DATE:               October 30, 2009

            TO:                     IDAHO BOARD OF OPTOMETRY 

            SUBJECT:       Investigative Report


Fiscal Year 2009

            Total Complaints received                                                                                          8

                        (Including 6 CE audit files.)


                        Closed by Board action                                                                       5

                        Closed following disciplinary action                                                2

                        Awaiting Board determination                                                          1


Fiscal Year 2008

            Total Complaints received                                                                                          4


                        Closed by Board action                                                                       2

                        Remaining under investigation                                                         1

                        Awaiting Board determination                                                          1



For Board Determination:


I-OPT-2008-1    C alleged R will not forward Cís family records due to an unpaid balance.  INV revealed that Cís child saw R for broken glasses, and C expressed an interest in contact lenses for the child.  C indicated some financial difficulty when she was told that Medicaid would not cover the contact lens fitting or any contacts that were received after the fitting process was complete.  R discounted the $31 contact lens fitting fee in an effort to help C.  The next day, C called Rís office requesting her childís contact lens prescription because she could get the contact lenses cheaper elsewhere.  Rís office staff informed C that there was an outstanding balance on the familyís account and that when the balance was paid, Rís office would release the information.  Later that day another OPT office faxed a records release and request for the familyís records.  Rís office staff explained to the other OPTís office staff that Rís office policy is to release requested medical record information, including glasses and contact lens prescriptions, when an outstanding balance is paid in full.  R also noted that the FTC Contact Lens Rule provides in pertinent part:  ďPrescribers may require a patient to pay for the eye exam, fitting and evaluation before giving the patient a copy of the contact lens prescription,Ē that the consumer may get the contact lens prescription when the fitting is complete, and that ďfitting contacts may involve more than one appointment.Ē  R stated that the childís glasses were mailed to Cís home the day they were received in Rís office, that R has not received payment from Medicaid for either the exam or the glasses, and that R has forwarded the childís glasses prescription and eye health examination records to the other OPT.  R stated he made an exception to his office policy because he discounted the charge for the non-covered contact lens fitting and the remaining balance is expected from Medicaid.  R stated that he was not given an opportunity to do specific measurements and place contacts on the childís eye or conduct an evaluation for correct fit and vision correction, so no contact lens prescription exists for the child.  IBOL recommends the Board authorize closure.


I-OPT-2009-1    C alleged Rís office personnel told C that Medicaid would pay for a scheduled appointment, but R walked out in the middle of an exam.  C also alleged that Rís office personnel came into the exam room and told C that she had to pay for the exam or it would not be completed.  INV revealed that when R met with C in the exam room, R noticed in Cís file that the insurance codes signified that C was not eligible for an eye exam unless there was a medical condition present.  R stated that he then left the room to verify coverage and review it with office personnel.  R stated that office personnel then went into the exam room to discuss the lack of insurance coverage with C and Cís options.  C determined not to proceed with the exam and left the office.  IBOL recommends the Board authorize closure.



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Last Modified - Thursday, October 22, 2009