a visit to the optometrist

B's glasses broke the Saturday of Memorial Day weekend. His spare is in a box in Chicago. And given the holiday, the earliest appointment available was Tuesday afternoon.

The frames were about eight years old, and literally just snapped, releasing the lens. There wasn't a good way to fix them. Tape wouldn't work and crazy glue usually does more harm than good. Thankfully B's vision isn't too bad, although not good enough to drive.

While B was in the office for his exam, I sat in the waiting area. I tried to read a book I had brought with me, but there was a bit of an pre-in-service training going on at the reception desk. It intrigued me as well as irritated me, so I thought I would share.

A man in a black suit came into the office. He represented a company that designed a machine that can 'see into the future'. The plan was that he was going to pick up lunch for the crew and do a training with them while they ate lunch. Since they had to wait a bit for their sandwich order to be ready, he went ahead and did a brief overview. He explained to the women behind the reception desk that this diagnostic test can detect eye problems like glaucoma up to eight years earlier than normal tests. It uses a laser- but they shouldn't tell that to patients, as people get freaked by lasers - to see details of the eye that no other instrument can detect.

The idea is that if a patient presents with a high pressure reading on the puff test (you know the one where they send a shot of air into your eye), then they should be referred for this test. Once a month, a clinician will come to the office and perform the test on the patients - no referring them outside the office. Depending on the results, the person returns to the office every six months for follow up. No one asked, but it sounds like while this test may indicate the possibility of a future problem, there is little that can be done but monitor the problem.

At this point one of the women asked about the cost. This is when the man in black asked if they currently asked patients for their medical cards. When they informed him they didn't, he said that starting today, they would.

Apparently this test is covered under most medical plans (as opposed to most vision plans). The truth is that most vision plans don't reimburse optometrists very well. The theory being that most of these patients would not use their service if they lacked coverage. Or at the very least, they would not be seen as often. The trade off is that optometrists can up sell patients on products, like prescription sunglasses and daily wear contacts. Of course with the popularity of laser eye surgery and the ability to order contacts on line, this has been a problem. So from a financial standing, it makes sense to try and milk the medical side.

Of course this is part of the problem with health care. You have this group of medical specialist that don't hold M.D.'s, but which are well trained and do in many cases prevent major health issues. These are the optometrists, dentists, therapists, chiropractors, and so on. Just think about it. An good optometrist can catch things like diabetes before a doctor. A dentist knows that eliminating gum disease is about more than a pretty smile - untreated it can lead to problems like heart disease and even cause problems in pregnancy. Therapists help people do things like stop drinking and smoking - again, helping avoid major health risks for a person. And a good chiropractor can save someone from major surgery, or at the very least get her out walking again. Despite all of this, these medical professionals are among the lowest reimbursed, if their services are even covered by insurance at all. It leads to the more clever of the bunch, trying to find a way to stay afloat, like offering tests which may or may not be of use to the patient.

Overall B's visit went well. He was seen on time and even managed to find a pair of glasses that fit his big head. I don't say that to be mean. B really does have a large head. It is usual that he is lucky to find a single pair of frames that fit. Usually they have him order a couple in his size and then come back, adding several days to the process. They also managed to have his glasses made by Thursday afternoon, which was great. Thankfully they had his prescription in stock, so were able to turn things around quite quickly. We were told it could take up to 10 business days. I figured I would do doing a lot of driving to Pasadena.

Still, I was left with a bad taste. I don't think that this is the answer. Oftentimes these doctors hire people who aren't detail orientated enough. Nor are they self starters. Or if they find someone like this, they don't stay very long because they can find better jobs. I know because I worked for two chiropractors one summer and both commented at how smoothly the office ran while I was there. Of course to show their gratitude they gave me a whopping $50. It is a two-way street people.

The people who run the front and back office for a doctor are responsible for the business succeeding or failing. Yet so often these workers are paid low rates and often without benefits. The doctors need them to help build the business and see that bills get paid, yet there is next to no incentive to do so. Imagine seeing your boss pull up in a new luxury vehicle while you can't afford braces for your kids. Would you continue to do it? Probably not.

I remember once while I worked for the company that owned the vision plan, having a billing issue. It turned out that the office staff forgot to have me sign one of the forms. As such, it had been denied. Instead of calling me and asking me to come in and sign the form, they let it go. I think it was when I called to make an appointment the following year that someone brought it up. Thankfully I was able to pull some strings and get it paid. I liked my eye doctor, although I questioned why she had such people working for her. I doubted my claim was the only one sitting in a pile unpaid.

Something similar happened at my podiatrist's office. The claims were sent several times, but denied for reasons unknown. Finally, a year later, I received an EOB (evidence of benefit) from my now former health plan, that payment had been made. In that year, I was no longer covered by the plan and had moved out of state. I called the doctor's office immediately to make sure that my bill was settled. I was told it would be at least 60 days before they saw payment, and then they would bill me for any difference. As it turned out, because of the billing codes they used, I got lucky and the insurance paid something they shouldn't have. I remember calling the insurance company and given my background was able to explain that either they should have paid both visits or denied them both. The woman on the phone agreed that both should have been denied, but of course wasn't going to do anything about it now. I should point out that I don't go to the doctor very often, and yet frequently have these problems. I know it isn't just me.

In a few hours, the race for the presidency could be a bit clearer. I am not holding my breath. I just hope that whoever wins starts the ball rolling to do something about this. The time has come. It is getting really crazy out there.


on the night stand :: The Tooth Book: A Guide to Healthy Teeth and Gums