The Free Exam and the Refraction Fee
ValueVision runs a newspaper ad: “FREE COMPREHENSIVE EYE EXAM-no purchase necessary.” A 45-year-old patient schedules an exam. After the exam, the optometrist says the “free” exam covered only the health evaluation; the refraction is $45 and the eyeglass prescription is $75. The patient has insurance that covers a refraction but not a “prescription release.” The office also refuses to give the patient her pupillary distance (PD), saying it is “proprietary.” The patient paid the $45 but not the $75 and left without a prescription. The optometrist tells her she can get the prescription after buying frames at the office. The office’s policy also requires patients to sign a form saying they “voluntarily decline” the prescription. No contact lenses are involved.
1. Does the Eyeglass Rule require the practice to release the eyeglass prescription, and can it charge $75 or withhold the PD?
Read the worked answer
Yes. The Eyeglass Rule requires the prescriber to provide the patient with a copy of the eyeglass prescription immediately after the eye exam, at no extra cost, whether or not the patient asks and whether or not the patient buys glasses. The $75 “prescription release” fee is prohibited. The prescription must contain the information needed to make the glasses, including the refractive powers and, where measured, the pupillary distance; withholding PD as “proprietary” undermines the rule. The patient’s $45 refraction fee can be billed as a service, but it cannot be used to condition release. The waiver form is also improper because the patient cannot voluntarily waive a right the rule gives her.
2. Is the “free exam” advertising deceptive?
Read the worked answer
It likely is. Advertising a “free comprehensive eye exam-no purchase necessary” when the practice then charges a mandatory $45 refraction fee omits a material condition. A reasonable patient would understand “free” to mean no charge for the exam needed to obtain a prescription. The practice can advertise a free health evaluation only if it clearly discloses the refraction charge and any other mandatory fees before the patient schedules. The combination of the free-exam claim, the undisclosed refraction fee, and the prescription-release fee compounds the deception. The Board may treat misleading advertising as unprofessional conduct, and the FTC or state consumer protection authorities may also have concerns.
3. What should the practice do to bring its advertising and prescription practices into compliance?
Read the worked answer
It should stop charging for prescription release, provide the prescription and PD at the end of the exam, and eliminate the waiver form. It should revise the advertisement to disclose the refraction fee prominently or drop the word “free.” Staff should be trained that the prescription belongs to the patient and that a purchase is never required. The practice should refund the $75 fee if any patient paid it and review recent encounters for similar denials. It should keep a written policy, post a notice in the office, and document training. If a complaint is filed, these corrective steps may reduce but not eliminate exposure.