# Optical Forums > Canadian Discussion Forum >  Eye exam why the price diff?

## RKM

Recently, a client came into my store who had got her eye exam done at an optometrists office she paid believe it or not $125! I asked what she had got done it seemed like a normal eye exam -- the optomtereist I refer to charges $70 who does the exact same thing . The information I gathered was that she was told that they would do an 'extensive eye exam' - this female is a healthy adult with no medical conditions and had a minor rx. What is the difference btwn extensive and regular eye exam? Can anybody justify the price difference?  Is this a cosumer be aware? My client was apparently unhappy when she found out the price that is charged by my optometrist... what is the range of prices with eye exams... who sets them... does optometry association have any control of this?

She asked if she could get her money back from the optomterist that charged her for the eye exam and then go to the optometerist I use... I told her that she could call the optomtery board and see what they can do... or talk to the optometrist and address her issue with the one who did charge her... I suggested that she also talk to the optometrist that I use and see if he can explain the difference....

what are ur thoughts on this...

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## For-Life

it is a free market system

Buyer beware.  I do not blame that Optometrist for charging what he or she does to that patient.  I may blame the doctor if charging too much turns out to be a poor business decision.

I see absolutely no reason for a refund or why the optometry board would get involved.

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## Golfnorth

> it is a free market system
> 
> Buyer beware.  I do not blame that Optometrist for charging what he or she does to that patient.  I may blame the doctor if charging too much turns out to be a poor business decision.
> 
> I see absolutely no reason for a refund or why the optometry board would get involved.


I agree that it is buyer beware. No reason for the refund. Optometrist provided the service and got compensated for it plane and simple. I somehow doubt that RKM wouldn't want all optician's prices to be regulated....right?

Regards,
Golfnorth

P.S. Now you have an even more loyal client who will use your optometrist and tell their friends.

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## chip anderson

Yeah that old $35.00 eye exam which included refraction has gone up a bunch.  But when you can regulate that they have to have one every year to get new glasses, you can get away with a lot.  When you buy retinal cameras you don't need you have to use it to pay for it.

But then the 50 cent  hair cut has gone up a lot too.

Chip

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## gemstone

My wife worked for an crooked ophthalmologist that charged significantly different (more) for patients with insurance for the same exam.  Is this not fraud?

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## Scott R

ODs I have worked with for years charge depending on services. Little less for refraction only. Little more for dialation. Little extra for kids. Variences depending on type of CL fit. If you work harder wouldnt you want to get paid more. Imagine if we got paid an extra $10 for progressive fits, or collected PIA fees (by now I would be driving a Ferrari).

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## Cindy K

RKM-- (Hello!!!! btw): I note you did say she had a 'normal' eye exam but did she mention if she had retinal photography done? That would explain the increased cost for certain. I've had a couple of clients who were led to believe this is now a part of a regular eye exam.

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## chip anderson

It's a nomal part if the guy needs to pay for his retinal camera.  I can remember when our patients with (we had no retinal specialist in the state) detachments were sent to Houston to see Alice McPherson, M.D.
Most left seeing 20/800, came back seeing 20/30+ and when they died they were still seeing 20/30+.
Then they started sending  them to New Orleans (closer, I guess) patients left seeing 20/80.  Came back absolultely raving about how modern the office was and the fact that the doctor took 250 pictures of the eye.  Still say 20/80 but thought the office and the doctor was wonderfull Same story when patients were sent to Memphis.
I don't know (even though I used to take retinal pictures [offered as a free service at the dispensary where I worked] ) from personal knowledge, but have been told that the only reason for retinal pictures is history and an excuse to talk at meetings (a big thing with a lot of doctors).  And I admit that the pictures we took were still slides. I was told doctor learns nothing he doesn't see during the course of a routine dilated exam of the patient.  Of course this might not be the case with some in today's system and if the picture is being taken for a doctor that  went to medical school to evaluate.

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## Penguin

People charge different prices for similair jobs. I just think that professionals from dentists to optometrists should list the price of their services in the reception area so that customers who are to shy to ask know the cost up front.
As long as it's above board the patient can make his own judgement and professionals who charge less should not imply that there's cheating involved.
Sherif L

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## rbaker

Posting fees and prices ! ! ! Been there, done that. You must be too young to remember the Carter administration. Then there were the OPC ceiling prices. Another abortion caused by the government trying to regulate prices.

Charge whatever you want and let the consumer beware. What’s the difference between charging an arm and a leg for professional services and selling the poor unsuspecting consumer something that he neither wants nor needs?

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## RKM

I do think that services should be charged for... 

however is there differences in the eye exams being offered? Is there actual differnces between each office on the type of exam? eg. regular eye exam vs extenisve eye exam--- or is that just saying the same thing?

Is there different levels of eye exams for an individual wanting to get there eyes examined? Is there a minimal requirement of what mandates a full eye exam? If there is different levels who decides what is needed the client or the office?

Lots of questions i know.... but i'm curious.:D

Raj Mann

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## orangezero

Its probably a bit correct to say everyone helps to decide.  The patient's complaints, the testing done, the doctor's decision making.  Its all decided by those in charge of the health care system, mainly medicare.

as an aside, chip, you still have no class.
"was told doctor learns nothing he doesn't see during the course of a routine dilated exam of the patient. Of course this might not be the case with some in today's system and if the picture is being taken for a doctor that went to medical school to evaluate."

Here is a thought, chip.  Since memphis is so close, go to the optometry school there and actually see what the students are learning.

Remember all, this is a public forum viewed by consumers so let me say this.  Chip is living and dealing with opticianry and optometry of the 1950s and his views on optometry are 30-50 years outdated in most cases.

Of course there are valid reasons for retinal photography, and it goes beyond doctor's wanting to have pictures for their powerpoints.  What a strange contention to make.  I don't think we (posters on this board) should allow chip to get away with saying these types of things, without some type of public rebuke.

I do think it would be best to make patients aware of the fees imposed.  Most ODs I talk to seem to think if a patient is coming to their private office, they are coming for them and not because they are the cheapest.  I'm not sure why the public can understand a lexus or bmw is not even close to a dodge neon.  But somehow, too many in out own industry can't make a distinction between quality, comprehensive eye care and a simple exam (7 and 4 anyone?) that takes 2-3 minutes of doctor time.  Now, I ask you, who really does those types of exams?  And how much do THEY charge?  The answers would be rather shocking to most on here.

Fees in my area range from $38 to over $300, and you better believe they are different types of exams.  Another point, some can get away with charging super high fees to everyone.  Others use the technical definitions of medicare guidelines to define a "routine" exam as a different service and thus a different fee.  Any type of pathology, or certain patient complaints, or intricate decision making allows for a different fee than the "routine" exam often quoted on the phone.  Therefore, to not make people upset, its always best to give a range for the fees depending on what specifically the doctor needs to do that day.

More and more ODs are going this route, to stay competitive.  The ones who aren't are the ones who are employed or have signed semi-illegal leases and can't control their own fee structure.  Or they are worried about raising fees, or they don't feel their services are worth enough, whatever.

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## Ory

There can be large differences in the cost of an exam.  Some practitioners charge a set fee for everyone, young or old, healthy or not, etc.  Others charge an increased fee for more complicated examinations, and many charge extra for a new patient as there is more baseline testing done.

I really don't think you can compare the services rendered without consulting the more expensive doc.  Perhaps he/she only books one patient per hour and some people will pay extra for the leisurely exam.  There are just far too many reasons that the fees can be different.

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## For-Life

> I do think that services should be charged for... 
> 
> however is there differences in the eye exams being offered? Is there actual differnces between each office on the type of exam? eg. regular eye exam vs extenisve eye exam--- or is that just saying the same thing?
> 
> Is there different levels of eye exams for an individual wanting to get there eyes examined? Is there a minimal requirement of what mandates a full eye exam? If there is different levels who decides what is needed the client or the office?
> 
> Lots of questions i know.... but i'm curious.:D
> 
> Raj Mann


It is the same as two stores charging two separate prices for Crizal.

Your client has as much right to complain about the OD's high price as the OD has to complain about your OD's low price.

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## orangezero

Look, an eye exam does not equal an eye exam.  One doctor may do something totally different than another.

For example, one doctor does a simple exam, eye health check with slit lamp, and writes out a prescription.

Another doctor does a screening VF with an autoperimeter, goldmann tonometry, amsler grid testing, dilation with slit lamp 66D and BIO with 20D, refraction, phorias and associated phoropter testing, spends 10 minutes discussing the various findings, and talks with the patient about the benefits of certain lens and frame options.  (and all the other things done in a routine exam).

Now, why does everyone think these two different exams both be charged the same?  Wouldn't it be reasonable to assume a patient that will pay $100 for a coating on their lenses may actually want to pay $50 more for additional testing on some of their most important sensory organs?  Even if it is "routine."  Shouldn't this be preaching to the choir here folks???

And this is assuming you have a patient who has no medical complaints and is perfectly healthy.  Certain patients require different types of exams, and this can only be decided by the doctor with the help of medicare guidelines.  They are actually quite clear although unfortunately are interpreted in a wide variety of ways and have the baggage of decades of changes.

Remember, its not just:
1. glasses exam
2. contacts exam
3. pink eye

We can all sit and complain that an exam costs $130 instead of $60, but once people have had the two different exams (from two different offices) MOST would rather go back to the more expensive place because they felt they got better service.  If the doctor doesn't provide feeling of enhanced services and really help his patients, he/she won't be in business too long.

However, I think its more deceiving to say you are giving a comprehensive, independent eye exam when in reality you are doing the absolute minimum to arrive at a prescription.  In fact, its usually the cheapest places that want you to believe the eye exam is the same where ever you go.  But its just not true.

I keep commenting on here not to complain, but rather because almost everywhere I've ever worked or filled in very few of the opticians/workers/receptionists understand why exams are different prices.  Seems obvious to me, but I guess I've just been doing this too long.

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## f2chow

For-Life ...I couldn't have said it better myself!

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## MarcE

> I do think that services should be charged for... 
> 
> however is there differences in the eye exams being offered? Is there actual differnces between each office on the type of exam? eg. regular eye exam vs extenisve eye exam--- or is that just saying the same thing?
> 
> Is there different levels of eye exams for an individual wanting to get there eyes examined? Is there a minimal requirement of what mandates a full eye exam? If there is different levels who decides what is needed the client or the office?
> 
> Lots of questions i know.... but i'm curious.:D
> 
> Raj Mann


Yes, there are different levels. 92001/2/3/4 and 92011/12/13/14, and 99xxx (fill in w/ about 40 different levels). All could be considered an eye exam. In our OD office they range in price from $45 to $150. We are pretty cheap. The 920xx codes normally include a refraction, but a refraction (92015) is $20 on top of a "medical" exam, which are the 99XXX codes. 

We have prettiest OD or OMD in 6 counties, she is the friendliest and spends the most time w/ patients. We have a modern clean office w/ super helpful and professional staff, convienent parking, pretty plants, . . . 

Guy down the street charges $69 for an exam w/ a completely wrong Rx. Gets snotty when a refraction is needed. And he's not very friendly in his old dank office.

$125 for a basic no complaint eye exam (without retinal pics) would be a bargain w/ our doctor, considering the other choices. But we only charge $80. She is booked 4 weeks out. I think we should charge $100 to try to clear out the appointment book a bit and only take the people motivated enough to pay the $100. That's how business works, and for the most part, doctors aren't good businesspeople. ODs are even worse. When someone is trying to charge whatever the market will bear, it seems strange in the OD marketplace, doesn't it.

People buy a Lexus for $15,000 more than the comparable Toyota Avalon (same parts, engine, chassis, leather, and most of the options) and feel good about. Maybe the OD that you refer to is a good deal considering, but maybe not.

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## orangezero

Medicare actually recently changed some policies to allow for "routine" exams.  They are the S-codes.  Technically, even the 92xxx level codes don't include a dilation, but the vision plans tried to make themselves appear a bit more grown up and tried to pass off those codes for what they cover.  So, there is a lot of confusion and it does appear a good deal of offices still use 92xxx ophthalmological codes (or eye codes) as routine.  Couldn't be further from the truth, no matter how many offices or vision plans use these numbers.

There are also the codes for consultations, codes for nursing home visits, codes for after office hours emergencies, and then a ton of procedure codes as well.

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## chip anderson

OZ:  
Don't you just love the government to making it simple for you?
At present I am about 30K behind in sqeezing money out of medicare and only do about five services that are covered.


Chip

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## orangezero

I'm not quite sure where everyone is coming from in regards to universal health care, single payer and the like.  If you really think about it, it seems most everything generally trickles down from medicare/medicaid anyway.  But, like it or not, its how we get paid.

The ironic part is that with eye care often times the reimbursements are much higher than most crappy vision plans.

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## Diane

When a patient makes a choice to go to a certain doctor, the doctor provides the service to the patient and payment is rendered, it is not up to a third party to decide whether or not the patient was overcharged.  It's actually unethical to discuss the fee with the patient "unless" you know ALL of the particulars.  

It's interesting how that patient may be happy with services rendered, until the fee is discussed with another person.  

Folks, we should be sure we know ALL the particulars, before making comments about fees to another doctor's patient.  Even if they bring it up, it can be unethical, so be careful.  I believe enough information has been provided in earlier posts about the differences in exams, as well as the office environment itself.  Technology has been introduced to help improve the eyecare of out patients.  We should embrace that technology.  Technology is also expensive and appropriate fees should be charged.  Perceived value of product and/or service can be changed if negativity is introduced.   Interesting how it may even affect how a patient sees out of the new eyewear.  We shouldn't be the ones to make patients question the ethics of the profession based on discussion of fees with them.  

Just my thoughts and not all of them at that.

Diane

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## HarryChiling

MarcE and Diane, thank you for your well thought out posts.  I will just say this.  I get my eye exams done at a store more than 50 miles away from where I live and pay $85.00 for the exam.  Now let me tell you that my benefits package includes a free eye exam once a year.  You may think I am paying too much for my eye exam when you compare FREE to $85.00, but I am glad he is giving me a discount at $85.00 and he is a great friend of mine.  Best eye exams in the business (yes he gives better eye exams than orangezero :bbg:, zing).




> What is the difference btwn extensive and regular eye exam?


Couldn't tell you, as we offer *Super Duper Eye Exams* here!




> We can all sit and complain that an exam costs $130 instead of $60, but once people have had the two different exams (from two different offices) MOST would rather go back to the more expensive place because they felt they got better service.


I am glad you put the MOST part in and I would like to emphasize on that.  Judge the exam based on the services provided.  A $130.00 eye exam can be expensive or cheap as compared to a $60.00 exam.  for example:




> Another doctor does a screening VF with an autoperimeter, goldmann tonometry, amsler grid testing, dilation with slit lamp 66D and BIO with 20D, refraction, phorias and associated phoropter testing, spends 10 minutes discussing the various findings, and talks with the patient about the benefits of certain lens and frame options. (and all the other things done in a routine exam).


This eye exam is $60.00, you just got the cheapest eye exam on the block.




> does a simple exam, eye health check with slit lamp, and writes out a prescription.


This eye exam is $60.00, you probably overpaid as there is someone in your area that would be cheaper.




> does a simple exam, eye health check with slit lamp, and writes out a prescription.


This eye exam is $130.00, you just got jacked buddy.




> Another doctor does a screening VF with an autoperimeter, goldmann tonometry, amsler grid testing, dilation with slit lamp 66D and BIO with 20D, refraction, phorias and associated phoropter testing, spends 10 minutes discussing the various findings, and talks with the patient about the benefits of certain lens and frame options. (and all the other things done in a routine exam).


This eye exam is $130.00, sounds reasonable to me.

I think what we are trying to get at here is the VALUE of the exam, not the PRICE.  When discussing anything with a patient you would be alot better off discussing VALUE with a patient, no one is ever upset if you can explain to them the value of the exam or services you provide.

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## orangezero

There certainly are a good deal of patients who only think of price when it comes to eye exams.  I generally (very, very generally in fact) feel they get what they pay for... unfortunately.  There is a certain level of care that is implied anytime someone says "eye exam" but its not always present, and not always *felt* and understood by the patient.

There is certainly a difference between real quality and perceived quality.  The trick is to provide both and do it at a reasonable fee.  If people complain about fees they usually don't know what they got, which is a failing of the office more than anything.


Probably could be applied to any field.

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## HarryChiling

> Probably could be applied to any field.


Like, for instance .................OPTCIANS :D. We see this a lot especially with the whole internet frame and even glasses. You hardly do get what you pay for. Lots of times they come in to buy glasses anyway. I have actually heard a couple of people say, "can I get some sort of break since the online shops messed up my glasses and this is my second pair". The nerve, I usually respond with, "yes, I'll take $75.00 off that pair to replace the lenses with the first pair at retail".

I try to rebut price based question with quality and value based rebuttals.  It's an attempt by me to try and get the mind set away from the price tag and realize, I will more than likely get the glasses done quicker, more accurate, and more cosmetically appealing than the other guy and that's where our office focuses.  I try and explain that we use great products that are tried and true, we hardly ever test out new products on our patients untill we know that they are quality product(most opticians in my area don't know what to do with that last one, I don't sell the free form and newest most expensive stuff and this is by far the greatest rebutal).

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## braheem24

An 'average' lawyer can charge anywhere from $80-400 per hour for an opinion.

In the end you're paying for the doctor's opinion, $39.00 for your is too much if you get the wrong diagnosis.

:cheers: to everyone who believes they're worth more.

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## Cindy K

We also need to remember that here in BC up until about six or so years ago, every man and woman was entitled to a free, provincial health care coverage paid, eye exam every two years. Despite routine eye exams having been deinsured from our provincial health care coverage (they're still paid for kids under 19 and those over 65 though most optometric offices now charge a user fee over and above their alotment from the medical plan, usually between $10 and $20 in my locale) many folks are still of the mindset that any medically necessary procedure and service (routine eye exams being one of these) are a medical service, and thus having to PAY for it is unreasonable. Its still recent memory for them. Now that optometric services have become a commodity that may be 'shopped' for (a notion contrary to the thinking of many folks here in BC) and that there is no 'standardized' or regulated fees for this service, many folks who had been used to just showing their CareCard are resisting this and questioning the charges.

Just curious, I wonder how often the optometric offices are asked to give their 'best price' on an eye exam...

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