs/new_laws.htm

It appears that in California, there is no requirement that the balance is paid in full.

 

[dfung]

Thanks for the replies, I appreciate it. And yes, I was referring to contact lenses.

At the end of a follow up visit to ensure proper CL comfort/fitting, a family member of mine requested an rx copy to purchase Cls elsewhere. The OD said it would ruin some form of research funding and said he'd match the competitor's price.

While matching is nice, it would appear that my family member's exam and fitting procedure had completed and the rx should've been released......

 

[KHE]

Thanks for the replies, I appreciate it. And yes, I was referring to contact lenses.

At the end of a follow up visit to ensure proper CL comfort/fitting, a family member of mine requested an rx copy to purchase Cls elsewhere. The OD said it would ruin some form of research funding and said he'd match the competitor's price.

While matching is nice, it would appear that my family member's exam and fitting procedure had completed and the rx should've been released......

That explanation makes so little sense.

If your family member was part of some research study, they should have been informed of it. Also, if you are part of a research study, generally the lenses are provided at no cost for the duration of the study.

I would say that not only in your family member's OD a crook, he's also a liar. I'd find a new doctor.

 

[PBEA]

I can think of several circumstances under which I would not release a keratoconic contact lens prescription, especially for purchase elsewhere. So to the poster make sure that your family member does not have an extenuating circumstance (eye condition) that might complicate the more routine interpretations of the "laws" posted here.

 

[dfung]

Would near-sighted w/ astigmatism having used toric lenses be an extenuating circumstance/condition?

 

[Ben Chudner]

I can think of several circumstances under which I would not release a keratoconic contact lens prescription, especially for purchase elsewhere. So to the poster make sure that your family member does not have an extenuating circumstance (eye condition) that might complicate the more routine interpretations of the "laws" posted here.

Is there an allowance within the FCCLA that makes it legal to refuse to release a contact lens prescription based on the circumstances? I not saying it's illegal, I am just curious as to what our rights are as prescribing OD's.

 

[Ben Chudner]

Would near-sighted w/ astigmatism having used toric lenses be an extenuating circumstance/condition?

No, but without knowing all of the details of the situation, it is impossible to for us to comment on what the doctor was doing. I do, however, agree with Ken that the explanation makes no sense. I have been a clinical investigator for several contact lens studies, and while the patients only get free lenses during the course of the study, the company that is contracted by the contact lens manufacturers to run the study could care less where the patient purchases their contacts.

 

[PBEA]

Is there an allowance within the FCCLA that makes it legal to refuse to release a contact lens prescription based on the circumstances? I not saying it's illegal, I am just curious as to what our rights are as prescribing OD's.

As a doctor if you feel it is necessary to restrict contact lens rx release (and you have a good reason, not because you just want them to buy from you). Then you are acting on the patients behalf, not your own. If thats not in the FCCLA fine print somewhere then who cares. I'm still not going to release a prescription for someone that I dont think should have one. I'd be happy to smash any comments to the contrary. To the poster, If you say so, but a "toric" lens might mean many things, its just not enough to determine whether your OD is pulling your chain or is legit. Also your info is like thirdhand hearsay, if you can clarify it at all it would help.

 

[Ben Chudner]

As a doctor if you feel it is necessary to restrict contact lens rx release (and you have a good reason, not because you just want them to buy from you). Then you are acting on the patients behalf, not your own. If thats not in the FCCLA fine print somewhere then who cares. I'm still not going to release a prescription for someone that I dont think should have one. I'd be happy to smash any comments to the contrary.

OK, I won't argue if you believe you are acting on the patient's behalf. I do have to ask, however, under what circumstances would you honestly believe you have a good reason to restrict contact lens Rx release? You mentioned previously that a KCN patient could justify a restriction. Aside from the fact that in my experience, KCN patients almost never want to purchase outside the prescribing doctor's office, how can you justify not releasing the Rx once you have finalized it? Let's say they purchase a pair from you and then want a backup pair. Would you require them to buy that from you? If so, how would you explain that to the patient? "I can't let you give these parameters to another provider because they may not copy them down correctly on the order form". How would you handle it if they requested a copy of their records? Would you black out the CL parameters so no other provider could order for them based on your work?

I only ask these questions because I have never run into a situation where I felt it was justified to not release a CL prescription, except in the case of a patient that had an unpaid balance or did not complete my fitting requirements.

 

[Ben Chudner]

I'm still not going to release a prescription for someone that I dont think should have one.

I guess my question is, under what circumstances would you feel that a patient should not be able to order contact lenses except from your office?

 

[PBEA]

OK, I won't argue if you believe you are acting on the patient's behalf. I do have to ask, however, under what circumstances would you honestly believe you have a good reason to restrict contact lens Rx release? You mentioned previously that a KCN patient could justify a restriction. Aside from the fact that in my experience, KCN patients almost never want to purchase outside the prescribing doctor's office, how can you justify not releasing the Rx once you have finalized it? Let's say they purchase a pair from you and then want a backup pair. Would you require them to buy that from you? If so, how would you explain that to the patient? "I can't let you give these parameters to another provider because they may not copy them down correctly on the order form". How would you handle it if they requested a copy of their records? Would you black out the CL parameters so no other provider could order for them based on your work?

I only ask these questions because I have never run into a situation where I felt it was justified to not release a CL prescription, except in the case of a patient that had an unpaid balance or did not complete my fitting requirements.

Of course, if records are requested then any/all tx are included as part of the record (for a small fee).

I was referring to the op who wanted to go shop the cost of lenses, which would normally be allowed, but might not be such a great idea if his friend has some existing eye condition. What part dont you get? bandage cl's, pediatric occluders, some kcn lenses, etc. All represent some examples that you might not get an "rx" to go shop the lenses. I consider certain dynamic conditions of the eye to be just that....dynamic. As such the contact lens "fitting" is not always going to result in an a paper copy "cl rx", for the patient to buy off of 1800contancts. I get the feeling you are baiting me, because I dont see how you can sit there and say that ALL cl rxs should be released so they can see what they cost somewhere else?

 

[Ben Chudner]

I get the feeling you are baiting me, because I dont see how you can sit there and say that ALL cl rxs should be released so they can see what they cost somewhere else?

I am not baiting you, and I did not say that ALL cl rx's should be released. I was curious as to which circumstances you would feel it was appropriate to withhold a cl rx. To be honest, I didn't think aout a bandage cl. Of course that could be because I don't consider that a cl fitting, nor would it fall under the FCCLA. I am not sure if the pediatric occluder falls under the FCCLA, however, once you have finalized the lens and the power that will work for your treatment, what does it matter where they get the lens from? If you are concerned that this is a dynamic condition and you are constantly making changes, then the fitting is not complete and it would not be subject to the law. Once a KCN lens in finalized, the actual ordering is not really rocket science, and I do believe you would be violating the law by not releasing that rx.

At the end of the day, I really don't care what you do in your practice. I was just wondering about your comment, because I have never felt the need to withhold a cl rx for a patient once I completed the fitting and their balance was paid in full. Let me reiterate that I do not consider a bandage cl or any lens where the parameters may change frequently to be a part of this discussion. Those lenses ar not finalized and therefore it makes no sense for the patient to shop around. In the case of the OP, it appears that he was referring to someone wearing soft (I assume) toric lenses, and I can't imagine a reason why I wouldn't release the rx unless the fit was not finalized, or the patient had a balance.

 

[KHE]

Of course, if records are requested then any/all tx are included as part of the record (for a small fee).

I was referring to the op who wanted to go shop the cost of lenses, which would normally be allowed, but might not be such a great idea if his friend has some existing eye condition. What part dont you get? bandage cl's, pediatric occluders, some kcn lenses, etc. All represent some examples that you might not get an "rx" to go shop the lenses. I consider certain dynamic conditions of the eye to be just that....dynamic. As such the contact lens "fitting" is not always going to result in an a paper copy "cl rx", for the patient to buy off of 1800contancts. I get the feeling you are baiting me, because I dont see how you can sit there and say that ALL cl rxs should be released so they can see what they cost somewhere else?

Though I am not sure, my understanding was that you could not withhold a prescription simply because a patient has a balance due.

That being said, I think that after rereading the persons original message, it is pretty obvious that they are NOT talking about bandage CLs, or a pediatric occluder or some of the other extreme and rare cases that you listed in your post. I stand by my original assertion that that other doctor is either a crook, or a liar. Especially given the outrageous explanation about research funding which makes zero sense.

 

[PBEA]

I only ask these questions because I have never run into a situation where I felt it was justified to not release a CL prescription, except in the case of a patient that had an unpaid balance or did not complete my fitting requirements.

Let me see if I get this straight, you will actually write out the 10 or so parameters (that are often necessary for some kcn lenses) onto an rx pad, inluding the fabricating laboratory, with say a 6 month expire date, so that joe blow can try and buy them from wallyworld? What if wallyworld cant get the lens (and they often cannot)? Or worse what if joe blow just takes that rx and buys several "backups" and never follows up until he/shes having a "problem" (you know like apical neo, or dangerously thin ectasia) with the lenses you prescribed? Also the pediatric occluders Ive used are custom made by hand, how do you write a "cl rx" for that? Ive had a few older aphakes try this crap you know. They are on a budget so they go to walmart get there rx and wear the lenses until they disintegrate, or have 10mm of neo surrounding a 3mm ulcer, or whatever. I agree with your balance issue though, I dont give a rats ass about any law says I have to do something for free, or tries to force me to cause harm to someone. IF the op was referring to routine cls then we agree that the OD is probably a slime ball, but its still an IF situation. IMO some "higher risk" patients should not be given a cl rx for shopping around. If they want to go to another doctor thats fine, Ill send along every pertinent shred of info I have, but I will not give out an Rx.

 

[Ben Chudner]

Let me see if I get this straight, you will actually write out the 10 or so parameters (that are often necessary for some kcn lenses) onto an rx pad, inluding the fabricating laboratory, with say a 6 month expire date, so that joe blow can try and buy them from wallyworld? What if wallyworld cant get the lens (and they often cannot)? Or worse what if joe blow just takes that rx and buys several "backups" and never follows up until he/shes having a "problem" (you know like apical neo, or dangerously thin ectasia) with the lenses you prescribed? Also the pediatric occluders Ive used are custom made by hand, how do you write a "cl rx" for that? Ive had a few older aphakes try this crap you know. They are on a budget so they go to walmart get there rx and wear the lenses until they disintegrate, or have 10mm of neo surrounding a 3mm ulcer, or whatever. I agree with your balance issue though, I dont give a rats ass about any law says I have to do something for free, or tries to force me to cause harm to someone. IF the op was referring to routine cls then we agree that the OD is probably a slime ball, but its still an IF situation. IMO some "higher risk" patients should not be given a cl rx for shopping around. If they want to go to another doctor thats fine, Ill send along every pertinent shred of info I have, but I will not give out an Rx.

I think we agree. The situations you are describing should fall outside the FCCLA. I was just looking for clarification.

 

[Ben Chudner]

Though I am not sure, my understanding was that you could not withhold a prescription simply because a patient has a balance due.

My fitting process as a matter of policy is not complete until the patient pays their balance in full.

 

[dfung]

Hi all,

Thanks for the input. The family member who was going in for a routine CL exam said that the OD didn't have much more to say other than research being ruined by copying the rx.

I suppose i can call the OD myself and find out what the scoop is.

This is all very interesting!