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I am Dropping Participation with BlueCross

This is the e-mail I just sent to BlueCross:

Dear BlueCross,

It is with regret that I inform you that I wish to terminate my contract with BlueCross and no longer be in your network. I understand that I have to continue seeing BlueCross patients for 90 more days.

If you are interested in why I am leaving you, my accounts receivable with BlueCross patients is unacceptably high.

Since I am an optometrist, I need fast, easy access to whether a member has a routine eye exam benefit (S0620, S0621) and whether a contact lens evaluation is covered (92310).

For non-Regence plans, I have to make lengthy phone calls and navigate through terrible phone trees before finally talking with a representative. This process takes longer than performing the actual exam.

While Regence has a nice website for explaining benefits and is good about paying what I expect, every other BlueCross association is unpredictable about paying what I’m expecting. I often have to send out statements or refunds. Usually statements. Hence the high accounts receivable.

I know this will hit you in the wallet as well since I am the lowest-fee eye doctor in Cache Valley. If in the future BlueCross comes out with a website that allows an optometrist to see vision benefit details for any BlueCross member from any state/association, then feel free to let me know, and I’ll reconsider. I would also reconsider if a new rule allowed one to participate only with Regence and exclude all other BlueCross associations.

Sincerely,
David J. Langford, O.D.

I find it unacceptable in this day and age that I can’t look up vision benefits for an entire insurance company in one place. This probably has something to do with BCBS being independent associations instead of one giant insurance company. It is still ridiculous and a big pain in my side that won’t be there in 90 days.

I feel sorry for my BCBS patients. If it’s any consolation, the Utah State University BlueCross beneficiaries can send in their receipt and get 70% reimbursed for a routine eye exam done out-of-network. Not bad.

Posted in Optoblog.

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How Movies Would End if Written by Utahns #002

[scrippet]
EXT. CITY STREET – DAY

Our plain-clothes, police action hero, DOYLE, stands in the street, arms outstretched. A 1971 PONTIAC LEMANS screeches to a halt, barely missing him.

Doyle pulls a gun and muzzles the driver.

DOYLE
Get out of the car!

The DRIVER acts like he is about to unbuckle his seat belt, but really he draws a GUN from his appendix holster.

BAM BAM BAM! All three hit Doyle in the chest. Bending down to a knee, Doyle returns fire, but his shots go wide as the LeMans skids out in reverse.

Doyle collapses on the blacktop.

The bad guy Doyle was chasing gets caught later by a smarter, more polite policeman who is still alive.
[/scrippet]

Posted in Optoblog.

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How Movies Would End if Written by Utahns #001

[scrippet]
EXT. DESERT HIGHWAY – DAY

KURT RUSSELL and KATHLEEN QUINLAN look blankly at the engine of their Jeep Grand Cherokee.

A TRACKER TRAILER pulls over, kicking up dust in their faces. A seeming normal-looking JOE hops out.

JOE
Looks like yer broken down. Why don’t the missus ride with me in ta town. You, feller, stay here till the tow truck arrives.

KATHLEEN
(to Kurt)
I don’t know…

KURT
That sounds perfect!
(to Kathleen)
I’ll see you later, honey.

They smooch. Joe is already opening the door to the passenger side of the cab. She walks over but questioningly looks back at Kurt.

KURT
Stay safe! I’ll be waiting. Right here.

Joe helps her up. Closes the door and walks around to his side.

JOE
Don’t worry. I’ll take care of her.

Kurt waves. The truck pulls out. Two hundred yards later, the truck crosses into the oncoming lane, CRASHES over a speed limit sign, and comes to a rest after glancing a concrete barrier.

EXT. CRASH SITE – CONTINUOUS

Kathleen exits the cab. With an unsteady gate she walks in the middle of the highway. Pupils dilated, she checks both directions frequently. She has BLOOD spatters on her face. She rubs an ear with one hand and holds a REVOLVER with the other. Kurt runs up.

KURT
What the heck happened?

Kathleen stows the gun back in her purse.

KATHLEEN
(shouting)
What?

Kurt leans in to her ear.

KURT
What happened?

Kathleen slows her jitters.

KATHLEEN
Well, he said he was going to rape, torture, and kill me. I said to stop the truck, but then he tried to restrain me, brandishing a knife. So I shot him.

Kurt looks at her and then into the cab. Joe is hunched over. Blood is spattered around the windows.

KURT
Well, we can still drive this rig into town. Do you want to dump the body out or unhitch the trailer?

KATHLEEN
Body.
[/scrippet]

Posted in Optoblog.

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Funny Utah Medicaid Observation

Utah Medicaid is changing their copays for 2014:

For Non-Traditional (Blue Card), they used to only cover the first $30, then you would pay the balance. Now, at my office your routine eye exam is covered without any copay since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Primary Care Network, a.k.a PCN (Yellow Card), you used to have a $5 copay. For 2014, there is no copay on the routine eye exam at my office since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Traditional (Purple Card), there is still no copay for 2014 on a routine eye exam.

I think it’s funny how the patient pays less to see an optometrist vs an ophthalmologist. On the face it doesn’t feel fair. Theoretically, for the same procedure code, why should the patient pay any different?

Practically, OMDs charge more than ODs, so maybe this is a way for Utah Medicaid to incentivize “clients” to see an optometrist instead of an ophthalmologist. OMDs could be miffed, but they probably aren’t because $3 isn’t that big of a penalty; therefore, it should cause very few patients to actually alter provider choice.

Still, it’s curious. I wonder at what OD/OMD copay differential the OMDs would become vocal.

Posted in Optoblog.

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Part Time Optometrist Position in Utah

Are you looking for a part time, fill-in-type optometrist job in Northern Utah? VisionHealth EyeCare is hiring a Saturday-only optometrist. See this webpage for a job description and how to apply.

Posted in Optoblog.

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Brian Regan Performing at Arena February 2014 in Salt Lake City

After my prior post, you might be reading this website to keep up with all things Brian Regan. You will be excited to find out that you can buy tickets to his show in Salt Lake City on Feb. 28, 2014 at Energy Solutions Arena, where the Utah Jazz play.

An e-mail announcing a pre-sale for Regan’s show advertised that this is the first arena venue for a [headlining] comic. Wow, that’s quite an achievement! Here is how I imagine the conversation went between Regan and his manager:

[scrippet]
INT. OFFICE – DAY
BRIAN REGAN, 50s and overweight because he hasn’t woken up to the virtues of the Paleo lifestyle, lays on a couch tossing a football up in the air to himself. His slick MANAGER sits behind a glass desk checking messages on his phone.

MANAGER
Brian, baby! Salt Lake City loves ya’. Should we do twelve shows this year instead of ten?

Brian sits up, missing the catch.

BRIAN
Oh, fetch. There has got to be a way we can take money from the Utahns without having to spend TWO FRIGGIN’ WEEKS there.

MANAGER
Dude, I know.
(beat)
I got it! We’ll do the first arena venue for any comic ever! We’ll get ‘em all in ONE NIGHT!

BRIAN
I don’t know. A lot of my comedy involves facial expressions. How are people gonna’ see that from the nose bleed seats at the Delta Center?

Brian pops a Lipitor pill in his mouth because he still hasn’t woken up to the Paleo lifestyle, just like all the other sheeple. Otherwise he would know that big pharma is making almost everything worse whereas a low-carb diet could solve all his problems. In fact, if Brian and his ex-wife had just been on the Paleo diet, its well-being benefits could have saved their marriage.

MANAGER
They call it Energy Solutions Arena now. Some nuclear waste people bought the naming rights a couple years ago. No problem. We’ll just have a camera on you and feed it to the Jumbotron.

BRIAN
Actually, they use a YESCO HD Video Board, not Sony. But if people wanted to see me on a screen, wouldn’t they just watch my DVD’s at home instead of fighting traffic?

MANAGER
Salt Lake has light rail, and Brian, [i]babe[/i], would you rather spend one night in Salt Lake City or two weeks?

Brian picks up a donut from the well-appointed donut box on the coffee table.

BRIAN
Call the Jazz and tell ‘em I’m coming.

Brian takes a bite. The Lipitor causes him to swallow funny, so he chokes and coughs up a bolus across the room and onto the glass desk.

MANAGER
Eww.
[/scrippet]

NOTES:
I made a donut and cholesterol theme because I recently listened to Brian Regan being interviewed on the Paul Mecurio podcast, and they talked about it.
Brian Regan’s record setting set of shows in SLC.
Info about the YESCO video display at ESA.
Mark’s Daily Apple regarding diet and mood.
More nutrition and mood info.
Statin drugs are dumb and dangerous.
More cholesterol.

Posted in Optoblog.


Dua’s Layer of the Cornea

Holy Cow! A new layer of the the cornea has been identified.

I think it should humble us that we think we know so much about something, yet not enough. It’s amazing what we don’t know.

Posted in Optoblog.

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Cool Site

I wanted to let you know about a useful site: eyewiki.aao.org

I particularly liked the page about slit lamp photography using your digital camera, a.k.a. “phoneography.”

I like the DIY homemade version, so I’m going to try it out and let you know how it goes within 1-2 weeks.

Posted in Optoblog, Reviews.

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@optotrician: This is Safe, Right?

I was halfway done administrating non-contact tonometry (a.k.a. air puff test) when a 30-something man asked, “This is safe, right?”

To which I replied, “Well, yah. A small percentage of people could faint, but…pretty safe.”

To be fair, I have never had anyone faint after the air puff, but I have had two different men almost faint (lightheaded, sweating, nausia, paleness) after Goldmann applanation tonometry and corneal foreign body and rust-ring removal.

It helps to be prepared for the vasovagal response, so I have on hand an ammonia-based respiratory stimulant and Sunny Delight sugary punch.

Posted in @ the Optotrician, Optoblog.

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@optotrician: Time for an Eye Exam

Don't talk to Willie!

Don’t talk to Willie!

Our Walmart Vision Center has a life-size poster of a tough-looking beared guy from Duck Dynasty. Someone thought it would be fun to put a Walmart name tag with the name “Willie” on it.

It’s strange having Willie in the optical because you see him out of the corner of your eye and you instinctively have to look over at him to see who’s there, but the then you feel stupid because you’ve already told yourself a thousand times before that Willie is just a cardboard picture.

The other day, an optician saw a lady trying to talk to Willie and asking a question. Of course it was only for a few seconds, but it was a couple seconds longer than most people would talk to a cardboard picture.

The VC manager decided to take the name badge of Willie after that. Now most people just come over and have a picture taken with cardboard Willie.

Posted in @ the Optotrician, Optoblog.

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