Is Haircut Insurance Next?

Hairstylists and eye doctors have a few things in common. There are independent and chain salons. Some charge more than others and quality can differ widely between low end and high end salons. Beauty shops provide services and also sell products related to their services. To contrast, of course becoming an eye doctor has a lot more schooling, and nobody ever died or went bald because their hairstylist didn’t perform adequately (right?) But what really sticks out to me is that there is no Haircut Insurance.

Little old ladies sometimes get their hair done on a weekly or bi-weekly basis. I can’t imagine what their budget must be for their hair care, and yet some people aren’t willing to invest in their eyes once a year!

I’ll bet the next big idea in the insurance industry is going to be Hair Insurance. You see, everyone needs a haircut, but not everyone actually gets a haircut, so that is the theory behind vision and haircut insurance. Yup, the hair stylists are going to have to suffer like the rest of us eye doctors. Actually, everyone will suffer, but first let me tell you how the insurance agents would sell hair insurance.

For a very affordable monthly premium, each hair-insured individual will get:

  • A routine haircut on a monthly basis (with a co-pay), and when utilizing a participating salon, any additional haircuts will be 50% off (plus the co-pay).
  • Any “extras” like coloring, bleaching, perming, etc will be contracted with participating salons to offer you these services at a 40% discount.
  • A “Nail Care” rider can be added to your policy for a modest premium increase.
  • Each policy will have a “product benefit” that allows them to get certain brands of shampoo, gel, etc. every other month (additional products may be purchased more frequently from participating salon for 30% off the retail price.
  • For low risk individuals, baldness protection insurance can only be obtained by an in-person interview with the insured, both parents, and both sets of grandparents, and a blood test. High risk individuals can get follicle transplant surgery at a participating provider for an amazing discount.

Here is what the hair insurance companies will tell the stylists:

  • If you become a participating salon, we will drive a lot of traffic to your door.
  • We will reimburse you for half your usual fees, but you still get the co-pays and plus all this traffic we’re going to drive to your door, and sometimes people get their hair cut more than just once a month and you can collect up to 60% of your usual fees for any haircuts more than the benefit.
  • You won’t make any money from the reimbursement on the first sale of shampoo, gel, etc, but since we are driving so many people to your door you can up-sell lots of people to additional premium products but only at 65% of your retail price.
  • Since we are an insurance company, you will have to start keeping detailed records of every haircare encounter. If you do not keep the records exactly the way we want (and we are not allowed to tell you how we want them), then we have the right to refuse payment and fine you until you go bankrupt.
  • If a client complains about a lowsy haircut, we will withdraw payment for services rendered until dispute mediation has occurred.
  • If you do not send in the hair cut insurance claim forms with the proper procedure and billing codes, then you will not be reimbursed. If you call and ask why your procedure and billing codes were incorrect, we will tell you that by law we are not allowed to suggest the proper codes. If you try submitting random codes in the hope that you’ll find one we accept, then we’ll make sure you go to jail. We will not notify you for at least 30 days when we receive an incorrectly submitted claim form. We will not reimburse for properly submitted claim forms if they are received more than 30 days after the date of service.

Now here is what will happen to the market when haircut insurance becomes available:

  • Clients will be forced to sign a paper before their haircut stating they will not sue if they think they get a bad haircut. Any dispute will be handled by 3rd party mediation.
  • Hair care product cost and haircut fees will immediately double (and justifiably so because reimbursement is so poor and now they have to keep detailed electronic records of each haircut (client c/o hair being too long; wants to know if receding hairline and thinning crown area are good candidates for FRS [follicle replacement surgery]. Client desires “his usual #1 fade.” From previous notes I reminded him that he usually gets a #2 fade. He still persisted about wanting a #1, so after he signed the waiver, I proceeded with a #1 fade. I left areas around the crown slightly longer to compensate for thinning. I suggested combing forward to help with the crown. Advised against certain OTC hair re-growth Tx since they can lead to complications. I will refer him to the FRS specialist for consult. Co-pay is $10 and balance billed to Hair Insurance.)
  • Most big box salons will not be allowed to be participating salons, so they will undercut everyone’s prices to attract those without hair insurance.
  • Most people will just go to whatever salon that accepts their haircut insurance, but the salons that do accept it will go out of business because the insurance company rules are confusing so they never get paid.
  • The salons that accept insurance and stay in business specialize in coloring, perming, and bleaching because that’s the only way they can turn a profit while still accepting insurance.
  • Little old ladies will now only get their hair done once a month “because that’s all my insurance covers.”
  • Most men will have flakes in their hair from the gel they use, but they’ll put up with it “because that’s the gel my insurance covers.”
  • Most women will have dry, damaged hair because their shampoo and conditioner combination is cheap, but they’ll use it because “it would have cost more to upgrade to the good stuff. I don’t want to waste the insurance benefit for which I pay all those premiums.”
  • Most people will go around with a bad haircut.
  • Hair follicle replacement surgery will be advertised in the funny pages.
  • Upscale salons won’t accept haircut insurance, and they will be the only ones that thrive because they center their business about the quality of their work, their salon environment, and their excellent service.

Neckties and the Doctor

Neckties of doctors containing bacteria are old news; however, I saw a news report on it again this week. There are those who advocate the abolishing of neckties from the doctor’s office and hospitals. I won’t complain about that, but isn’t there another alternative to think about?

How come the necktie industry hasn’t come up with washable ties? In our day of space-age fabrics and technology, surely someone somewhere can manage to successfully market washable ties.

In Memory of D. Bret Ball

A friend and classmate of mine, Bret Ball, died yesterday, December 9, 2005 in his home. He was diagnosed with cancer 10 months after we graduated from optometry school. He went through many treatments, but the Lord saw fit to call him Home. He will be greatly missed, and I pray for his wife and family.

I first met Bret while in undergrad. It was outside the biology complex. Him and Nate (another PUCO 2003 classmate) are good friends, and I talked with both of them about optometry school aspirations. The first semester of opt school, there were 4 of us “Idaho Boys” that sat next to each other in the front row. I routinely sat next to Nate and Bret through most of opt school. We studied and practiced together. I was part of the crew that helped him move into a different apartment. He helped my family move when we left Oregon. We ate ribs, Bret’s favorite, to celebrate the end of a semester. Bret and Rachel have left many positive memories with my family. They are true friends.

I can say without hesitation that Bret was a very good man. He was a man of faith, family, and friends. He was also one of the smartest in our class. While the field of optometry has lost one of its rising stars, his impact will most be felt with family. I would ask any of you reading this blog to pray for Rachel and the kids and help the Ball family in any way you can.

Practice Names Never Used

Have you heard the Book Never Written jokes? Like, Under the Grandstands, by I.C. Butts.
Well, I was thinking of eye doctor practice trade names never written:

  • The Evil Eye Center
    Dr. Lucy Fuhr
  • Ojo Loco
    Dr. Nicolas Riviera
  • Center for Blindness
    Dr. Woopy A. Daisy
  • Spit in your Eye
    Dr. Toba Koe
  • Lazy Eye Clinic
    Dr. Couch
  • Potato Eye Clinic
    Drs. Ida Ho and “Spud” French
  • Crossed Eye Center
    Dr. Strawberry Mousse
  • Pink Eye World
    Dr. Moe Pink

Any others?

Bad cord management on Sonogage Corneo-Gage Plus 1AS

In my original review of the Sonogage Corneo-Gage Plus 1AS, I neglected to mention one of my pet peeves. First, please look at this picture closely.

Bad cord management on Sonogage Corneo-Gage Plus 1AS

It shows an unwound cord while the probe wrests on 2 black, plastic deals. It is very tedious to manually unwind the cord.

Vacuum cleaner companies long ago invented a way for cords to be quickly unwound by turning a knob that allows the cord to be released. Please, Sonogage, follow their example and put a turny-knob-thingy on one of the deals that holds the probe so I can quickly release the cord. The more I use this thing, the more I hate spending the extra 3 seconds to unwind the cord.

Review of Sonogage Corneo-Gage Plus 1AS

In my first review for Optoblog, I’ll focus on the most recent equipment addition to our clinic, the Sonogage Corneo-Gage Plus 1AS. There are a couple different versions out there, the “1” and the “2.” We somehow got the 1AS. I’m not sure what the AS stands for, but it might have something to do with not having a printer. Sonogage’s website isn’t clear on the different models available, and the complete set of features they list are only available on the “2.” We chose not to get one with a printer because. . .what’s the point? Just write the numbers down in the chart! A few years ago, the docs that used to work in my clinic chose to staple into the chart note the little printout from our ARx/AK instrument. The ink has faded beyond recognition, so in my opinion the optional printer is a waste of money, and I’ll detail another reason why later.

We’ve had our Corneo-Gage Plus 1AS 6 months, and it hasn’t required a recharge on the battery. In fact, the battery level indicator still reads 100%! Truthfully, we only been using it 1-2x per day on average, but still, the battery life is pretty impressive.

The probe has 50 MHz transducer, which is a big selling point because it’s supposed to be more accurate than lesser frequencies. Available on the “2″ is the ability to measure epithelial thickness. Sonogage states they are currently the only pachymeter that does this. Also, the “2″ has feature of automatic IOP correction instead of having to look at a paper table.

On the downside, the most glaring inconvenience is that the Corneo-Gage Plus requires pressing buttons 3 different times in order to turn it off. Sure, I can see how you wouldn’t want to accidently turn it off, but requiring two button pushes would be sufficient. Three is overkill and a nuisance.

Picture of Sonogage Corneo-Gage Plus 1AS

While the cord from the instrument to the probe is 4’10”, that isn’t long enough to reach from my counter to the patient in the exam chair. Actually, I could get one eye, but the other is too far away. Many doctors will not have this problem, though, since my exam lane is probably wider than average. I just have to set the pachymeter on my stool during testing.

I can’t imaging they can’t make the Corneo-gage form factor smaller, especially for those of us who didn’t get the extra printer option. After all, the Pachmate DGH55 is a little larger than a big pen. I assume the bulk of the Corneo-gage form factor is from the battery inside. (I’d love to open it up, but that would void my warranty.) Despite being shoe-box size, it is completely portable between our 4 exam lanes.

Now, I will explain why the printer option is a completely useless option that is a total waste of money. The Corneo-gage Plus is continuous read, so you put the probe on the cornea and stay there until you here 5 beeps. Then go to the other eye. In the end you would have 10 readings, the first 5 are for the first eye, and the last five are for the second eye. For each eye, you automatically throw out the first and last readings. The lowest of the middle three readings is the corneal thickness which you record. No averaging is required. That is why I see no point in getting the printer models because you only have to write down (or hopefully type) one number per eye in your chart.

Some might say that not having a “Right” and “Left” button for taking readings is undesirable. I answer that it’s easy to listen for 5 beeps then switch eyes. No fuss with having to press extra buttons. It’s a time saver, really.

So, why did we choose to buy the Sonogage Corneo-Gage Plus 1AS sight unseen and without a demo? Thomas and Melton, of course. Those two guys’ word is optometric gospel. In fact, to all the drug reps out there, don’t even bother coming to my office. If you want me to use your product, you need to convince Thomas and Melton- not me. Anyway, they endorse this pachymeter, and that’s good enough for me.

One of their selling points was a free table for corrected IOP from corneal thickness. I would expect it to come with any pachymeter, so it’s not a real selling point. Also this is information available for free from many sources, including Melton and Thomas’s website. Another selling point is that they used this pachometer in some study. Big deal. Other pachometers were used in other studies, and any ophthalmic instrument maker can donate a several thousand dollar instrument to some poor study. (By the way, we paid ~$2,500 for our pachometer. That’s the government price. It’s hard to believe they’re worth that much, but selling to ECPs is kind of a small market.)

Some very useful information came with our Corneo-Gage Plus. The instruction booklet was very clear, helpful, and comes with a handout entitled “Pachometry Reimbursement Codes” to help you know how to bill. The guideline for billing pachometry is if there is “a reasonable expectation that the outcome of corneal pachometry will impact decision-making in the medical management of the patient.” So, every glaucoma suspect in your office needs this, and they will allow anyone with a c/d over .3 or elevated IOP to be a candidate for pachometry.

While following corneal disease, like Fuch’s, bullous keratopathy, or corneal edema, you may bill for every pachometry reading as long as you documented in your original plan of care the need for repeat pachometry. Reimbursement assumes a bilateral procedure, so don’t try to bill for one eye at a time. Just plan on always taking readings from both eyes. Medicare only reimburses a small amount (~$12) and only once in the lifetime of the patient with glaucoma.

So, your pachometer is not a money-making machine, but it is standard of care now. We should all have one, unless you are satisfied to be practicing like a commercial optometrist in the back closet of an optical shop whose only care is to sell more glasses. (Seriously, I interviewed for an optical chain which shall remain nameless. They had several locations all within one state. When I asked where the visual field machine was, he said none of the 16 locations except one had a visual field instrument. So then I asked how much disease they see. He replied something like, “Oh, the people who come see us don’t have much disease.” Right. Or maybe it’s just that you don’t look because your 10-15 minute exams don’t allow enough time to find any problems. And what’s the deal with having an exam “room” the size of a thimble and a curtain instead of a door? What are you- the wizard of Oz?)

Anyway, thumbs up for the Sonogage Corneo-Gage Plus 1AS (no printer). If I did a lot of LASIK co-management (or CRT?), I would opt for the “2″ for it’s epithelial thickness measuring ability. If fact, I would tell everyone to opt for the “2” anyway because it has the feature where you press a button on the selected measurement, and it tells you the adjustment number to find true IOP.

Ode to Subway

I’m going to depart from my optometry theme to sing the praises of Subway. I’m also going to admit to the whole world one of my most deepest, darkest secrets. One that sometimes alienates me from the rest of humanity.
I am not a sandwich eater.
I think it’s the texture, mostly. I can’t reconcile it. It seriously grosses me out. My wife, of course, is a normal person who eats sandwiches and loves to eat at Subway. When we spring for fast food, she always wants to go to Subway. I have to go across the street to some fast food place to get chicken nuggets (I don’t get a burger because that, of course, is a sandwich).
Enter Subway’s recent addition of toasted subs. Several years ago I forced myself to try a pizza sub because I like pizza, so I was hoping it would be similar. Wrong. The coldness of it all changes everything. Now, with toasted subs, it tastes and feels just like a pizza. It’s delicious!
Now I can stay by my family while ordering food. My family spends more time together because of Subway’s toasted subs/pizza sub.
I love Subway.
To Subway owners, please make sure pizza subs are on the menu in your store. You never know when I’ll travel outside of my home town and need a hot, toasted pizza sub.