Eyes On Parkway

Initial Business Response /* (1000, 5, 2015/06/25) */
Upon arriving for her appointment, the patient claimed that she was on disability and that she was applying for Medicaid Expansion. So out of courtesy, not requirement, we made a few phone calls to check her eligibility, which we discovered it...

had expired December 31, 2014. At that point she said, West Central Human Services will just pay for it, we just need to send them the bill and insisted it would be covered. So we continued on with the exam. I have enjoyed exams with this particular patient and thought the same about the most recent full eye exam. I had a nice chat with the patient and thought the exam went well. She gave me no indication at the time of the exam or after, that she had any problems with how the exam went or how I treated her. I am racking my brain to figure out at what point in my encounter with her was I ever rude.
Her chief complaint was that her distance vision seemed like it could be sharper. I evaluated her Visual Acuities upon entrance of the exam and with her current glasses/prescription and she was able to see 20/20 in both her left and right eyes. Upon performing a refraction (the part of the exam where the patient leads me to determine her prescription), there was such a minimal change in her prescription that ultimately I left the choice to the patient if she wanted to fill the prescription and actually thought that in the case she didn't have insurance coverage, these results would be a relief to the patient. The prescription I wrote for her provided 20/20 vision in the right and left eyes, which was the same as her entering corrected acuities. The DMV requires 20/40 to pass the Visual Acuity portion of the licensing process. With her current glasses, she passes with flying colors. I also told her that I had created 2 prescriptions for her, she could either have a single vision pair of glasses or she could opt to try a bifocal. Both prescriptions were entered into the computer system the day of the exam. When I checked her vision without a bifocal and just with her distance prescription, she could read 20/20 on our near vision test. With those results, I typically let the patient decide if they feel like they really strain at near and would benefit from a bifocal, they can sure try it. As far as night vision goes, she has a moderate amount of astigmatism and this is a common complaint, even with glasses on, that most astigmats have and there's not a whole lot that can be done to fix that problem besides having the correct prescription and adding and anti-glare. I have several patients that don't drive at night due to poorer night vision and it's a fact, there is only so much a pair of glasses can do for night vision, especially those with astigmatism.
At the end of the exam I passed her off to our optical staff to try to figure out the insurance issue as I had another patient waiting. I had them to call West Central before anything was decided about glasses so that if they didn't cover glasses the patient could decide how she would want to proceed with ordering any materials. The staff made the call and was told they do not cover any vision services or materials, that just Medicare and Medicaid would cover, which we service both of those insurances. The patient said she is applying for Medicaid and if she would be eligible for Medicaid, she could have received a free pair of glasses from us, we are set up with that "program".
I honestly don't know how differently I or my staff would have handled this situation. My staff is professional, kind and helpful when it comes to caring for patients. We don't have to verify insurances before patients have exams and often times, medical clinics don't and if you don't have coverage, but thought you did, they don't provide you with free services for something that was ultimately your responsibility to verify and know beforehand. The insurance information is the responsibility of the patient, insurance companies at times won't even give us information and only allow the policy holder the ability to obtain information about their plan. We did look into the insurances that the patient provided and called to check her eligibility before the exam, again it is not required of us to that, it is out of courtesy that we offer this service. We told the patient that she was not covered by the insurances she provided. She then proceeded to tell us that it was fine because West Central Human Services will cover the cost of the exam, we just needed to send the bill to them. We proceeded with the exam. After the exam when it was time to decide what to do with glasses, we did call West Central Human services to double check options and we were told that they wouldn't cover the exam or materials and that is when she became upset. She asked us if we have programs available to patients and we accept Medicaid patients, which isn't required of us, but we chose to provide exams and materials to those on Medicaid. The staff nor I never refused to help her with glasses. According to the staff, she didn't even give them an opportunity to help her with the glasses.
For several of our patients who are struggling financially, we have offered a payment plan where they make small monthly payments. We have also given extreme discounts on materials and services for those in need. She never even gave a chance to discuss, she became upset quickly when we told her she didn't have coverage, if anything we feel she refused our help. I feel my staff handled themselves professionally and accordingly. They followed the steps they needed to and looked into the situation as deeply as they could. They never refused her service, it was her choice to look for glasses if she wanted to purchase glasses.

Exact notes in our computer system from employees stand point: [redacted] and [redacted] worked with patient. [redacted] called Sanford Medicaid Expansion Plan (she came with print-out of info along with big binder). It had expired Dec 31, 2014. She also had a client number with West Central Human Services, and thought they would cover something. Sheet she had from West Central said their was a 0% discount through March 2016. When [redacted] called West Central, they explained they don't supply vision services (exam or materials). Only thing that would cover anything would be Medicare or Medicaid. She had neither, but expressed she was trying to get it. Left not pleased with us because "there are programs out there that pay for things like this."
The patient would like a refund, but she didn't pay anything, so there is no money to refund at this time. I have tried to contact the patient a few times to resolve the issue and come to a solution but she has not returned my phone calls. I have left her a few messages and phone numbers to call me back at and haven't heard from her. It is really hard for me to deem this fair, but out of the goodness of my heart, I have decided to write off her balance. If she feels like she received a poor exam and that she is a threat on the road due to her poor vision, I suggest she not drive until she gets a second opinion and if she sees another optometrist, I would also recommend that she make sure she has coverage if she doesn't want to pay for the exam as I may be one of the only ones in town that does free eye exams for those in need.