Eyes have it Optician wins my business; But doesn't sell me anything

 

I WENT TO THREE OPTICIANs the other day to get a lens to correct one eye; the other eye just has a new lens implanted (due to cataract) and I see "pretty good" with the new lens. The other eye has a "developing" cataract.

The ophthalmologist's optometrist pushed for me to buy contact a contact lens from the ophthalmologist's optician. The optician was likewise strongly inclined to push for a contact.

Not being sure I could tolerate something in my eye I asked if there was someway I could check to see if I could accommodate the foreign object over my pupil.

Sure - for $100.

I THINK THAT $100 is $99.99 too much to pay to just find out if I could tolerate a contact lens. I demanded my prescription; with the script in hand, I marched out.

The next day I went on my Search for a Corrective Lens.

My first stop was at a "Two Pair for $69" optician I had used in the past. Mind, I never got two pairs of glasses for $69; it always came out closer to twice that price, what with my high correction and polycarbonate lenses. I showed Janet The Optician my prescription and she suggested I would be better off in many ways with a contact.

"But, Janet, I'm not sure my eye will tolerate a contact."

With that, Janet got up and, telling me to follow her, went to the store's collection of contacts. "Wash your hands<" she instructed as she selected a lens.

Back at her station, she opened the contact's container and told me to fish out the tiny lens. When I finally managed this, she gave me instructions on how to insert the lens. Since I once wore (hard) contacts, I half listened to her - much the way experienced air travelers pay attention to the fight attendants during the safety spiel - with other things going through my mind. My mistake..

Fortunately, Janet was patient and once I admitted I needed "encouragement" I got the lens over the pupil.

My eye didn't complain and within a few minutes it was as if there was nothing in the eye … except I now had great distant vision. My "very close" vision was something else. The remedy, Janet said, would be a bifocal lens, but, she said, that decision would be between me and the store's ophthalmologist. Meanwhile, she worked up a "worst case" cost for a year's supply of bifocal contacts.

So far, my only "cost" to discover I can wear contacts had been just a little time; my wallet remained closed.

I decided to shop around before having the exam. I went to two other optical shops and basically told the persons there what I had told Janet. Neither offered to let me see if I could tolerate a contact; both were happy to tell me I could get an exam for contacts for more than the "Two Pair for $69" store would charge.

Back to Janet. She arranged for the store's ophthalmologist to examine my eye for contacts.

Bottom line: the ophthalmologist, noting the massive difference between the right eye and left eye, recommended I "live with" my current "no lens" condition until after my next cataract operation (probably within 12 months). In the end I paid for a standard exam.

Neither Janet nor the ophthalmologist work on commission so neither was under pressure to sell me something that, in the end, might have been contra-indicated.

It would have been nice to have (close to) 20/20 in both eyes, but I can "live with" one good eye for middle to distant vision and one bad eye for very close small print reading.

My personal "bottom line" is that IF I need correction after the second surgery, my first - and probably only - stop will be at Janet's workstation at the "Two Pair for $69" store.

Opuscula Visualize Bottom line

 

Medicare Advantage programs - and they all seem similar in this respect - allow customers roughly US$115/year toward corrective lenses, with frames, or contact lenses.

The lenses are "plain vanilla," no polycarbonate, no line-less bifocals, no tints, no, no, no.

Installed in a pair of Chinese frames.

One pair. $115.

Compare this to non-Advantage plan glasses.

In my area, there are at least two chains offering two pair for $69.

Same plain vanilla lenses.

Same made-in-China frames (albeit with a wider selection that I saw at two Advantage-approved vendors).

And a "free" eye exam in thrown in.

Even Sears has a two-for-$75 offer on tv. (Whatever happened to Roebuck?)

I'm curious.

If I can get TWO - count'em, 2 - pair of plain vanilla lenses in made-in-China frames for $69, why do Medicare Advantage providers charge $115 for a pair of glasses AND pay more for an eye exam?

Medicare claims to be on the outlook for fraud.

Medicare claims to be on the outlook for cost savings.

I pay slightly more than $100/month for Medicare. That money is then paid to the Advantage plans.

IN ADDITION to my monthly payment, Medicare pays ADDITIONAL MONEY to the Advantage plan based on several variables, including the Medicare (geezer) population served by the Advantage plan.

Like newspapers that make their money on advertising with rates based on circulation, Advantage plans make their money by head count, not on an individual's monthly payment to Medicare.

Consider the competition for customers in geezer-heavy geographic areas, both in terms of advertising and in rates. In South Florida, the competition is fierce and the rates available to customers ranges from zero additional dollars to whatever the market will bear; elsewhere - in rural Maryland, for example - rates start with an added cost to the covered geezer of from about $50/month to whatever the market will bear.

Why, then, don't the Advantage providers contract with the "discount" companies? There are several that are nationwide, or nearly nationwide. It seems that the Advantage providers could negotiate a discounted price - say $50 in lieu of $69 - and still make their profits, albeit with only a slightly reduced margin. Medicare, likewise, could reduce its payments to the Advantage providers.

This also could apply to Obamacare.

Advantage-contracted optometrists and opticians may take umbrage at the idea that a discount optometrist and optician may be eligible for Advantage dollars. Most discount opticians accept prescriptions from any optometrist, so Advantage-contracted optometrists would face the loss only of their related optician business. (On a personal note, I found an optometrist with whom I think I can have a good, long-term relationship.)

The "bottom line" question is: If a "discount" optician (chain or independent) can offer eye exams and TWO PAIR of glasses, albeit "plan vanilla," for $69, why is Medicare allowing Advantage providers to pay a non-competitive price for simple lenses in Chinese frames?

 

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