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Since October 16, 2020 I have had to take an extra step at the end of the exam to explain to patients they they need to sign a statement saying that they received a copy of their contacts lens Rx. Firstly, some people get a bit apprehensive when asked to sign any kind of legalese- as they should. Second, the question “why?” pops up when they’ve been wearing contacts for years and never had to do this rigmarole before.

So, obviously, the Contact Lens Rule was created to punish all optometrists for the sins of a few. No doubt that online retailers were behind this. You would think the proper way to handle a complaint that your optometrist didn’t give you a finalized prescription would be to tell your state optometry board and let them correct the issue as their rules dictate. But that wasn’t good enough for the Feds, so now we live in a county where the FTC has requirements for optometrists- although the punishment for not complying isn’t spelled out clearly.

So if we’re going to take away power from the states regarding their administration of licensed professions, then let’s just be consistent and have a national optometry license and tell the states that they can take their boards and throw them in the septic tank where they also think all the optometrists belong.

Tags: 1-800, Comics, contacts, doctors, Government, patients

This is the e-mail I just sent to BlueCross:

Dear BlueCross,

It is with regret that I inform you that I wish to terminate my contract with BlueCross and no longer be in your network. I understand that I have to continue seeing BlueCross patients for 90 more days.

If you are interested in why I am leaving you, my accounts receivable with BlueCross patients is unacceptably high.

Since I am an optometrist, I need fast, easy access to whether a member has a routine eye exam benefit (S0620, S0621) and whether a contact lens evaluation is covered (92310).

For non-Regence plans, I have to make lengthy phone calls and navigate through terrible phone trees before finally talking with a representative. This process takes longer than performing the actual exam.

While Regence has a nice website for explaining benefits and is good about paying what I expect, every other BlueCross association is unpredictable about paying what I’m expecting. I often have to send out statements or refunds. Usually statements. Hence the high accounts receivable.

I know this will hit you in the wallet as well since I am the lowest-fee eye doctor in Cache Valley. If in the future BlueCross comes out with a website that allows an optometrist to see vision benefit details for any BlueCross member from any state/association, then feel free to let me know, and I’ll reconsider. I would also reconsider if a new rule allowed one to participate only with Regence and exclude all other BlueCross associations.

Sincerely,
David J. Langford, O.D.

I find it unacceptable in this day and age that I can’t look up vision benefits for an entire insurance company in one place. This probably has something to do with BCBS being independent associations instead of one giant insurance company. It is still ridiculous and a big pain in my side that won’t be there in 90 days.

I feel sorry for my BCBS patients. If it’s any consolation, the Utah State University BlueCross beneficiaries can send in their receipt and get 70% reimbursed for a routine eye exam done out-of-network. Not bad.

Tags: doctors, Income, insurance, patients

Holy Cow! A new layer of the the cornea has been identified.

I think it should humble us that we think we know so much about something, yet not enough. It’s amazing what we don’t know.

Tags: doctors, eye, science

If it’s the law that I have to give them the Rx, then can it be the law that they have to keep it? Or pay for another one? Or pay to have it faxed or verified by a third party?

I have seen contact lens Rx’s on the black top of the Walmart parking lot. Can’t people at least take it home before throwing it away?

I wouldn’t be so annoyed, but lately lots of people have been asking for copies of their Rx, and every time I feel like asking, “What happened to the one I already gave you?”

I don’t get paid to fill it out the second time, you know.

Tags: Comics, contacts, doctors, Government, patients

A urologist posted a sign at his office, and some people are going nuts.

So…I’m not sure I would pick that fight because I just want money in exchange for services, but if I felt that a certain person or entity were actively fighting against me obtaining patient volume and deserved fees, then yes, I would have to push back.

This doctor also put some literature in his waiting room about the negative effects of Obamacare and its timetable. Holy cow, imagine the left’s vitriol if you stuck a Bible in your waiting room! I put NRA magazines in my waiting area, and guys love them! I also put National Geographic in there too. You know, just to keep it balanced. I think it’s the doctor’s right to put any decent reading material he wants in the waiting room. No one is forcing them to read it. They can take their business somewhere else if they want.

I’ll bet 80% of my patients don’t even know what magazines I have in my waiting area since I don’t like to keep people waiting.

I’m still participating in Medicaid until it doesn’t make it worth my while. I don’t really agree that there is such a thing as government sponsored-medicaid, but for now I think of it as getting my own tax dollars back.

Anyway, I reserve the right to express my political, economic, and religious views to anyone who will listen, inside or outside the clinic. Just because I’m a doctor doesn’t mean I can’t be active in causes I believe in. However, I don’t think people pay me to preach to them. I’m pretty sure they came in for an eye exam. Plus I don’t have time to go off on political or religious rabbit trails because I hope the next patient is almost done with their paper work.

I don’t care what a patient’s political/religious/etc philosophy is. I don’t care if I have to speak to them in English or Spanish or through a family member interpreting, I just want a fee in exchange for a service, and I want to perform as many exams per day as possible.

Tags: doctors, Free Speech, Government, insurance, patients, politics

When I went to renew my Utah optometrist license, I was greeted with this pop up:

Since my photo is grainy, it says,

“Under Utah law a contact lens prescription expiration date shall be two years from the commencement date unless documented medical reasons require otherwise.”

Here is the excerpt from the Utah Code regarding “Contact lens prescription”:

58-16a-102. Definitions.
(3)
(b) A prescription may include:
(i) a limit on the quantity of lenses that may be ordered under the prescription if required for medical reasons documented in the patient’s files; and
(ii) the expiration date of the prescription, which shall be two years from the commencement date, unless documented medical reasons require otherwise.

I would say it is pretty standard practice to make youth Rx’s one year, but my advice to other Utah eye doctors would be to make sure you have a check box in your chart documenting how the youth’s Rx is still changing which requires yearly monitoring, history of eye infections and need to yearly monitor eye health, etc.

I am not exactly sure when this law came into effect, but I have known about it since 2006 after I moved to Utah. From intermittent observation of outside Rx’s brought in to my vision center or patients coming in for an exam, I would say about half of the area eye doctors know about this law. Either ignorance or they document every little thing as an excuse to yearly monitor contacts. I don’t want to slight The Vision Council’s campaign of “Check Yearly. See Clearly.” but the law is the law.

What would you say is sufficient medical reason to change an adult’s contact lens Rx to less than two years?

1. Seasonal allergic conjunctivitis? What would you change before two years after recommending Pataday/Alaway, ClearCare, and daily disposable during the worst weeks?
2. Contact lens-related dryness? What would you change before two years after recommending Oasys/Biofinty and ClearCare/Optifree PureMoist and Refresh Contacts?
3. Mild corneal neovascularization? What would you change before two years after recommending a silicone-hydrogel, adhere to manufacturer replacement schedule, and no overnight wear?

I would be careful because if you get too knit-picky, your patients will go elsewhere for exams.

Tags: contacts, doctors, Government, law, optometrist, Organized Optometry, patients

The Utah Optometric Association is very worried about H.B. 408 which is being introduced for the 2012 legislative session. I know they must be worried because a volunteer optometrist from the association called me, and I’m not even a member of the UOA.

It turns out they are rightfully worried because while the title, “Use of Optical Scan Machines,” might seem innocuous, what is really behind the curtain is pernicious.

While there is currently no text on the le.utah.gov website for H.B. 408, sources say that the bill’s sponsor, Greg Hughes, from Draper, UT (home of 1800Contacts) intends to allow the current prescription law to be changed to allow a person to buy glasses based on the reading of an autorefractor.

Apparently, the plan is for a company, like 1800Contacts, to set up a Glasses Kiosk in a popular store, like Walmart. (By the way, 1800Contacts has been selling glasses for a while.) The person puts their head in the machine, the autorefractor spits out some glasses numbers, a pupilometer measures a p.d., the person selects their frame and lens options, then they slide their credit card and wait for their glasses to arrive in the mail. (Maybe a nicer kiosk would measure the Rx in your current glasses and have you look at an eye chart, and factor those measurements into the numbers the kiosk “prescribes” you.)

If allowed, I predict an unintended consequence will be that no optical will adjust your glasses for free, like they currently do. You will have to show a receipt just to get your glasses adjusted, so everyone buying glasses from kiosks or internet sites will walk around looking like goobers and in pain from poorly adjusted glasses.

Other obvious consequences will be that people will walk around with headaches and blurry vision since autorefractors are notoriously inaccurate and will usually over-estimate nearsightedness and underestimate farsightedness. And say nothing of the fact that many people need prism to see straight/avoid headaches.

But here is the biggest reason to forsake this bill: People need eye exams to ensure good eye health. A refraction is only one piece of a complete eye exam. I’ve already written about the woman who only wanted more contacts, but because she had an eye exam, I saw some worrisome findings and referred her for more specialty care which discovered a brain tumor.

That’s just one patient. I’ve actually done that a couple times with brain tumors. Other times I’ve had patients whom I’ve diagnosed leukemia, diabetes, pituitary adenoma, increased cerebral spinal fluid pressure, glaucoma, macular degeneration, eye infections, allergy eyes, and more all just from a “routine eye exam.” None of these people thought there was something wrong- they just wanted new glasses or more contacts.

We can’t ignore that an eye exam is more than just looking at an eye chart and getting a refractive prescription.

But let’s say you wanted to. Let’s say you are simply a consumer advocate who wants to help people buy glasses. Your idea is to waste everyone’s time and money by making a law to separate the refraction from an eye exam. The consumer who values their eye health will simply also get an eye exam in addition to buying a glasses Rx and purchasing spectacles from a kiosk.

Okay, Utah Legislature, why are you stopping there? What if I’m a business that wants to sell antibiotics cheaper, to more people, than the present system of physicians and pharmacies? I want to set up kiosks that take your temperature. If you have a high temperature, you get vended an antibiotic. Sounds great for consumers, right? Why should eye care providers and opticals be the only ones to suffer? Make physicians and pharmacies suffer as well!

If you want to change the system, change it fairly for everyone. Let’s be just like third world countries which don’t require doctor prescriptions at pharmacies or optical shops. If it’s about consumer advocacy, what could be better, right?

Of course, you will essentially be forcing a large portion of health care providers to change professions. And don’t even mention how news reports will be full of people self treating, taking the wrong medicine for the wrong diagnosis, and dying. It’s a small price to pay for consumer choice, but since I have some libertarian leanings, I wouldn’t mind trying it out as long as every medical profession participates and not just optometrists.

However, if you don’t think that all roads should be toll roads and marijuana should be legal, then let’s continue to require prescriptions for medicines and medical devices, like glasses and contacts.

Choose one, Utah Legislature. Just be consistent across all professions to make the playing field level.

If you have an opinion on 2012’s H.B. 408, then contact your Utah lawmaker.

On a side note, I hope the sponsor of H.B. 408, Greg Hughes, is happy with himself. The UOA is burning tens of thousands of dollars (that it can’t afford) on lobbyists that only work for six weeks to fight H.B. 408. Even if HB408 is defeated this year, who knows if it will come up again next year and they’ll have to spend more money again! Mr Hughes, I’m not sure how you can sleep at night. You are causing poor optometrists to spend tons of money fighting legislation that you introduced only because a big business told you to. Even if you said you were sorry and withdraw the bill, you can’t un-burn the cash you’ve caused to be burned.
Please, lawmakers, try to think outside your wallet when making decisions about bills to consider during legislative sessions. I propose we only allow you to meet every two years in order to provide more stability for us business owners.

Tags: 1-800, doctors, economy, Government, optometrist, Organized Optometry, patients, politics

Does anyone know good sites to buy old optometry equipment at a discount price?

Tags: doctors, Equipment, For Sale, management

The topic of today’s post is the most searched term that brings people to my little blog, so I thought I would directly answer the question, “How do I become an optometrist.”

Here are the steps as I see them:

1. Go to college and major in any field you want. You will be required to take prerequisite courses before entering optometry school, and most of these courses are taken during a biology-type major. But, you can major in statistics or Spanish, but it will take extra time to graduate AND get all the optometry school prereqs. Don’t let that put you off because if you don’t get into optometry school, you will want a degree that you can use to do something you love. About the only thing you can do with a biology degree besides work for the federal government is work at McDonalds.
2. The summer after your second or third year of college, take the OAT and score well. Make sure you check the option to have your scores released to all the optometry schools that you are considering.
3. As part of your optometry school application, you have to observe a few optometrists in different practice settings (private, government, research/academic, commercial) for around 30 hours. This takes time, so schedule ahead before your application becomes due. It’s also very important because you may discover that being an optometrist is not for you. That’s a good lesson to learn before you spend huge amounts of money becoming one.
4. If you still want to be an optometrist, get your application together and send it in when your fourth year of college starts. There are usually essay questions and a personal statement. Try not to write anything naive. You’ll also need to round up all your official college transcripts. Hopefully you are a fine human being and have cultivated outstanding personal, academic, and work references. I threw in a clergy reference as well. Each optometry school might have a slightly difference process, so please read their website like the careful, well-educated person you are.
5. Interested schools will call you up and schedule an interview usually starting around January. You will have to pay your own travel, food, and accomodations, so if you get a lot of interview requests, you may want to prioritize them if you don’t have unlimited funds and time. By the way, do well at the interview.
6. Wait for all the offers to pile in, and accept the one you want. I would pray about it. It’s a big decision.
7. Spend big money to attend optometry school and pay attention because there is a test later. Spend some more money on your own optometry equipment and reference books.
8. Work with a professor that you respect to plan, execute, and write a thesis project during your second year of optometry school.
9. Pay your money to take the NBEO 3-part testing and do well.
10. During your fourth year of optometry school, you will travel around to different preceptorship sites. You can focus on the type of settings you would like to work in, or better yet, experience several different settings to give you more experience if your preferred setting doesn’t work out right out of school.
11. If interested in specializing, you can do an optional optometry residency. During your fourth year you will apply and then be invited to interview for residencies. They are preferred for several modes of practice like government, academia, and LASIK centers. You’ll learn more about this and be able to make an informed decision after being in optometry school.
12. Graduate from optometry school
13. Apply for optometry licenses in the state(s) you wish to practice in.

Congrats, you would then be a practicing optometrist. For those of you counting at home, that was a minimum eight years of your life after graduating high school. I wish you luck in your quest to find a job and be happy with your career.

Before you can start working, you will need spend money on a license, malpractice insurance, perhaps a DEA number, and apply for all the insurance panels you want to take. If you decide to work for yourself instead of someone else, you’ll need to take care of a whole bunch of business related stuff that is beyond the scope of this post.

Don’t forget you will need to spend a whole bunch of money every year in the racket known as continuing education conventions.

Tags: Answers, doctors, optometrist, optometry school

This week I heard about a New York physician telling all his medicaid patients that they had HIV/AIDS, even though they didn’t, because he could bilk Medicaid for tons of money running HIV testing/office visits.

Today I hear about an optometrist in Utah who bilked Medicaid for patients he never even saw!

Before insurance companies (especially government ones) start bearing down on all of us with burdensome regulations because of a few bad actors, let’s take a step back an look at the problem from a different angle.

This is why insurances shouldn’t pay for physician office visits, but if they want to, then leave the doctor out of it and just reimburse the patient. My car insurance doesn’t pay for oil changes or gasoline. If my car insurance was crazy enough to offer an oil change benefit, then that would be great, but if I’m Convenience Lube, then no way would I take deferred payment from some car insurance company. I would demand the car owner pay at the time of service, and their crazy insurance company can reimburse the car owner later. If my car is in a major accident, then I would less likely have cash on hand for an expensive repair, so this is when the insurance companies would step in. Besides, autobody shops are much more accustomed to dealing with insurance compared to oil change shops or gas stations.

This is how it should be in healthcare. Only certain providers would really have a need to regularly bill insurances. Mostly doctors doing surgeries, hospitals, or other high cost care environments.

Number one, this helps lower the cost of medical care because people find out how much it actually costs since doctors don’t have a big menu/price sign over the reception desk. Second, doctors don’t have to spend tons of money and time filing claims. Third, the incidence of doctors perpetrating insurance fraud would go down because doctors would have less opportunity anyway. Fourth, if something isn’t covered by insurance, who presently gets to eat it? Usually the doctor. Patients paying their own office visits would force the patient to be more accountable for whether they really want/need a particular service, regardless if they expect their insurance to reimburse or not.

The doctor shouldn’t be beholden to any insurance company. He should deliver care according to his training/experience. She shouldn’t have to try to remember that Insurance A will pay for a visual field once a year, but Insurance B will allow it twice a year, etc. He shouldn’t think about if he has the patient do an extended medical history, he can upgrade his exam from level 3 to level 4 to bilk the insurance company for all they’re worth because hey, the patient is only paying a copay, right?

I think big ticket items like billing for surgeries or expensive procedures should still be billed by providers/hospitals since this is what insurance is for: paying for catastrophic, unexpected events. But all the little stuff, like inpatient food service and routine exams and regular office visits should be paid up front by patients. It would lower healthcare costs because providers could lower prices since their labor and accounts receivable would decrease. It would decrease over-utilization since patients have a financial stake in the process. It would decrease fraud since there would be less opportunity to create fraud by the majority of doctors/patient encounters.

Tags: doctors, fraud, Government, insurance, patients