Optometry Coding & Billing Alert

Question: After an eye exam and refraction, the patient wanted a copy of his contact lens prescription. However, the patient also has an outstanding balance with us. Are we required to give him the prescription?


South Carolina Subscriber

Answer: A past-due balance is not enough reason to refuse to release a contact lens prescription to a patient, according to the Fairness to Contact Lens Consumers Act (FCLCA), enacted in 2003.

But it's a different story if the patient hasn't paid for the visit in which the prescription was generated. Section 3 of the Act, subtitled -Immediate Payment of Fees in Limited Circumstances,- says, -A prescriber may require payment of fees for an eye examination, fitting, and evaluation before the release of a contact lens prescription, but only if the prescriber requires immediate payment in the case of an examination that reveals no requirement for ophthalmic goods.- In other words, if you require all of your patients to pay immediately--even those patients who don't need contacts--you can withhold the prescription until the patient pays.

Most important: If the patient provides proof of insurance coverage, it counts as -immediate payment,- according to FCLCA. If the patient has shown proof that his insurance covers the exam, fitting and evaluation, you must release the prescription to him.

Learn more: You can download a Federal Trade Commission guide to the law at http://www.ftc.gov/bcp/conline/pubs/buspubs/contact.pdf.