I can't tell if this doctor is just a jerk, or if they committed a legitimate violation. YANMD/YANML. This is Virginia, USA.
I've had high myopia and have been wearing rigid gas permeable (RGP) contact lens for twenty years. Long story short, I couldn't afford to see my current optometrist because he doesn't take insurance. I couldn't afford to pay out of pocket so I made an appointment at a place that was in-network for my health insurance
Now. I consider myself an assertive person, but the events at this appointment caught me totally off guard.
The first part of my exam was done by the optometric assistant (henceforth OA).
After the OA did my medical history/chart exam/intraocular pressure test, I notice her walking toward me with something in her hand while saying "Okay and now we're going to dilate your eyes!"
No advance notice given. I was not prepared for having my eyes dilated the rest of the day. I quickly threw my hand up and said "Wait, wait, wait. Is this necessary?"
OA's response: "Uh... well. Yes. Dilations are necessary."
Me: "No one informed me that I would be having a dilation done today. I'm not mentally or emotionally prepared to leave here and spend the rest of my day with my eyes dilated, and I also don't have anyone to drive me home if it impacts my vision to the point of not being able to see when I'm driving."
Her: "Well, your vision is really bad. You should always have a dilation when your vision is this bad."
Me: "Okay. But I've been to many, many vision exams throughout my life and I was always informed before the exam if I wanted a dilation. In fact, at my last annual exam, I asked my optometrist if the dilation was necessary and he informed me that based on my age, vision, and other medical history, a dilation would be overkill and that while it's a useful diagnostic he didn't see it as necessary. He gave me the option to decline and I signed a paper to decline the dilation. Other than my myopia, I don't have any other known vision symptoms (like floaters) or diseases. Again, I did not plan or prepare to have my eyes dilated [aside: this was on a hella bright, cloudless day, to boot] and I would like to decline."
OA: "Someone told you that you don't need to get your eyes dilated? That's very bad practice, that person is wrong. You should have your eyes dilated every single year."
Me: "But it is optional, not required, correct?"
OA: [after a long pause, where she looks confused about what to say] "...No. It is not optional. You have to get this done."
Me: [silent]
OA: [speaking very quickly] "...it's not an option but yes you can decline it if you want to but that's at your own risk, I guess you can decline it and you can just sign the paper."
Me: [feeling overwhelmed, slightly confused, and also annoyed] "Look, fine, I'll do the dilation. If you really insist it's necessary then fine."
OA: [victorious expression on face]
Me: "This doesn't cost extra money, does it?"
OA: "Nope! Insurance ALWAYS pays for dilations- " [starts putting dilation drops in]
I surrendered because I didn't want to argue anymore. The OA was aggressive and I just wanted to move on. (Note that I have had my eyes dilated many times in my life, so this was not the first time at the dilation rodeo.)
Immediately after she puts in the dilation drops she has me remove my contacts, and the optometrist finally comes in. At this point the dilation drops had been in my eyes for all of two or three minutes. My vision was still adjusting.
The optometrist sweeps in and says, "Hi I'm Dr. Schmoptometrist, so I understand your other optometrists have been telling you that you don't need your eyes dilated? Well that's wrong and don't ever let anyone tell you that because you need your eyes dilated every single year! Don't EVER let ANYONE tell you you don't need your eyes dilated!"
I was overwhelmed by how hyper and aggressive she was, so I just said, calmly, "Thank you for the information."
She then swings the phoropter in front of me to start the eye exam. This is where I was shocked. She starts with my right eye, asks me to read the letters, and asks me which lens is clearer - 1, or 2? 2, or 3? I tell her right away, "Um... I can't see. My vision is really, really blurry. I keep blinking and I can't really see any of the letters."
She says, "Just keep going. 1 or 2?"
Me, even more uncomfortable because I feel like there's no way possible that this lens exam could be accurate since I can't see with my eyes dilated and blurry, "Uh... um... [struggling, blinking a lot to try to get my eyes damp enough for my vision to hopefully get less blurry] uh... this is still all really blurry... I guess 2. 2 looks better than 1, I think." At no point did the doctor ever acknowledge that I said my vision was blurry. In fact, she kept silent other than telling me to "just keep going" after my initial protest, and asking me "1 or 2?"
I keep thinking, "Er, none of these are really good lenses right now because I can't see from the blurriness - hopefully we'll keep going until it improves..." and then she abandons my right eye and moves on to the left. I've never been to an optometrist who sped through the contact lens exam so quickly. It always takes 5-10 minutes per eye.
After she burns through my contact lens exam lickety-split, she pulls out the mega flashlight and checks out my dilated eyes for retina issues, and there aren't any. (Surprise.) Then she goes to her computer and starts typing, doesn't say anything. I feel confused and uncharacteristically meek - too shocked and intimidated to say anything. Eventually she tells me the front desk will order my contacts and they'll call me when they come in.
At the front desk they tell me they'll call me when the contacts arrive and when I come in they'll make sure the contacts are the right prescription. I hear them say this but I don't really think much about the comment at this point.
So, I get home, and an hour later it dawns on me that:
- Whenever I've had my eyes dilated, it was always done at the very end of the exam. Dilation drops were never put in until after the contact lens part of exam, which makes sense because it makes your vision unusually blurry.
- No optometrist has ever spent so little time on the contact lens part of the exam. That's always been the longest part. It has usually had me wondering "Is this over yet?" but I still appreciate the precision and thoughtfulness put into the exam.
- This is the first time I've had an optometrist not give me my prescription at the end of the exam.
Now, I realize that they were ordering the contact lenses for me on site, through their contact lens provider. But after researching FTC regulations and the Contact Lens Rule, my understanding - and correct me if I'm wrong - is that is they are prepared to sell me contacts (to me, calling in a prescription and ordering contacts is being 'prepared to sell'), then the contact lens fitting is 'complete' and they have to furnish the prescription to me.
I immediately felt conflicted because I think they obtained a shitty, inaccurate prescription from the exam, but I wanted them to give me the prescription because I was so unhappy with the experience and wanted to just order the contacts from another contact lens provider. Why? Because I don't think my insurance company covers more than one eye exam a year, I can't afford to pay for a full blown RGP contact lens exam out of pocket, and any contact lenses would be better than the ones I'm currently struggling with. I want the prescription so I can just get some contacts to hold me over for the next few weeks until I can go back for another exam for a more accurate prescription.
So, here I am, not knowing if I should be mad that they did a shit job examining my eyes for contact lenses, or mad and demanding they release the prescription to me so I can take my business elsewhere. These two things are basically in direct opposition of one another.
I call their office the next day and say, "Hi, can you please call my prescription in to ________. The receptionist (after putting me on hold twice - I think she was new) proceeds to tell me that I have to come back in to be seen again. I ask why. She says so they can "Teach me how to put them in."
I about lost it. I told them I'd been wearing RGPs for twenty years, as the doctor should know from the vision history I provided, and I did not need to be taught how to put them in. I told them they needed to come up with a better reason than that. They put me on hold. Then they came back on the line and said that the doctor simply had not signed off yet on the prescription so they could not fax it anywhere else. I told them that they were supposed to give me a copy of the prescription after the exam, and that I didn't understand why they would order contact lenses for me if the doctor was not satisfied with the results of the exam they did. I told them I wasn't coming back and they needed to fax the prescription before I filed a complaint with either the FTC or the state board of optometry or both. They said they'd speak with the doctor and call me back.
The next morning I get a call from the clinical director. She said that the doctor could not sign off on my prescription because they needed to fit the contacts on me first. I said that there's always a possibility the contacts may not be the right fit, but that every other optometrist has always given me the prescription immediately after the exam and told me to come back if the contacts don't seem right after about a week or there are serious issues. I told her that what she was telling me was absurd and I couldn't accept it. The clinical director then proceeds to tells me, "It is your fault [direct quote] because you did not know what brand of RGP contacts you are currently wearing. The doctor has to make sure that your eyes will accept the brand of contacts she ordered." First time hearing this! Also, my last optometrist never asked me what brand of contacts I already wore; likewise I never had a problem with whatever brand he requested on the prescription.
I told the clinical director that this sounds like it may be a violation of FTC/contact lens rule, and that if they did not fax my prescription to me or to my choice of contact lens provider by the end of the day, I would file a complaint to have the FTC review their procedure. I also said that I couldn't believe they dilated my eyes before the contact lens exam and that it made my eyes blurry and that it couldn't possibly be common practice. That's when the clinical director asked me how long I was an optometrist. I asked her how long she had been an optometrist, and she said, "I'm the clinical director." I said, "So what?" and she said, "So... [long pause] I'll be happy to set up a new eye exam for you with a different optometrist." I told her no, and I was not coming back. She said okay and to have a nice day and ended the call. Four hours later, they uploaded an electronic copy of my medical record to their online portal. Note that they'd already uploaded one the day before, but it was much less detailed. This new, more detailed medical record appeared to list the results of my contact lens exam, but I don't see how this could be considered a 'prescription' by anyone - it's just the medical record documenting my medical history, exam, test results and the doctor's plan of action.
I'm really upset about how this was handled. I later find out that this optometrist (and clinical practice) have several bad reviews online, citing how the particular optometrist is always rushing through the exams and text messaging on her phone (to be fair, I didn't catch her texting) and that the clinical practice bills absurdly high rates to insurance; they are also known for long delays in contact lens/glasses orders coming in. Given that my past eye doctors have only had me come in one time for an exam, given me my prescription on the spot, and told me to come back only if I have a problem with the contacts, I feel like they purposefully gave me a shitty initial exam so that I'd not only have to come back to make sure the contacts were 'correct', but so that when the first prescription didn't work out (because it was done poorly) they'd have a reason to order more and have me come in a second time. More appointments, more billing, more money. All for what I view as completely unnecessary things. I also feel like they could be strategically phrasing what they're doing so that it falls into some kind of legal loophole.
So, my questions:
1) I can't tell if this doctor is just a jerk, or if they committed a legitimate violation of the FTC rules regulating contact lens exams and prescriptions. Can anyone help me to clarify this?
2) Depending on #1, what should my next step be? (Given my financial and insurance circumstances, as well as the fact that I'm in moderately urgent need of new lenses?) I have no idea if I should keep pushing them to give me my prescription, file a complaint, give up and go somewhere else and hope my insurance will pay for more than one eye exam in a year, or what.
I've had high myopia and have been wearing rigid gas permeable (RGP) contact lens for twenty years. Long story short, I couldn't afford to see my current optometrist because he doesn't take insurance. I couldn't afford to pay out of pocket so I made an appointment at a place that was in-network for my health insurance
Now. I consider myself an assertive person, but the events at this appointment caught me totally off guard.
The first part of my exam was done by the optometric assistant (henceforth OA).
After the OA did my medical history/chart exam/intraocular pressure test, I notice her walking toward me with something in her hand while saying "Okay and now we're going to dilate your eyes!"
No advance notice given. I was not prepared for having my eyes dilated the rest of the day. I quickly threw my hand up and said "Wait, wait, wait. Is this necessary?"
OA's response: "Uh... well. Yes. Dilations are necessary."
Me: "No one informed me that I would be having a dilation done today. I'm not mentally or emotionally prepared to leave here and spend the rest of my day with my eyes dilated, and I also don't have anyone to drive me home if it impacts my vision to the point of not being able to see when I'm driving."
Her: "Well, your vision is really bad. You should always have a dilation when your vision is this bad."
Me: "Okay. But I've been to many, many vision exams throughout my life and I was always informed before the exam if I wanted a dilation. In fact, at my last annual exam, I asked my optometrist if the dilation was necessary and he informed me that based on my age, vision, and other medical history, a dilation would be overkill and that while it's a useful diagnostic he didn't see it as necessary. He gave me the option to decline and I signed a paper to decline the dilation. Other than my myopia, I don't have any other known vision symptoms (like floaters) or diseases. Again, I did not plan or prepare to have my eyes dilated [aside: this was on a hella bright, cloudless day, to boot] and I would like to decline."
OA: "Someone told you that you don't need to get your eyes dilated? That's very bad practice, that person is wrong. You should have your eyes dilated every single year."
Me: "But it is optional, not required, correct?"
OA: [after a long pause, where she looks confused about what to say] "...No. It is not optional. You have to get this done."
Me: [silent]
OA: [speaking very quickly] "...it's not an option but yes you can decline it if you want to but that's at your own risk, I guess you can decline it and you can just sign the paper."
Me: [feeling overwhelmed, slightly confused, and also annoyed] "Look, fine, I'll do the dilation. If you really insist it's necessary then fine."
OA: [victorious expression on face]
Me: "This doesn't cost extra money, does it?"
OA: "Nope! Insurance ALWAYS pays for dilations- " [starts putting dilation drops in]
I surrendered because I didn't want to argue anymore. The OA was aggressive and I just wanted to move on. (Note that I have had my eyes dilated many times in my life, so this was not the first time at the dilation rodeo.)
Immediately after she puts in the dilation drops she has me remove my contacts, and the optometrist finally comes in. At this point the dilation drops had been in my eyes for all of two or three minutes. My vision was still adjusting.
The optometrist sweeps in and says, "Hi I'm Dr. Schmoptometrist, so I understand your other optometrists have been telling you that you don't need your eyes dilated? Well that's wrong and don't ever let anyone tell you that because you need your eyes dilated every single year! Don't EVER let ANYONE tell you you don't need your eyes dilated!"
I was overwhelmed by how hyper and aggressive she was, so I just said, calmly, "Thank you for the information."
She then swings the phoropter in front of me to start the eye exam. This is where I was shocked. She starts with my right eye, asks me to read the letters, and asks me which lens is clearer - 1, or 2? 2, or 3? I tell her right away, "Um... I can't see. My vision is really, really blurry. I keep blinking and I can't really see any of the letters."
She says, "Just keep going. 1 or 2?"
Me, even more uncomfortable because I feel like there's no way possible that this lens exam could be accurate since I can't see with my eyes dilated and blurry, "Uh... um... [struggling, blinking a lot to try to get my eyes damp enough for my vision to hopefully get less blurry] uh... this is still all really blurry... I guess 2. 2 looks better than 1, I think." At no point did the doctor ever acknowledge that I said my vision was blurry. In fact, she kept silent other than telling me to "just keep going" after my initial protest, and asking me "1 or 2?"
I keep thinking, "Er, none of these are really good lenses right now because I can't see from the blurriness - hopefully we'll keep going until it improves..." and then she abandons my right eye and moves on to the left. I've never been to an optometrist who sped through the contact lens exam so quickly. It always takes 5-10 minutes per eye.
After she burns through my contact lens exam lickety-split, she pulls out the mega flashlight and checks out my dilated eyes for retina issues, and there aren't any. (Surprise.) Then she goes to her computer and starts typing, doesn't say anything. I feel confused and uncharacteristically meek - too shocked and intimidated to say anything. Eventually she tells me the front desk will order my contacts and they'll call me when they come in.
At the front desk they tell me they'll call me when the contacts arrive and when I come in they'll make sure the contacts are the right prescription. I hear them say this but I don't really think much about the comment at this point.
So, I get home, and an hour later it dawns on me that:
- Whenever I've had my eyes dilated, it was always done at the very end of the exam. Dilation drops were never put in until after the contact lens part of exam, which makes sense because it makes your vision unusually blurry.
- No optometrist has ever spent so little time on the contact lens part of the exam. That's always been the longest part. It has usually had me wondering "Is this over yet?" but I still appreciate the precision and thoughtfulness put into the exam.
- This is the first time I've had an optometrist not give me my prescription at the end of the exam.
Now, I realize that they were ordering the contact lenses for me on site, through their contact lens provider. But after researching FTC regulations and the Contact Lens Rule, my understanding - and correct me if I'm wrong - is that is they are prepared to sell me contacts (to me, calling in a prescription and ordering contacts is being 'prepared to sell'), then the contact lens fitting is 'complete' and they have to furnish the prescription to me.
I immediately felt conflicted because I think they obtained a shitty, inaccurate prescription from the exam, but I wanted them to give me the prescription because I was so unhappy with the experience and wanted to just order the contacts from another contact lens provider. Why? Because I don't think my insurance company covers more than one eye exam a year, I can't afford to pay for a full blown RGP contact lens exam out of pocket, and any contact lenses would be better than the ones I'm currently struggling with. I want the prescription so I can just get some contacts to hold me over for the next few weeks until I can go back for another exam for a more accurate prescription.
So, here I am, not knowing if I should be mad that they did a shit job examining my eyes for contact lenses, or mad and demanding they release the prescription to me so I can take my business elsewhere. These two things are basically in direct opposition of one another.
I call their office the next day and say, "Hi, can you please call my prescription in to ________. The receptionist (after putting me on hold twice - I think she was new) proceeds to tell me that I have to come back in to be seen again. I ask why. She says so they can "Teach me how to put them in."
I about lost it. I told them I'd been wearing RGPs for twenty years, as the doctor should know from the vision history I provided, and I did not need to be taught how to put them in. I told them they needed to come up with a better reason than that. They put me on hold. Then they came back on the line and said that the doctor simply had not signed off yet on the prescription so they could not fax it anywhere else. I told them that they were supposed to give me a copy of the prescription after the exam, and that I didn't understand why they would order contact lenses for me if the doctor was not satisfied with the results of the exam they did. I told them I wasn't coming back and they needed to fax the prescription before I filed a complaint with either the FTC or the state board of optometry or both. They said they'd speak with the doctor and call me back.
The next morning I get a call from the clinical director. She said that the doctor could not sign off on my prescription because they needed to fit the contacts on me first. I said that there's always a possibility the contacts may not be the right fit, but that every other optometrist has always given me the prescription immediately after the exam and told me to come back if the contacts don't seem right after about a week or there are serious issues. I told her that what she was telling me was absurd and I couldn't accept it. The clinical director then proceeds to tells me, "It is your fault [direct quote] because you did not know what brand of RGP contacts you are currently wearing. The doctor has to make sure that your eyes will accept the brand of contacts she ordered." First time hearing this! Also, my last optometrist never asked me what brand of contacts I already wore; likewise I never had a problem with whatever brand he requested on the prescription.
I told the clinical director that this sounds like it may be a violation of FTC/contact lens rule, and that if they did not fax my prescription to me or to my choice of contact lens provider by the end of the day, I would file a complaint to have the FTC review their procedure. I also said that I couldn't believe they dilated my eyes before the contact lens exam and that it made my eyes blurry and that it couldn't possibly be common practice. That's when the clinical director asked me how long I was an optometrist. I asked her how long she had been an optometrist, and she said, "I'm the clinical director." I said, "So what?" and she said, "So... [long pause] I'll be happy to set up a new eye exam for you with a different optometrist." I told her no, and I was not coming back. She said okay and to have a nice day and ended the call. Four hours later, they uploaded an electronic copy of my medical record to their online portal. Note that they'd already uploaded one the day before, but it was much less detailed. This new, more detailed medical record appeared to list the results of my contact lens exam, but I don't see how this could be considered a 'prescription' by anyone - it's just the medical record documenting my medical history, exam, test results and the doctor's plan of action.
I'm really upset about how this was handled. I later find out that this optometrist (and clinical practice) have several bad reviews online, citing how the particular optometrist is always rushing through the exams and text messaging on her phone (to be fair, I didn't catch her texting) and that the clinical practice bills absurdly high rates to insurance; they are also known for long delays in contact lens/glasses orders coming in. Given that my past eye doctors have only had me come in one time for an exam, given me my prescription on the spot, and told me to come back only if I have a problem with the contacts, I feel like they purposefully gave me a shitty initial exam so that I'd not only have to come back to make sure the contacts were 'correct', but so that when the first prescription didn't work out (because it was done poorly) they'd have a reason to order more and have me come in a second time. More appointments, more billing, more money. All for what I view as completely unnecessary things. I also feel like they could be strategically phrasing what they're doing so that it falls into some kind of legal loophole.
So, my questions:
1) I can't tell if this doctor is just a jerk, or if they committed a legitimate violation of the FTC rules regulating contact lens exams and prescriptions. Can anyone help me to clarify this?
2) Depending on #1, what should my next step be? (Given my financial and insurance circumstances, as well as the fact that I'm in moderately urgent need of new lenses?) I have no idea if I should keep pushing them to give me my prescription, file a complaint, give up and go somewhere else and hope my insurance will pay for more than one eye exam in a year, or what.