Gregory Optometrics

April 29, 2014
Dear [redacted]:Thank you for your letters in reference to the abovenoted case. I will attempt to explain the difficulty experienced by the claimant and hopefully resolve the issue.She did in fact leave her prescription for eyeglasses on February 14, 2014, as stated....

As you may be aware, we cannot process eyeglass fabrication under Medicaid until an authorization has been received from Medicaid to do so. Effective February 1, 2014, DC Medicaid changed their claims processing handler to a new entity, [redacted], This entity has experienced quite a bit of difficulty initiating their system and making it compatible to the previous one used. As a result of this slow down, they have experienced a tremendous backlog of claims waiting to be processed. In fact, we were told that [redacted] placed a priority in getting the hospitalsauthorizations processed first. Unfortunately, our patients believe it is our office that is holding up the processing of their eyeglasses. Not only is this completely untrue and illogical, it has put a severe financial strain on our business as we cannot be paid until those authorizations can be processed, Our office has complained to numerous supervisors within DC Medicaid and to our Councilmans office; even at this late date, we are still just receiving some of the claims dating back to February.Our office is not alone in experiencing this extraordinary delay. The delay extends to each vision provider. Some patients have cancelled their orders and elected to be serviced elsewhere, however they experience the same delay since each provider must submit claims to the same entity. We have explained this to the patients, and it is of course their option to continue service with us or elsewhere.I have enclosed on a separate sheet the fax requesting authorization for this particular patient on February 18, 2014 and a second fax for the same patient on March 11, 2014. The authorization was finally received on April 16, 2014, and her order was processed. Her eyeglass order is ready for pick up at her convenience,We are apologetic for this patients delay, however it was well out of our control. We will speak with her personally and attempt to resolve the other issues she stated. We are frequently labelled as rude and uncaring when we cannot give the patient the answers they would like to hear. Even though we are extremely busy most days, we do attempt to provide courteous and professional service.I trust I have answered this query to your satisfaction, however if there are further questions please do not hesitate to contact me or the office manager.Sincerely,

Review: On feb.14,I dropped off a prescripition for my glasses, they told me it would be ready in to weeksI started calling on the 4th week to see if my glasses were ready, then after that I called weeklyEvery week they told me they were not readyOn the 6th week, on tuesday March 25, someone told me that it will be ready some time this week.The week went by and no phone callOn the 7th week I called I was told to hold on, the first call no one ever came back to the phoneI believe they have caller ID because as soon as I called I was put on hold before I could even say anythingThe 2nd call I was put on hold and told "we are looking", I waited, no one ever returned to the phoneI feel this business has been giving me the run around and playing gamesSome of the employees there are pretty rude and inmmature.I will NEVER go back there and I wish I had never wasted all this time with themAs of today,April 1, I still do not have my glasses.Desired Settlement: I would like for someone to speak with the owner and show him my complaintI would also like for the employees to be reprimandid
Business
Response:
April 29, 2014Dear [redacted]:Thank you for your letters in reference to the abovenoted caseI will attempt to explain the difficulty experienced by the claimant and hopefully resolve the issue.She did in fact leave her prescription for eyeglasses on February 14, 2014, as statedAs you may be aware, we cannot process eyeglass fabrication under Medicaid until an authorization has been received from Medicaid to do soEffective February 1, 2014, DC Medicaid changed their claims processing handler to a new entity, [redacted], This entity has experienced quite a bit of difficulty initiating their system and making it compatible to the previous one usedAs a result of this slow down, they have experienced a tremendous backlog of claims waiting to be processedIn fact, we were told that [redacted] placed a priority in getting the hospitalsauthorizations processed firstUnfortunately, our patients believe it is our office that is holding up the processing of their eyeglassesNot only is this completely untrue and illogical, it has put a severe financial strain on our business as we cannot be paid until those authorizations can be processed, Our office has complained to numerous supervisors within DC Medicaid and to our Councilmans office; even at this late date, we are still just receiving some of the claims dating back to February.Our office is not alone in experiencing this extraordinary delayThe delay extends to each vision providerSome patients have cancelled their orders and elected to be serviced elsewhere, however they experience the same delay since each provider must submit claims to the same entityWe have explained this to the patients, and it is of course their option to continue service with us or elsewhere.I have enclosed on a separate sheet the fax requesting authorization for this particular patient on February 18, and a second fax for the same patient on March 11, The authorization was finally received on April 16, 2014, and her order was processedHer eyeglass order is ready for pick up at her convenience,We are apologetic for this patients delay, however it was well out of our controlWe will speak with her personally and attempt to resolve the other issues she statedWe are frequently labelled as rude and uncaring when we cannot give the patient the answers they would like to hearEven though we are extremely busy most days, we do attempt to provide courteous and professional service.I trust I have answered this query to your satisfaction, however if there are further questions please do not hesitate to contact me or the office manager.Sincerely,