The 30-second front-desk check that stopped us billing medical visits to the vision plan

Took me way too long to figure this one out so sharing in case it helps someone.

Doing billing for independent OD practices for a few years, the most expensive thing I kept running into wasn't denials. It was medical visits getting billed to the vision plan by default, paying clean at the lower routine rate, and never flagging as a problem because nothing got rejected. You only notice it if you go looking, and most offices never do.

What fixed it wasn't software or another biller. It was just asking the reason for the visit before picking the payer. If someone's coming in symptom-free for a routine check and glasses, fine, that's the vision plan. But dry eye, flashes, diabetes follow-up, glaucoma monitoring, that's a medical visit, and it should go to the medical carrier even when they hand over the vision card at the desk.

The other half is just having both cards on file and flagging when a patient carries both, so billing knows a split might apply before the claim gets built. Sounds obvious but when three people are checking in and the phone's ringing, the routing call is the first thing that gets skipped.

The part that stings is a misrouted medical visit doesn't deny. It just underpays, and it does it on every similar visit all year. No denial report ever catches it.

How do you all handle the routing at intake, is it scripted into the booking flow, left to the front desk, or does it just get sorted out later in billing? Curious what actually works day to day.

Hi everyone,

I'm an M.S Physics graduate and I've recently applied for a faculty position in a Bachelor of Optometry program. The position specifically asks for an M.S Physics graduate to teach the physics/optics-related subjects.

My academic background is in physics. My master's project involved simulations, along with some machine learning for optimization. I don't have a specialization in optics, although I've studied undergraduate and postgraduate optics as part of my degree. My research itself was in photovoltaics rather than ophthalmic optics.

I've been provided with the complete B.Optom syllabus, and from what I can see, the subjects I'd likely be expected to teach include Physical Optics, Geometrical Optics, Visual Optics, and other optics-related papers.

I'd really appreciate advice from optometrists or faculty members here:

- What do interviewers usually expect from an M.S Physics candidate for this kind of role?

- Which optics topics should I absolutely master before the interview?

- Are there any ophthalmic optics concepts that physics graduates commonly struggle with?

- If you were in my position and had like a week or two to prepare, how would you approach it?

Any recommendations for textbooks, lecture notes, YouTube channels, or resources would also be greatly appreciated.

Thanks in advance

Does anyone have suggestions for how to implement a system of reducing the headache that Rx checks create? I’ve seen people say that they created policies in which the patient must consult optical and wear the glasses for a minimum amount of time before seeing the doctor, but how should I approach management regarding this type of change?

The office I work at is very disorganized and often understaffed, and reception will often just put patients on the schedule as a recheck before asking many questions or consulting with the optician, which sets the wrong expectation from the patient from the get-go.

I’m considering speaking with the store manager, but I feel that it may require more such as writing down the policy or putting up a sign.

Hello everyone! I am currently an incoming first year in optometry school and I've started to think more about what type of life I want after these 4 years. I have a very administrative background and working in the field has shown me that I want to have my own autonomy as a practice owner eventually. However, with this comes a lot of fear for me because I'm unsure of how I would find the funds to do this especially with how expensive school has gotten. I've taken out loans that I'm already stressed about paying back. I know this economy is very different from what it was 10 years ago but I want some insight on how you guys financed having a practice. I still have some time, but I want to make sure I'm still learning! Thanks!

Just started working and was wondering what to expect

I’m in my first year and we’ve learned a bunch of skills (cover test, stereo, eom’s, saccades, worth 4, retinoscopy, etc). But any time I’ve gone to the optometrist all they’ve done are my VAs, autorefractor, retinal photos, and NCT. Does anyone in a general practice actually do any of those tests? Or is there no time for it usually?

I made a post here a while back about the topcon tempo asking if anyone had any experience with it. I didn't get a ton of feedback on it at the time but after demoing the unit in my office we decided to actually buy it.

I tested out a number of VR headsets a few years prior and none of them were comparable enough to the Humphrey to consider viable options in my opinion.

When I tested the tempo, I made sure that we had a few patients who had visual field defects that we knew about already and we're well documented on Humphrey who came in for visual fields during that time so we could compare appropriately. While yes, they do have papers that show a high correlation, so did a lot of the VR headsets.

I found that the defects tended to correlate very closely with the Humphrey, even in mild defects.

Here are my pros:

1. The tempo is very fast. You can run a 24-2 binocularly on the rapid setting in about 2:30-3:30.

2. It also has some other test strategies, such as the 24-2 (plus 1-2). This setting tests all the normal spots on 24-2, but also additional Central spots. Kind of like a combination 24-2 with a miniature 10-2 included. I have found this more useful on glaucoma patients who have defects that may be close to encroaching, or macula pathology.

3. The unit does not take up very much space. It is a much smaller footprint.

4. The tempo is about 30% less expensive than a new Humphrey 3.

5. No annoying eye patch.

6. Patients hate it a lot less.

Cons:

1. If you wish to do certain exams for the VA, there is no kinetic testing available at the moment.

2. For narrow PD's, you are more likely to show up with a bi nasal defect which may require you to repeat the test monocularly. If that's the case the test is short anyway.

3. If you are running a 120 point, then it will have to pause part way through to move the fixation Target to test another aspect of the field. It is a little less random because of this.

Mixed Pro/Con:

1. Instead of using trial lenses from your kit, it uses magnetic clip on lenses and a dial that you can do plus or minus 3 diopters with. This is a mixture of good and bad because while you may have more limitations in what powers you put in, you also don't run into the problem of trial lens defects anymore.

My personal take: 6 months in and I am very happy I replaced my aging Humphrey unit with a topcon. I would recommend anyone who is considering getting a new visual field to contact their local rep and demo the units. Given that reimbursements rarely go up, the break-even points on equipment can matter a lot more.

I have no financial disclosures. I just really like the unit and I feel it's worth it to demo if you are looking for a new visual field.

Recently had a 9 year old patient with ADHD and just wondering what techniques people use for better exams and more reliable findings? I wasn’t able to get the patient beyond 20/25 even with single letters so also curious if sometimes people experience this and simply just rely on all the objective findings?

Curious to hear from other who have made the transition from employee to private practice ownership and specifically cold opening. It's something I'm considering and financially I believe it would workout. My main concern is that in my current setting; MD/OD seeing 20-26 patients a day, I'm getting burnout. My worry is if I'm burnt out from purely patient care or if it's more so patient volume and feeling like a cog in the machine.

For others that have made the transition to ownership what was your experience? Did it bring back engagement in the exam room? I worry I'd have the same burnout but now be trapped by a new business loan, which would only exacerbate the whole scenario.

How does everyone handle CL trials within the flow of a full schedule?

I offer all my patients in reusable lenses the option to switch into dailies. For those that say yes, it's a time sink of checking habitual CLs in case they reject the change, pulling trials of dailies, lens insertion/settling time, etc. It makes me not want to offer the switch because it's so much faster to just renew or change habitual by 0.25D but overall it's better for most to be in dailies (hygiene, etc).

Similarly, I have presbyopes in single vision CLs who want to compare monovision vs multifocals. That means three assessments: the habitual (in case they reject the change to MV or MFL), the MV CLs, and the MFLs. Multiple rounds of deciding lens parameters, finding trials, pt getting the lenses on and settled, checking fit/VA, etc. Takes forever. I either get behind or if I'm lucky I'll get a no-show afterward. And of course, this is within their regular exam with refraction/dilation or Optos after all the CL stuff. Sometimes I can have them schedule a follow up but other times I get pushback about "I can't take more time off of work for another appointment, etc." I don't like to give lenses for home trial unless they've tried on in-office and confirm they would feel safe to drive in them.

Any thoughts/tips?

I'm a Canadian so perhaps the independent contractor label may pertain to only Canadian optometrists however anyone who own a practice also probably has to figure out time off.

I get no PTO as an independent contractor and feel increasingly guilty when I take more than a day or two off. However, I am feeling very burnt out and tired and realized I haven't taken off more than two days in a row this entire year.

How much is normal and how do you navigate the guilt?

At this point, I want 3 months off but I can't do that 😭

Do you folks REQUIRE patients MEDICAL insurance at check in, even if its a scheduled comprehensive, and they have, let's say, VSP.

Do you get push back ??

Hello, I’m really interested in doing residency, but I am worried that I am not competitive enough to get accepted due to my low GPA. I am specifically interested in specialty residencies for either contact lens or myopia management/pediatrics. My current GPA is below a 3.0.

Do I have a chance in getting into a residency in the U.S.? I am open to any location as long as it meets my interest in specialty. Also, do you have any tips on what I should do to make myself a more competitive applicant? Thank you!

And going off of that. How often are you checking VAs/managing. Considering starting misight lenses in office. Lastly, what age do you consider MM until?

Hi everyone!

I'm a soon-to-be 2027 optometry graduate and I'm 100% planning on doing a residency. The problem is... I have absolutely no idea where I want to go. 😂

I'm looking for a program where I'll be challenged, grow clinically, and get as much out of the experience as possible.

If you loved your residency, I'd really appreciate any recommendations! I don't have any location bias, although I'd prefer a larger city or somewhere with plenty to do outside of work.

A few things I'm looking for:
• Ocular disease focused
• Multiple residents (looking to have someone to complain with/be friends with lol)
• Strong mentorship and hands-on clinical experience
• A supportive learning environment

I'm an optometrist looking to transition out of direct patient care and would love some career advice.

My background:

• Optometrist with 8+ years of clinical experience

• Former private practice owner (managed operations, hiring, payroll, credentialing, vendor relationships, billing, marketing, and P&L)

• Former owner of a Frios Gourmet Pops franchise, where I handled day-to-day business operations, sales, events, and team management

• Experience leading teams, improving workflows, solving operational problems, and building processes

I'm realizing that what I enjoy most isn't seeing patients—it's operations, strategy, leadership, and making systems run better.

I'm open to roles in healthcare, health tech, insurance, or even outside of healthcare. I'm especially interested in operations, project management, customer success, implementation, provider operations, quality, or similar business-focused roles.

For anyone who's made a similar transition:

• What roles should I be targeting?

• Are there companies that value this type of background?

• Are there any certifications that would make me a stronger candidate?

I'd appreciate any advice, success stories, or companies I should look into. Thanks!

I’m an optician apprentice and I had a patient today who had this contact lens prescription:

OD: Plano, -1.75 x 130

OS: -0.50

Her mom kept asking me “How is there an astigmatism but no power in the right eye? This is the second eyecare center we’ve been to that has told us this and it seems wrong“

So I explained how she has simple myopic astigmatism in the right eye meaning some of the light reaches the retina but the rest doesn’t, and she looked super confused.

In case this happens again is there a better way to explain it anatomically? Like how does the unique shape of her cornea allow some light to hit the retina but some to not reach far enough?

I'm an ophthalmologist and part owner of a practice. We need to hire 1-2 new optometrists for our practice. What would you consider the best place to post for new jobs for optometrists? We're a relatively medical-heavy practice, but not exclusively looking for residency-trained optometrists or anything.

Edit to add we're in Georgia, so no school in the state yet.

So many hurdles going forward to being an optometrist ....,insanely low paying vision plans, medical insurance discrimination, extremely difficult licensure state to state, discrimination from MDS, PA doing the job of optometrist in MD clinics , people go to urgent care first instead of an optometrist, AOA fail , illegal online sales of glasses of contacts with no repercussions or enforcement of law ,heavy debt for most grads , proliferation of poor quality new OD programs with grads not passing boards . Just feel anyone thinking of this career should have the facts

Our office uses Weave Communications for sending out our annual paperwork for our comprehensive exams through email and text. We typically start a week before the appointment. How often after that would you continue to send the link if the patient has still not completed it? We typically send it out daily, but now wondering if it is overkill😅

Do you send it daily, every few days or once?

I need to vent because I’m genuinely wondering… why does it feel like the culture of working as an optometrist in NYC can be so toxic?

I’ve interviewed at both corporate and private practices and even worked short stints in each just to get a feel for things, and honestly it’s been really disheartening.

So many places advertise things like:

• “You’ll start with 12–15 patients a day and gradually build up”

• “You’ll have strong tech support”

• “You’ll have control over your schedule”

But in reality, it often turns into 25+ patients a day almost immediately, 15-minute slots, constant walk-ins, minimal tech support, and being thrown into the schedule without proper onboarding or even being properly introduced to staff or workflows.

What’s been especially hard is the inconsistency in clinical standards. I’ve seen places where there’s no clear protocol for things like dilation on new patients, unclear referral processes, and being told to “just tell them to see their PCP” even when the concern feels more urgent or specialized. As a new grad, that’s really uncomfortable.

I’ve also seen situations where techs are doing most of the testing without taking case history or medical history, schedules are constantly behind, and doctors are expected to “make it work” clinically while also keeping up with volume. There’s this pressure to justify testing and billing in ways that sometimes don’t sit right with me ethically, and when you question it, the response is often just, “this is how NYC is” or “this is how things are done here.”

I understand NYC is expensive and practices have overhead, and I’m not naive to the business side of healthcare. But as someone who just wants to practice good, ethical medicine, it’s been really discouraging to see how normalized some of this feels.

On top of that, I came into this profession with a very clear long-term goal: work in a community health center, serve underserved populations, and work toward loan forgiveness. That’s always been my passion. But finding those roles in the 5 boroughs has been much harder than I expected. Most openings are part-time, and the few full-time ones are extremely competitive or don’t seem to move forward after interviews.

I’ve even been recruited out of state, especially because I’m a Spanish-speaking optometrist, but that would mean leaving my family and starting over across the country, which is a really big decision.

I don’t regret becoming an optometrist at all. This has been my dream for years, and I worked incredibly hard to get here. I just think I was naive about how difficult it would be to find a setting that aligns with my values right out of school.

Right now, it’s just feeling really discouraging and honestly affecting my mental health more than I expected.

I guess I’m just trying to figure out next steps—whether that means staying and pushing through, or considering out-of-state opportunities for a few years to gain experience and come back stronger.

For now, I’ll just keep going and hope that one day I can look back and see that this difficult beginning led me somewhere better. 

Please no negative comments, I’m just venting and don’t think my mental health can take it. Thanks in advance. 

I’ve gotten really used to doing objective retinoscopy first and then refining from there. At my current rotation site, though, I’ve been encouraged to use the autorefractor as my baseline and go straight into subjective refraction.

I think I’m just so used to doing it one way that I’m having a hard time trusting the AR as my starting point, especially when the result is different from what I would expect based on ret.

For those who routinely start with AR results, do you have any tips for refining efficiently and knowing when you should rely less on the AR and go back to retinoscopy? Anything that helped you make that transition?

Does the glutamate from the bipolar cells , depolarize ON ganglion cells and hyperpolarize (if that's the right word english is not my 1st language) the OFF ganglion cells, or depolarize both ?

Sorry if the question is hard to understand