# Optical Forums > Canadian Discussion Forum >  Faxing Rx's

## mma

I was wondering what the policy on other OD offices is?  We currently get at least a couple requests each day for patients or optical stores requesting the Rx to be faxed.  We have been faxing in the past, but its taking up too much of our time.  Can we refuse and just ask the patient to pick it up?

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## Golfnorth

> I was wondering what the policy on other OD offices is?  We currently get at least a couple requests each day for patients or optical stores requesting the Rx to be faxed.  We have been faxing in the past, but its taking up too much of our time.  Can we refuse and just ask the patient to pick it up?


I don't think that it would be the best for the patient if you refused to fax. I get OD's offices phoning me asking me what progressive lens I fit a particular person with. I'm not going to refuse.....let's try to get along. I remember what happened to me in the early 80's when there were no fax machines. A small town OD refused to give me the rx over the phone and the unfortunate patient had to pick up the rx from the OD and drive 45 minutes out of her way and drop me off the prescription at my home. Now that's convience!

Regards,
Golfnorth

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## chip anderson

The ones that are ******** usually won't fax or E. Mail, these are the same ones that try to hide behind HIPPA.  Or even mail Mail an Rx.  The nice ones send it an smile.  By law _all_ should have given them a copy *at time of examination.*
Think of it man, you are saying your office staff is too important to be bothered with giving the patient his prescription.  If you that busy you can afford more help that has time.

Chip

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## icare

I tend to agree that it is a simple service that shows the patient that you still care about them.  At times, I wonder if it will become more abused as alternative online optical providers grow a bigger footprint.

There is a law somewhere that permits the doctor to charge for additional copies of Rx's.  It must be in place for some practical reason.  It isn't fair for any one patient to force doctors' offices to provide numerous Rx's without regard for the time and effort involved.  If it's lots of different patients, maybe the dispensary structure should be examined for flaws.

In private practice, where long-term patients appreciate consistent care, there is good reason to continue serving the patient requests without complaint.  In a cut-throat commercial practice where patients seemingly do not care who the provider is, there is cause to be more restrictive.

Some pharmacies have resorted to requiring patients to present the Rx and won't accept a fax.  There are valid reasons for doing so.  A copy of a copy is not a clear authorization in any case.

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## optical maven

I always give the patient a copy of their Rx at the time of the exam and fax Rx's as requested.  If the Rx is more than 2 years old I charge a fee to rewrite the Rx and ask the person to pick up the paper.  I've had people pick up Rx's that are over 5 years old.  Are opticians filling these?

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## icare

When the Rx is expired, we won't give the patient any more copies.  There are very, very few exceptions.

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## NorthStar

In our office all patients are given a copy of their Rx at the time of their exam. It takes time to pull the file and do the work. If they want another copy they have to pay for it, and we prefer to fax to avoid typos. Unfortunately, we also had to start charging for file transfers due to Rx requests masquarading as file transfers.
As well, patients should be given their original copy back and not have their Rx kept for safekeeping by the optical store.

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## wolfman

We will fax the RX, never give it over the phone, to much of a chance of an error. If the RX is expired then we will still give it but write in big letters "expired" and then give the date, so there can be no confusion.

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## NorthStar

To clarify, I _automatically_ write out the patient's Rx right after the exam.  It is their responsibility; if they lose it or don't have it with them, they will pay for the time for a faxed duplicate because we are already busy dealing with the patients in our office.  Why should I inconvenience the patients in my office for somebody who forgot their Rx?  Try obtaining your drug Rx phoned in to your pharmacy by your GP or even a free Rx copy.
Am I wasting my time automatically writing out the Rx for all my patients?  Perhaps I should do it only upon request of the patient and fax for free?  It should save everybody time, and I am sure the optical store appreciates it when the patient is already carrying their Rx.

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## opti-refractonator

Since when did prescriptions for eyeglasses start expiring?  You can recommend that the patient come back every year or two, but refusing to fax a rx to an optical because it expired is bullsh*t.  We all have stories about doctors that don't give rx's out because they are expired, or they need to be signed.  I understand that it does take the doctors' staff time to do this, but if they didn't, than what do they do all day anyway.  Seems to me that a secretaries job is to do exactly that.  There are always people that abuse the system, but thats not what I am talking about.

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## f2chow

> North Star:
> 
> My internists and specialists have never been reluctant or charged for giving an Rx to my pharmacist. Of course you optometrist are much more important that mere medical physicians.
> I have never had one refuse a phone call or to even Rx something without charge for something that could be prescribed without an office visit or exam. Never had one fuss because I lost or miss-placed an Rx.
> You think you mo' Impoatant dan u is. O.D. doesn't mean Optical Deity.
> Chip


Seriously, are you for real ...?

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## NorthStar

So instead of automatically giving the the patient a copy of their Rx at the time of the eye exam, you would prefer I only write Rx's upon request and fax for free?  
My experience with GP's is quite different.  They don't do anything for free including simply re-writing an Rx, and I don't blame them.

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## opti-refractonator

dude, your attempt to be funny or whatever you are trying to be makes you look like an idiot and a racist for mocking the way other people speak.  please stop.

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## mlm

Chip, if I want my medication prescription sent over to my pharmacist by fax, I pay $20 for the convenience.  I don't get charged if I come in to see the doc for 5 minutes to tell her I need a refill.  And my GP will only rx 3 months worth at a time.  So if I had those all called in, I'm spending $80 a year.

opti-refractonator, do you seriously think that all an OD's staff does is sit around and wait for rx requests?  I for one am not a secretary, I'm a paraoptometric.  I do more than answer phones, check people in and take their payments.  I'm getting really tired of everyone assuming that the assistants in an OD's office are pretty little girls who can't think for themselves, wear short skirts to increase eyeglass sales and do everything in their power to keep people from talking to or seeing the doc. :angry:

Yes, I will fax over an rx if asked.  I will not give it over the phone because I don't want someone accusing me of giving out the wrong Rx just because they wrote something down wrong.

Yes the Rx will be written as expired if the patient is overdue to come in for an exam.  Just like my GP won't give me an expired Rx if she wants to see me.  So if you decide to make glasses off that expired Rx because "rx's don't really expire", then don't look for sympathy if it turns out that you need to do a re-do because the patient can't see better with the new glasses.

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## tmorse

> I was wondering what the policy on other OD offices is? We currently get at least a couple requests each day for patients or optical stores requesting the Rx to be faxed. We have been faxing in the past, but its taking up too much of our time. Can we refuse and just ask the patient to pick it up?


Well, since OD Rx errors (admittedly rare) are paid jointly by the Retail Optical/lab rather than the Dr. office, I think the OD can suck this FAXING cost up to the cost of doing business.;)

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## mma

what a touchy subject! i had a feeling that some animosity would develop over this.  i wish OD and opticians were a bit more understanding of each other.  i really have a lot of respect for opticians.  the one's i have dealt are very knowledgeable.

i give out rx's to all pt's at the end of their exam, including those that buy glasses from me.  i don't charge for copies of rx's.  

it is an inconvenience to have to pull a chart, rewrite and fax an rx.  it's an inconvenience to me not because i'm an OD, but because i'm busy, just like opticians are very busy also.

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## mma

> Well, since OD Rx errors (admittedly rare) are paid jointly by the Retail Optical/lab rather than the Dr. office, I think the OD can suck this FAXING cost up to the cost of doing business.;)


 
this is true for most optical stores.  however, there are a number of stores in my area that will not redo lenses for a Dr error.  the redo cost is passed onto the patient.  and then guess who the patient expects to pay for it?

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## renee1111

> this is true for most optical stores. however, there are a number of stores in my area that will not redo lenses for a Dr error. the redo cost is passed onto the patient. and then guess who the patient expects to pay for it?


And guess what, you should have to pay for it too! If it's your error why would you even consider passing the cost onto the patient?

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## optical maven

In Missouri, there is no educational requirements to become an optician.  Hence Chip's obvious inferiority complex.  Any fees each person charges is their business.  If my customer/patient is unhappy they'll go to someone else.  Also Chip, Canada doesn't have socialized medicine.  We do have a single provider insurance system that happens to be publicly run.  But for those who only watch Fox news and who probably have never travelled more than 200 miles from their homes, I would expect such ignorant comments.

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## NorthStar

There are also opticals who charge for Rx information.  I have dealt with a couple of opticians who charge for release of CL info. and refuse to give it over the phone.

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## Dave Nelson

> You're treating receptionists with the same disdain you accuse OD's of directing at you. How about a little respect all around?
> 
> What you're not getting is that every office is different and in some, yes, perhaps they have someone who is strictly a front-desk person. I'm a receptionist (who doesn't mind faxing Rxs, btw) and I do FAR more than what you've described. There is ALWAYS work to do. 
> 
> And "cute little receptionist" is beyond insulting.


Ya had that one comin' Chip.

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## opti-refractonator

you are absolutely right to be insulted that the od's receptionist would be cute and little.  I have never seen an od's receptionist that was either one of those.

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## renee1111

> There are also opticals who charge for Rx information. I have dealt with a couple of opticians who charge for release of CL info. and refuse to give it over the phone.


I have never called any office, whether it's an OD or an Optician, to get contact lens info forwarded. After all it is my responsibility as an Optician to evaluate the fit, regardless of prior CL lens wear or not. So if the patient remembers what they had previously worn, great. If not, no big deal....gives me the opportunity to fit what I think is best anyway.

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## kidsparrow

> Well I guess I'm being chastised because the O.D.'s can't affort cute petite receptionists, Huh? I guess only the OMD's can afford cute petite receptionist. The O.D. models must be fat and ugly, I guess.
> 
> Chip


 
Wow, way to be a grown-up.  :Rolleyes:

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## Jubilee

What in tarnation does the esthetics of the receptionist.. IF THERE IS A DEDICATED RECEPTIONIST have to do with whether one should charge for this service?

It is time consuming and a bit inconvenient to disrupt whatever task you were doing, be it answering patient questions, filing insurance assisting the people who happen to be in your office currently or what have you to take care of faxing copies of Rx's to various offices, providing duplicate receipts for flex care, etc. The question is.. is it enough to warrant an additional charge to do so...

My answer is that is depends on what you want your office to portray to your patients. If you want to be the discount provider where everything is cheaper than Walmart, then perhaps if patients are already buying services ala carte, a fee would be in order to keep prices lower for the rest of the public. However if you are an office (like mine) where we try to promote the idea that we will take care of you, and patient's come first! Then perhaps a seperate fee would not be a wise move, though if it is seriously taking that much time away and causing significant costs for labor, ink, paper, etc.. then perhaps a minor adjustment to your exam fee is in order to cover those costs.

Chip, for what it is worth, I know you are one of the best in the business when it comes to technical skill. However not every office operates with the cliche's you put forth, nor is every other practicioner/provider a money grubbing fool. Everyone caters to the clientel / patient base they so desire, and if they are doing it well.. they make money. But please, do not assume that every office is either like yours or other "bad" offices you have encountered.

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## Steve Machol

FYI: I don't have the time or patience to baby-sit Chip any more so all of his posts and the posts quoting him have been removed. Nice job Chip.  :Rolleyes:

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## MarcE

Do any Canadian's resent the fact that so many of your southern neighbors "invaded" your forum and tried to impose our capitalistic and imperialistic will??

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## tmorse

> Do any Canadian's resent the fact that so many of your southern neighbors "invaded" your forum and tried to impose our capitalistic and imperialistic will??


NAH... we're just as capitalistic and imperialistic as ya'll.;)

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## AdmiralKnight

> Do any Canadian's resent the fact that so many of your southern neighbors "invaded" your forum and tried to impose our capitalistic and imperialistic will??


Only the bits where they start quoting laws. :D

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## icare

> It is time consuming and a bit inconvenient to disrupt whatever task you were doing, be it answering patient questions, filing insurance assisting the people who happen to be in your office currently or what have you to take care of faxing copies of Rx's to various offices, providing duplicate receipts for flex care, etc. The question is.. is it enough to warrant an additional charge to do so...
> 
> My answer is that is depends on what you want your office to portray to your patients. If you want to be the discount provider where everything is cheaper than Walmart, then perhaps if patients are already buying services ala carte, a fee would be in order to keep prices lower for the rest of the public. However if you are an office (like mine) where we try to promote the idea that we will take care of you, and patient's come first! Then perhaps a seperate fee would not be a wise move, though if it is seriously taking that much time away and causing significant costs for labor, ink, paper, etc.. then perhaps a minor adjustment to your exam fee is in order to cover those costs.


Brilliant rationale.

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## HarryChiling

_Sir/Ma'am, it seems the place you had your exam done isn't willing to fax over the Rx, if you'd like I can squeeze you in to see our doctor and our office policy is to never hold your records hostage.  Or we can wait and see what they'll say next?_

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## AdmiralKnight

I always fax them, personally. They payed for the rx. Even if we gave them one and they lost it, are you really going to risk loosing a long term patient to get a couple bucks from them?

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## HarryChiling

> I always fax them, personally. They payed for the rx. Even if we gave them one and they lost it, are you really going to risk loosing a long term patient to get a couple bucks from them?


, penny wise pound foolish.

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## kws6000

> _Sir/Ma'am, it seems the place you had your exam done isn't willing to fax over the Rx, if you'd like I can squeeze you in to see our doctor and our office policy is to never hold your records hostage.  Or we can wait and see what they'll say next?_


This will only work if the patient is due for an exam anyway,unless your dr is willing to work for free.

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## HarryChiling

> This will only work if the patient is due for an exam anyway,unless your dr is willing to work for free.


The patient is given an option a choice that the other office denies them, should they chose to wait fro the Rx, I will do my best to get it from the office and often times the patient sees how difficult it is an refuses to go back.  If the patient decides to see our offices doctors we never give the exam away and it's not a hard sell.  You think that a doctor that holds an Rx hostage is a good doctor?  The good ones don't need to play these games, so often I suggest if our office is going to make the glasses they might as well get an exam our professionals can trust and they can have confidence in.  Bottom line is that the longer the doctors office takes to fax em the Rx the more time I have to win the patient over for additional services and all gloves are off.

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## Jubilee

I have no doubts about your logic Harry. No doubts whatsoever. However thinking about my own work arrangement where there are days when I am running the office by myself, I may not be able to fax that RX over in the next 5 mins. If I am assisting patients in my office, Triaging by phone, or such things, I feel like my focus should be on those currently in my office demanding my attention. Or heck even on days where there are a few of us, If one of us is doing visual fields, a second helping patients in the dispensary and a third taking care of insurance and payments.. shouldn't our focus be on those who are in our office and there to spend money with us?

Please note, we will do everything in our power to try and get that RX faxed ASAP, however it has taken me an hour at times when I am presented with a steady stream of pickups, repairs, and emergency issues.

(and yes, we are busy enough that we need to hire an additional person, but that would require someone worth hiring)

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## AdmiralKnight

That's different though. If Harry calls you up, asks for the Rx and you say "Yeah, no problem, it might take a bit though, we're a bit busy.", he's most likely not going to throw out that option to the person. However, if he calls and you give him a hastle, or are trying to avoid faxing, that's a different story.

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## HarryChiling

I don't go at the patient like a ravenous wolf if that's what is coming across. Most offices will fax the Rx no problem but some like mentioned hide behind the HIPAA, then I fax them a copy of:

http://seikoeyewear.com/CE/CE9.html (bottom of the page ECP Communications)

After that any objection to with holding the Rx is just unprofessional and often I will ask them to fax over a consent form, and I show that to the patient along with the article from above.

Being busy is totally different than trying to blow someone off. Ultimately my goal is to provide that patient in front of me with eyewear and that is there goal as well, I pride myself on doing my job well and in almost every case I can get them their Rx or sell them on a more competent exam by professionals that not only understand the laws but understadn that they come first.

BTW if you called our office for an Rx it would arrive at your office before you hung up the phone. It's called Winfax, you set it up as a printer and then hit print in your EMR software and send it the Winfax printer and punch in the fax number in the box provided. Instead of taking the name down on paper I am searching in our computer, instead of writing down the fax number on paper I am punching it into the fax field in winfax. No additional effort, no need for additional patient charges. Very cheap to set up, less than what most doctors spend on additional equipment in their offices that do nothing more than provide unnecessary tests.

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## tmorse

> It is time consuming and a bit inconvenient to disrupt whatever task you were doing, be it answering patient questions, filing insurance assisting the people who happen to be in your office currently or what have you to take care of faxing copies of Rx's to various offices, providing duplicate receipts for flex care, etc. The question is.. is it enough to warrant an additional charge to do so...
> 
> Then perhaps a seperate fee would not be a wise move, though if it is seriously taking that much time away and causing significant costs for labor, ink, paper, etc.. then perhaps a minor adjustment to your exam fee is in order to cover those costs.


Yet what about the time, effort, expense, frustation, etc that retail optical dispensaries routinely absorb doing no-charge re-do's for DR errors? 
It may be that a few opticals charge the patient, but the vast majority do not, for fear of offending the Dr. and losing future Rx's. 
Optician store owners suck it up, and OD/OMD's should do likewise when their _staff_ has to FAX a replacement Rx. Poor Babys...:p

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## Jubilee

Well we keep 90% of our exams in the office dispensary. We get more remakes from the MDs down the way (typically post cataract who refuse to do co-management) then we do from our own office. Our lab routinely tells us we have the lowest remakes by far..

However, I do see your point. I realize you are there to do a job, the same as we are. Everyone has their own business philosophy based upon the experience they want to provide. They may or may not be in alignment.

My office does not charge for such things. I get maybe 3 calls a month for Rx's, so it really is no big deal. Then there are times like last week when one particular internet contact lens company felt the need to do an rx verification for a patient 5 times over 3 days. Each one coming at a time when I was in the middle of working with patients. I had responded on at least 3 of those occasions with a fax. However they still felt the need to keep calling us.

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## icare

> _Sir/Ma'am, it seems the place you had your exam done isn't willing to fax over the Rx, if you'd like I can squeeze you in to see our doctor and our office policy is to never hold your records hostage.  Or we can wait and see what they'll say next?_


Please forgive me, Harry.  With all due respect I find this type of baiting unprofessional.  I don't know if your doc agrees.

When ODs start hawking exams, or let others do it for them, bad things happen.  Next thing you know, the exam will be free with a pair of glasses.

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## kidsparrow

I honestly think that the patient comes first, and that it does me no harm to fax his or her Rx in a timely manner to whatever optical they choose. We use iFile in our office, so it takes me about ten seconds to print, stamp, and fax it. If it's such a big deal for other offices, maybe they should find a system that allows them to do it as easily, like Winfax, as Harry suggested. As busy as we are, I find the time to comply with any request.

I've only had one instance when an optical employee was rude to me, and even then I sent the Rx over. It's not about me, or her, it's about the patient. 

But having said that, rudeness serves no one!

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## chip anderson

Bravo Kid!

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## HarryChiling

> Please forgive me, Harry. With all due respect I find this type of baiting unprofessional. I don't know if your doc agrees.
> 
> When ODs start hawking exams, or let others do it for them, bad things happen. Next thing you know, the exam will be free with a pair of glasses.


It's not baiting, look some patients come to our office because they have been coming to me for years, I don't care where they get there exams done, but if there doctor is behaveing unprofessionally and decides that careing for the patient takes a back seat to his allmighty job, then it's my goal to help MY PATIENT get everything they need.

No ones letting me hawk and exam, I am offering our offices professional services to a patient when there current offices falls short of expectations.  Again icare as long as the office isn't holding the script out of mallace then there is no problem and no issue, but when the double talk starts and the laws are misconstrued to hold onto a script that isn't that expensive anyway the doctor cheapens his service and loses the patient to our office.

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## kidsparrow

> Next thing you know, the exam will be free with a pair of glasses.


The last optical retail store I worked for, this WAS the case. The promotion was "Free Eye Exam with Purchase of Glasses." We would just charge upfront for the eye exam and then subtract that cost from the glasses purchase.

edit: Sorry to de-rail; I know this wasn't the issue at hand!

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## chip anderson

It was also very, very Illegal Kid.

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## kidsparrow

Is it in Canada? Or is it a fuzzy issue?

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## chip anderson

Kid:
Don't know about Cannada, is in U.S.

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## For-Life

It takes that long to fax two rx's a week?

Seriously!

What are you going to charge them?  $20 each.  What is that, an hours work.


Is it that you feel that it is taking too much time or are you annoyed that they are going elsewhere?

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## optical maven

For me personally, trying to get someone to stay and buy glasses when they are not interestd, only leads to animosity from the patient.  Those who do this may have short term gain, but long term they won't see the person again.  With so much lousy work done at optical stores (the Adaptar specials, poly as a high index, poor AR coatings) people eventually come back and stay.

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## kws6000

> Yet what about the time, effort, expense, frustation, etc that retail optical dispensaries routinely absorb doing no-charge re-do's for DR errors? 
> It may be that a few opticals charge the patient, but the vast majority do not, for fear of offending the Dr. and losing future Rx's. 
> Optician store owners suck it up, and OD/OMD's should do likewise when their _staff_ has to FAX a replacement Rx. Poor Babys...:p



Well ,in my office,I get stuck with a lot more rechecks on my time due to optician screw -ups than opticals doing redoes on my account.

Wrt faxing rxs,we give every patient their rx.we will fax the rx when we have the time (within 24 hrs),but Im not going to have the staff neglect in- office patients because some optical wants the info immediately.

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## chip anderson

KWS:  

YOu won't believe this but you doin right.

As I said before, the reason they have faxes and E. Mails is so that you can tend to things when you have time.  If it's urgent, you give it over the phone (and have them read it back, if it's an Rx.).

For this reason, I always (when I have the fax number) request Rx's by fax, so no one has to "drop everything right now."


Chip

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## renee1111

> With all due respect I find this type of baiting unprofessional.


Yet, you think that withholding or charging for a duplicate Rx is a "professional" thing to do? Alrighty then...

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## kidsparrow

> Yet, you think that withholding or charging for a duplicate Rx is a "professional" thing to do? Alrighty then...


Sorry, but where did he say that? I may have missed it...  :Confused:

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## optical maven

There is nothing unprofessional with charging a fee for time spent.  That is not the same as withholding information.  That's against the law and just dumb.

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## For-Life

If you are charging, you are withholding information.  

Again, how much are you guys charging?  At $20 an hour, it should work out to about $1, because it takes no more than 5 minutes.

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## kidsparrow

I can only speak for my office, but we don't charge. But as I said, we're set up so that it's not a hassle for us. 

Why can't people just NOT lose their Rx? :p

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## Oedema

> If you are charging, you are withholding information.  
> 
> Again, how much are you guys charging?  At $20 an hour, it should work out to about $1, because it takes no more than 5 minutes.


So I take it that you freely take PD measurements for internet shoppers?  In Ontario OD's may charge up to $21.60 as an administrative fee to release an Rx duplicate.

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## optical maven

First I give everyone an Rx, whether they ge glasses from me or not.  If an Rx is less than 2 years old I don't charge a fee.  If it is more than 2 years old, the file has been moved into a storage area and requires time to find and rewrite.  I charge for my time, without any apologies.  That is not withholding anything.

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## HarryChiling

> So I take it that you freely take PD measurements for internet shoppers? In Ontario OD's may charge up to $21.60 as an administrative fee to release an Rx duplicate.


 
That example makes no sense, comparing a service for FREE to a copy of a service already paid for is not gonna work.  Anyway please please please keep charging ludicrous fees for a copy of the Rx.

$21.60, as an administrative fee.  Wow!  Does anyone ever really pay that though?

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## For-Life

> So I take it that you freely take PD measurements for internet shoppers? In Ontario OD's may charge up to $21.60 as an administrative fee to release an Rx duplicate.


PD is not the property of the patient here.  The RX is.  Patient already paid for the RX (yep, remember that time in your exam room).  Patient did not pay for the PD.

$21.60 admin fee for what?  We know that the person duplicating the RX makes anywhere from $7.75 to $20 an hour working for you.  How hard it is to copy it down from a copy, get the doctor to sign it, and fax it off?

Justify the cost.  Prove that this is not bitterness that they are going else where.

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## For-Life

> First I give everyone an Rx, whether they ge glasses from me or not. If an Rx is less than 2 years old I don't charge a fee. If it is more than 2 years old, the file has been moved into a storage area and requires time to find and rewrite. I charge for my time, without any apologies. That is not withholding anything.


Then improve your filing, because if it takes that much time to produce the rx for external reasons, it takes the same time to produce it for internal reasons.  Don't most ODs use the patients old file when they see someone (if they have it)?  You are telling me that your staff spend that much time looking for it when you see someone for a check up?

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## For-Life

> That example makes no sense, comparing a service for FREE to a copy of a service already paid for is not gonna work. Anyway please please please keep charging ludicrous fees for a copy of the Rx.
> 
> $21.60, as an administrative fee. Wow! Does anyone ever really pay that though?


they pay and leave.  Now you did not just lose them as a glasses customer, but you lose future exams too.

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## kidsparrow

But they're getting a copy of the Rx. Even Staples charges for making a copy.

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## HarryChiling

> they pay and leave. Now you did not just lose them as a glasses customer, but you lose future exams too.


In the USA since often times the patient will be using insurance the doctors may want to recheck there contracts to see if this is allowable and if so what waivers or acknowledgments they have to get in order to charge the patient these administrative fees.

When I see my GP I know that once a year we pay a $20.00 fee to cover things but you better believe if I didn't discuss this initially and didn't sign and acknowledgement that I would have a bad taste in my mouth.  To me it's assumed that the overhead of the practice is included in the fees I paid to the doctor unless specifically told otherwise I assume I can use the bathroom and not pay $0.50 for the amount of toilet paper I used and $0.20 for the soap and have a prorated bill sent to me for the water I consumed.

At some point in the future this will all be moot as people will have you immediately fax or email their initial Rx to: 

Google Health:
https://www.google.com/accounts/Serv...2Fp%2F&rm=hide

It may be a good idea to inform patients about this service.  I already allow our patients to use our phone and use:

Google 411:
1-800-GOOG-411

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## For-Life

> But they're getting a copy of the Rx. Even Staples charges for making a copy.


10 cents, not $21.50

AND, you did not already pay them $80 to make the original.


Guys, this goes back to the thread I started a couple of months ago.  We have lost our whole perspective on service.  There are so many patients that get their RX from the same doctor, but shop elsewhere for glasses.  Do you really want to ruin that relationship?

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## kws6000

> 10 cents, not $21.50
> 
> AND, you did not already pay them $80 to make the original.
> 
> 
> Guys, this goes back to the thread I started a couple of months ago.  We have lost our whole perspective on service.  There are so many patients that get their RX from the same doctor, but shop elsewhere for glasses.  Do you really want to ruin that relationship?


Charging this fee would likely p**s off the patient,and would likely be bad for the practice unless you dont care about losing the patient .

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## Excalibur

> Charging this fee would likely p**s off the patient,and would likely be bad for the practice unless you dont care about losing the patient .


The patient is entitled to a copy of their rx at the time of their visit. If they lose it, tough titty. We will reissue another copy of an rx gratis in many cases, but we are well within our rights to charge for a duplicate -- our time is worth money, so is yours.

If your time and expertise is worthless, continue doing what many in the industry continue doing routinely ie. giving away free goods and services such as frame adjustments and repairs for items not bought in your office/store.

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## For-Life

> The patient is entitled to a copy of their rx at the time of their visit. If they lose it, tough titty. We will reissue another copy of an rx gratis in many cases, but we are well within our rights to charge for a duplicate -- our time is worth money, so is yours.
> 
> If your time and expertise is worthless, continue doing what many in the industry continue doing routinely ie. giving away free goods and services such as frame adjustments and repairs for items not bought in your office/store.


again, if you make the time  commitment charge, how long does it take to do this?  So what do you charge, a $1

It will take you longer to write the receipt.  


Plus, this is not giving away goods and services.  This is giving the patient a product that is rightfully theirs.  Again, remember that you already made your $80 off of them, and it cost you little to provide that services (no COGS).

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## chip anderson

Maybe someone can bribe the insurance companies into having a code for sending records.

Seriously, when I make a patient a prosthetice eye, I have never had a physician or O.D. give me any debate, charge or reluctance to writting a letter stating the need for submission to the insurance company.  Of course I never told one of them "Stop everything this instant and you do this now!"

Chip

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## HarryChiling

I remember some years back that GP's in Maryland tried to pass on their increased insurance premiums to the patients in the form of a fee, from the laws perspective that would be considered overhead and included in the doctors exam fees, the doctors argued that the insurance companies cut their costs so it is necessary to have these fees.  The response was that they have a choice whether they wanted to sign a contract with the insurance company or not and that these things should be negotiated with the insurance companies not the patients.

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## tmorse

> If your time and expertise is worthless, continue doing what many in the industry continue doing routinely ie. giving away free goods and services...


And not to forget... 're-do lens costs' incurred as a result of OD/OMD refraction errors.;)

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## chip anderson

Not "Errors" re-evaluation of the patient's condition and need.

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## Excalibur

> And not to forget... 're-do lens costs' incurred as a result of OD/OMD refraction errors.;)


Doctor: "Mrs Jones, please look at the letter on the chart and tell me is it clearer with lens 1 or lens 2"

Patient: "Lens 1"

Doctor: "and which lens is clearer, lens 1 or lens 2"  etc etc etc. Patient is poor at judging, and makes an error in judgment when determining lens powers during refraction.

Doctor notes down refractive findings and information is written correctly on rx. Patient takes rx to optical, and has problems with her new rx. Rx is made to spec, but pt cannot see because she gave the doctor the wrong 'answers'. This is by FAR the most common scenario in my practice.... so how is the doctor to blame if the pt has ****ty judgment skills and leads the practitioner astray? 
 :Mad:

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## For-Life

Keep in mind Excalibur, and I have never seen you so I do not know how you do it, but some doctors just try to rush the patient through the process.  They flip the lenses so quickly that they confuse them.  So it goes both ways.

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## Oedema

I work with a lot of "indigent" patients that by far give consistent missleading responses during refraction.  I don't understand why, or how, but it happens to me all the time - and to the extreme such that some would take on an extra 2 diopters of additional unnecessary cylinder if I didn't know any better.:hammer:

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## Excalibur

> Keep in mind Excalibur, and I have never seen you so I do not know how you do it, but some doctors just try to rush the patient through the process.  They flip the lenses so quickly that they confuse them.  So it goes both ways.


Fair enough. When I do see a patient to reconfirm an rx, 90% of the time it was due to improper manufacturing of the appliance and not an rx that needed adjusting.

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## tmorse

> Doctor: "Mrs Jones, please look at the letter on the chart and tell me is it clearer with lens 1 or lens 2"
> 
> Patient: "Lens 1"
> 
> Doctor: "and which lens is clearer, lens 1 or lens 2" etc etc etc. Patient is poor at judging, and makes an error in judgment when determining lens powers during refraction.
> 
> Doctor notes down refractive findings and information is written correctly on rx. Patient takes rx to optical, and has problems with her new rx. Rx is made to spec, but pt cannot see because she gave the doctor the wrong 'answers'. This is by FAR the most common scenario in my practice.... so how is the doctor to blame if the pt has ****ty judgment skills and leads the practitioner astray?


No Red-Green (duochrome) test? Better, or just smaller and darker? You've got all these years of training and this is Far the most common problem? Well one way to solve it... get an EYELOGIC instrument:D

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## Excalibur

> No Red-Green (duochrome) test? Better, or just smaller and darker? You've got all these years of training and this is Far the most common problem? Well one way to solve it... get an EYELOGIC instrument:D


My previous post was a very simplistic explanation of the questioning approach during a refraction. As you know, a significant proportion of the refraction is based on subjective information and as such depends on a patient's accuracy of response. An Eyelogic system or even a R/G balance still requires a subjective response and in the case of a patient with poor judgement can lead to flawed data.

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## MarcE

> Fair enough. When I do see a patient to reconfirm an rx, 90% of the time it was due to improper manufacturing of the appliance and not an rx that needed adjusting.


That is amazing. 90% of the time it's manufacturing error. WOW!

Let's see: 
1. there is prescriber error
2. there is patient error (as you explained earlier)
3. there is fitting error (measurements, frame, lens choice, BC, material, etc.)
4. there is the error of unmet expectations (verbalized or not)
5. there is lab/manufacturing error (which is checked twice before the patients sees it and twice again before the patient is sent back to the prescriber for a recheck)
6. and maybe some rare ones like transcription errors

Hard to believe that the eyewear was manufactured incorrectly 90% of the time after 4 checks. My own stats indicate that this is not the case. I'm not saying that the prescriber is wrong of the time 90%. I blame most Rx changes on confusing patient responses.

Here is an interesting thought that Chip brought up about human nature.
http://www.optiboard.com/forums/showthread.php?t=29926

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## HarryChiling

You know it was actually an optometrists that said this, "Opticiasn on Optiboard are not your average optician"  The problem was I was thinking of opticiasn as the ones I read up on here and I like to think this is how all opticians think, but sadly we are the minority.

Couldn't it be just as possible that the optometrists here are not your average optometrists?

Food for thought, maybe optometrists here are disgusted with the average optician, and maybe I am disgusted with the average optometrist.  At least here we're better than good at what we do.

BTW I don't find that 90% of remakes are due to fabrication error, I usually find that 50% of what is considered fabrication error is well within ANSI, but someone either doesn't know better or uses that as an excuse to cover a segment, PD, lens, or prescription change.  Be gratefull the manufacturer often doesn't nit pick and charge for the errors many pass off as the labs error or manufacturer error.

I have right now a job in my stack that came back from their doctor as the seg heights were too high, then the doctor wrote down a seg height (which was the same as what we made it) and then changed the Rx. :hammer:  It's a turd move that happens all the time, but I do understand it the patient has this prescription in hand and often will read it.

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## chip anderson

Don't all that "trainin" teach one how evaluate patient interpretation error?

Can neurosurgeons blame thier brain surgery failures (open skull, patient contious relating experiences as probes inserted as "the patient told me the wrong things?"

If so, how accurate art those refractions (at $1000.00 a pop) done on patients with total anesthesia?  How accurate are those that interpret brain waves as lenses are placed in front of the eye?

Chip

:finger:

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## tmorse

> Not "Errors" re-evaluation of the patient's condition and need.


err... right.

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## mlm

> You know it was actually an optometrists that said this, "Opticiasn on Optiboard are not your average optician"  The problem was I was thinking of opticiasn as the ones I read up on here and I like to think this is how all opticians think, but sadly we are the minority.
> 
> Couldn't it be just as possible that the optometrists here are not your average optometrists?
> 
> Food for thought, maybe optometrists here are disgusted with the average optician, and maybe I am disgusted with the average optometrist.  At least here we're better than good at what we do.


I think this is a great point.  It's a good thing to keep in mind when any thread start degenerating into personal attacks against each other.

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## rgregg48

I have no problem faxing a CL or Spec rx to another practice, by request.
I will not fax expired RX.

My understanding is , if an MD or OD has one exam charge and does not
have an add on charge for the contact lens fitting,, than he /or she is not 
legally bound to give the patient a written CL rx.
If the Doctor charges for an exam and extra charge for the CL fitting fee,
Than the patient is legally entitled to a written copy to be kept by them
and filled anywhere they chose...... some doctors request one followup
after a week, to make sure everything is well, before finalizing the rx.

On Glasses, if a patient says it has been 4 years since there last exam
but say "i can see just fine with these"  i will usually insist they get 
a new exam, either by the doctor in our practice, or any practicioner they 
choose... If the 2 year rx is under 4 years old , i will duplicate the glasses
but request the patient sign a waiver stateing " I have been strongly
advised that my glasses rx has expired and have been told it is recommended
to get another exam,,,, I have declined to comply since it is my
belief my prescription eyeglasses are providing the same acuity as
when first  dispensed.

Im not saying this would totally avoid any and all liablity, but its better
than nothing.

Rick

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## k12311997

> It was also very, very Illegal Kid.


 
When I worked for US Vision we had a similar promotion and nothing illegall about it.  It was simply a rebate for the amount of an exam (up to a maximum) applied toward the purchase of glasses.  It did not require and exam from the doctor next door.  No different than a dollar off promotion except that it promoted getting an exam.

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## chip anderson

K numbers:

As many times as we have published Eyeglass I here and you can't see anything illegal about this.  Nothing about _the practioner may not discount or reduce his fees on conditon of purchase of eyeglasses?_

_Chip_

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## RT

Maybe we ought to debate US law somewhere other than the Canadian Discussion Forum.

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## k12311997

> Maybe we ought to debate US law somewhere other than the Canadian Discussion Forum.


 
sorry, but I have to respond to this





> K numbers:
> 
> As many times as we have published Eyeglass I here and you can't see anything illegal about this. Nothing about _the practioner may not discount or reduce his fees on conditon of purchase of eyeglasses?_
> 
> _Chip_


_The independant_ _practioner is not discounting or reducing his fees on conditon of purchase of eyeglasses.   The optical shop is giving a discount up to the amount of the exam fee on a pair of glasses_ EVEN IF THE EXAM OCCURED ELSEWHERE.  The practioner is not benefiting from the sale of the glasses or reducing his fees and no one is breaking eyeglass I or any laws it is just a sale gimmick.

and again sorry for debating US law on the Canadian Forum.

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## kidsparrow

Edited to be nice. :D

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## icare

> Food for thought, maybe optometrists here are disgusted with the average optician, and maybe I am disgusted with the average optometrist.  At least here we're better than good at what we do.


Not me.

I have a huge respect for dedicated opticians - particularly those that are licensed.  I've learned a great deal here thanks to all of you and I appreciate the excellent advice I've frequently received.  I hope it works the other way around. We have much to offer each other.

Can't we all just get along......:D

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## va_optikal

> I always give the patient a copy of their Rx at the time of the exam and fax Rx's as requested. If the Rx is more than 2 years old I charge a fee to rewrite the Rx and ask the person to pick up the paper. I've had people pick up Rx's that are over 5 years old. Are opticians filling these?



You bet they are, I've seen it.  ( Not me) They make the patient sign their name saying that the optician is not responsible for any issues with the rx.

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## AdmiralKnight

> You bet they are, I've seen it.  ( Not me) They make the patient sign their name saying that the optician is not responsible for any issues with the rx.


I won't if there's an expiry date on the rx, if not, sure. I don't see anything wrong with it, ESPECIALLY if the doctor's are still giving them out, and charging, 5 years after the exam. Why else would the patient want a copy of their rx if not to get glasses made?

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## Excalibur

I used to ask my staff to call a patient's CL fitter (with patient's consent) to obtain the last CL parameters used to provide continuity of care and aid in refitting that needed to be done. The overwhelming majority of stores said 'we will not give you that information'. If I was to withhold a patient's rx/information after consent was given by the patient, I would be taken to task by my regulatory body.

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## kidsparrow

But wouldn't that be your responsibility as the patient's new provider of the lenses? 

As far as type of lens, etc., I'm always amazed that people have no idea what lens they're sticking in their eye every day.

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## tmorse

> I used to ask my staff to call a patient's CL fitter (with patient's consent) to obtain the last CL parameters used to provide continuity of care and aid in refitting that needed to be done. The overwhelming majority of stores said 'we will not give you that information'. If I was to withhold a patient's rx/information after consent was given by the patient, I would be taken to task by my regulatory body.


The CL fitter's knowledge, expertise, experience, 'work' in selecting final lens parameters is, in my view, *proprietory.* 

So if, as you say, a refitting 'needed to be done' then simply "DO YOU OWN WORK". This was the response I received from a famous Vancouver pediatric Ophthalmologist many years ago when I asked for a young girl's  soft lens parameters. 

And, 'since a refitting needed to be done', the young girl was put into RGP's, which she and her parent adored. :Cool:

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## Oedema

> The CL fitter's knowledge, expertise, experience, 'work' in selecting final lens parameters is, in my view, *proprietory.* 
> 
> So if, as you say, a refitting 'needed to be done' then simply "DO YOU OWN WORK". This was the response I received from a famous Vancouver pediatric Ophthalmologist many years ago when I asked for a young girl's  soft lens parameters. 
> 
> And, 'since a refitting needed to be done', the young girl was put into RGP's, which she and her parent adored.


thats an interesting position considering all the *****ing and moaning about OD's you've accused of doing the same.  :Confused:

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## tmorse

> thats an interesting position considering all the *****ing and moaning about OD's you've accused of doing the same.


Explain please.

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