Glasses - What's the process??

[rents]

Hi,

I'm new to this group. I am on ODSP. I've been reading some of the
postings on this site/by this group and I have found the information
helpful and informative. I thank everybody who has posted for sharing
their ODSP experiences for these reasons!

I'm hoping someone can give me direction on this issue: I am in the
process of requesting the Vision Care Benefit: I need new glasses.

I have read "Directive 9.14 Vision Care Benefits." I do qualify. What
I don't understand is how to actually get the coverage??

It says on the COMSOC website in an article entitled "Health benefits:
Vision" (see:
http://www.mcss.gov.on.ca/en/mcss/programs/social/directives/directives/ODSPDirectives/income_support/9_14_ODSP_ISDirectives.aspx)
to "contact your local Ontario Disability Support Program office and
ask for a Vision Care benefit authorization form."

I did this and received a letter back from my workers saying "your
request for Optical coverage under ODSP has not been approved because
you have not submitted a prescription for eyewear to the office."

I may be misunderstanding. Do I need to take a Vision Care benefit
authorization form to the place that I purchase the glasses from? Or
can I make the purchase and simply submit the receipt to ODSP? Also,
is my worker correct in her handling of this? I don't think so. I'd
appreciate input from people who have been through this process.

Thanks again!

rents

[erekale...@gmail.com]

Your office is requesting you get the test done first to approve you are
eligible so you don't go get glasses made and find out you are not covered I
guess....

I believe you take the form back to get approval and they give you a form to
take to the optician...

Years ago I found someone who operated out f their home and was very
competitive.....Costco is sometimes very competitive when things come on
sale - I got my eyewear there at 80% off - right time and right place for
me.

Whatever you do do not purchase first - some of things they will not cover
unless you get approval first

[Atb]

Alright, first things first, welcome to the group. I'm glad you've
found our posts interesting & useful. Hourly we can continue to
provide helpful info. In terms of getting coverage for glasses it
shouldn't be too hard assuming you have all your ducks in a row.

You start by seeing a eye doctor, if you bring your drug or dental
card (some will accept a copy) to the doctor then the exam is free.
The doctor gives you a prescription for the type of glasses you need.
If you need something special make sure the doctor specifies exactly
what & why on the prescription. For example I need transition lens
with extra dark tinted clip ons because of extreme light sensitivity &
unbreakable frames/lens because of falls, seizures, motor difficulty,
etc. so my script says that plus the numbers. Its important because
they cover alot less for basic glasses. If you just need basic no
frills single vision glasses then you are held to the jurisdictional
limit for frames & lens. If you require special glasses like me then
they pay for the lowest actual costs.

So once you have your script, you look around to find a place that has
the glasses you want for the best price. If you are getting basic
glasses then you don't need quotes but if you need something special
you usually need to submit 3 quotes & they will pay the lowest. Once
you have your script & know where you are buying your glasses, you
contact ODSP to obtain an eyeglasses preauthorization form, they
usually require a copy of the script before they will give you the
form that says you're approved.

In most cases once you submit a copy of your prescription they will
approve you within a few days, in some cases the same day even. You
can have the form mailed to you or you (or an authorized person) can
pick it up from the office. You take that form with your prescription
to the store you intend to buy from & order your new glasses. You can
theoretically choose any store but cost is likely a factor. If you
want you can get something that costs more then the provided coverage
& pay the difference yourself. For example I go somewhere that has 2
or 3 for the price of 1 specials & I pay the extra 30 or so dollars I
can get an extra pair of glasses.

Once you pick out your frames, lens & any extras, the store will take
your paperwork & order your glasses. Once you receive your completely
completed glasses & are completely satisfied, then & only then do you
sign the form indicating you have received the glasses & are satisfied
with them. Its very important you don't sign the form beforehand
because you give up your rights & the only power you have since they
don't get paid until you sign. Almost every time I've done this the
stores gave tried to get me to sign the form when I ordered, long
before I got the glasses. Its not right but it is pretty common. Once
you've got your glasses & are happy with them, you sign the form. You
get one copy & the other two are for the store & ODSP. The store is
then responsible to submit the paperwork. After you sign you've done
everything you need to do.

Basic coverage is pretty lean, last time I checked around $100 for
frames plus the cheapest lens. Also ODSP will only pay for glasses
with a 3 (I think maybe 2) years warranty. NEVER, ever buy & pay for
something before you have been approved & told to proceed. In almost
all circumstances if you do, ODSP will refuse to pay you back for it.
So never buy something assuming ODSP will pay for it. Generally
speaking ODSP will approve any eligible person for new frames/lens
every 3 years with replacement kens every 2 years or as needed if a
significant change has occurred to your vision. There are exceptions
of course, if your glasses are lost, stolen or damaged & enough time
hasn't passed then the ODSP workers have the discretion to approve
despite being too early. Contacts or other specialty products in
limited circumstances can be covered based on a documented medical
need each time they are needed.

Hopefully this helps you & is what you are looking for. To recap,
first you see the doctor, get the script, obtain any needed quotes,
submit a copy to your caseworker, get approved, receive the
preauthorization form, take the form to the store, pick your glasses,
place your order, receive/inspect your new glasses, sign the form,
take your copy, settle any remaining costs & then enjoy your new
glasses.

ATB

[rents]

Hi ATB,

Thanks for the reply and information! This is one of the reasons I
joined this group: to benefit from the experience of others.

Appreciate your tips:
- submit eye script to worker before buying frames & lenses. I would
have made bought them and then submitted. I may not have been
reimbursed.
- do not sign form until make sure glasses are correct and everything
is good.
- have the script specify exactly what I need so I am reimbursed and
not just for the basic.

Thanks again! I will follow your advice because I think it's prudent
however I don't agree with the other poster that my office is making
the request to make sure that I'm covered. I think ODSP is being
obstructive: I'm able to assess and make a decision as to whether or
not I am eligible. If I'm not it's no loss to ODSP: they don't pay-
out. As above, I've read the "Directive 9.14 Vision Care Benefits."
There is nothing in there that says I need to submit anything to
ODSP.

ODSP knows that the more steps in the process and the more restrictive
the process is, the harder it is - and especially so for the disabled
- and as a result fewer people will make it through the process and
they save money (by ripping people off).

I'd appreciate some views of others on the latter. Thanks again!

Rents

[StarTears]

Appreciate your tips:
- submit eye script to worker before buying frames & lenses. I would
have made bought them and then submitted. I may not have been
reimbursed.
- do not sign form until make sure glasses are correct and everything
is good.
- have the script specify exactly what I need so I am reimbursed and
not just for the basic.


>

> Basic coverage is pretty lean, last time I checked around $100 for
> frames plus the cheapest lens. Also ODSP will only pay for glasses
> with a 3 (I think maybe 2) years warranty. NEVER, ever buy & pay for
> something before you have been approved & told to proceed. In almost
> all circumstances if you do, ODSP will refuse to pay you back for it.
> So never buy something assuming ODSP will pay for it. Generally
> speaking ODSP will approve any eligible person for new frames/lens
> every 3 years with replacement kens every 2 years or as needed if a
> significant change has occurred to your vision. There are exceptions
> of course, if your glasses are lost, stolen or damaged & enough time
> hasn't passed then the ODSP workers have the discretion to approve
> despite being too early. Contacts or other specialty products in
> limited circumstances can be covered based on a documented medical
> need each time they are needed.
>

i just recently got new glasses and the basic amount for frames that ODSP gives is apparently $43 and that is a province wide amount.  if you get more for frames you are lucky. most optical places will have a selection that are for people in low income.

if you need transitions or clips for your glasses [so they become sunglasses as well] you MUST have this on the prescription and it specifically say this.  it should be standard to get transitions due to the harmful effects of the sun on your retinas but hey, that'd be proactive prevention here.

thirdly, lensecrafters has a policy to give ODSP/OW people great deals on their frames.  they absorb part of the costs for frames personally.  you can choose ANY $129 priced frame [i think its that it could have been $149] and its not as limited.  they were really good for the pair i just got and they will always fix or adjust for free.

star 

[Uppity Woman]

This amount hasn't changed in 20 years,  you'd think they'd increase it. My optometrist has glasses and frames within the ODSP amount, they don't look the best but I don't much care since they are only reading glasses, which I mostly wear at home. If I wore glasses all the time, I'd be looking at paying out of pocket to get nice frames. My big complaint is they frame styles, it's so hard to find ones with BIG lenses, I do not want to look out of a pinhole. Which is why I had to settle for ones I otherwise likely wouldn't have got otherwise, to get the larger vision field.   Uppity   -------Original Message-------

[Atb]

I'm not sure what to say because I only once got basic coverage for my
glasses & that was about 9 years ago while I was on OW waiting to be
approved for ODSP. At that time they told me that the maximum basic
amount for frames was $95, it might have changed since or its possible
they weren't supposed to pay that much but did so by accident. All I
can say is they covered $95 worth of the frames & I paid another $50
something. I do agree that whatever the basic amount is frames, that
amount is supposed to be universal across the province.

I also agree that whether intentional or not, the process for getting
coverage of our mandatory or discretionary benefits is designed in
such a way that many people are simply not able to complete said
process which forces them to do without, pay out of pocket for
something they can't afford to pay for or not get the full amount they
are entitled to under the law. It superficially does in some very
unethical ways decrease the costs of running the program but that
didn't make it right nor does it always save money in the long run.
However the step in the process where you provide a copy of your
eyeglasses prescription before getting the preauthorization form is
theoretically meant to be used to determine exactly what amount is
going to be covered & how to correctly complete the preauthorization
form. It isn't & shouldn't be used as a way to delay, avoid or defeat
the recipient's rights &/or abilities to obtain these rights. Though I
do believe there are cases where it is used to add a stumbling block
to decrease the likelihood of having to pay out the benefits the
person is entitled to.

I do understand why ODSP staff require the prescription prior to
authorizing since its the only way they have to determine exactly what
amount to authorize. Thus that particular step isn't inherently a
intended stumbling block though it does have the ability to become one
in the hands of an unscrupulous person.

ATB

[justice4odsp]

I have found that, as long as I remember to do the order right, I can make a prescription for 1 pair of glasses work find when meeting the requirements for ODSP. Star's right about getting extra details on the prescription if it is needed, but remember, the one question ODSP might ask is, can you prove there is a medical need?  I had the prescription from the eye-doctor that said there was a medical need when I recently needed to get 2 pairs of glasses, not one, but ODSP rejected it.  It's a long story, which many on this forum know about, so if you want to read more about how it eventually had to go to the SBT while I waited for 4 months, please read More Costly Mistakes in the ODSP Office on my Blog. To read other ODSP related Blogs and see a video of me talking about ODSP, go to http://www.wheelchairdemon.blogspot.com instead. 

As for finding good frames, I've found that my Optician has end-of-line frames that he will let me pick from or choose to pay extra for in installments.  The big chains won't let customers do that. The small businesses, like David's Optical that I use here, often will because they know you will spread the positive word and it will bring them more business.

As for getting the forms, I found what works best is to get the prescription, take it straight to the ODSP office in person (they need to see it), wait while they fill the forms out, and then take the form and the prescription to your optician of choice.  I've never had to get estimates before. Is this something new?

Once you get the glasses, sign the form, give it back to the optician, and they will mail it in for you... at least that's how it works for me.

When I used to go to Lenscrafters, my experience wasn't so good.  The main problem I had is I wear bi-focals (tri-focals now) and they kept misaligning the reading lens with  where my eye naturally wanted to look to read. For 5 years I couldn't, for the life of me, understand why I was never able to get used to bifocals... and then I met David's Optical. I could instantly see and I've had no problem adjusting to prescription changes ever since. 

justice4odsp

[Atb]

Justice as I said, though I might not have been clear enough is you
only need estimates if you are getting something beyond the basic
coverage, like in my case.

ATB

Btw you are right about the fact that small independently owned &
operated businesses tends towards being significantly better then
chains though it isn't always the case. The same applies to
optometrists' offices that sell glasses directly. If I didn't need to
get at least one extra pair I would most certainly just get it from my
optometrist or local small business, since I generally prefer to
support said businesses then big box or chain stores.

[StarTears]

I have found that, as long as I remember to do the order right, I can make a prescription for 1 pair of glasses work find when meeting the requirements for ODSP. Star's right about getting extra details on the prescription if it is needed, but remember, the one question ODSP might ask is, can you prove there is a medical need?  I had the prescription from the eye-doctor that said there was a medical need when I recently needed to get 2 pairs of glasses, not one, but ODSP rejected it.   

the medical need for transitions though is pretty easy,  you get migraines or bad headaches because you are light sensitive.  your case louise is the stupidity of the kingston office and no one doing their flipping job at all.

remember ultimately that this is a major purchase for any chain or mom/pop store.  YOU are still a customer and can demand a different clerk and good treatment despite who is paying for the glasses.  lensecrafters will also do up your glasses for you within a week and wait 90 days for payment from the government.  i must say i was impressed.

in ottawa you can only deal with specified vendors [venzia opticians] , no choices of anyone who sells.  i got some designer frames last time but they barely lasted.  they were nice frames though.  thats how most places do their cheap frames for us- they are end of the line or discontinued styles.  lensecrafters gives you pick of the lot....plus they cover $129 no matter what. so you like a style that is $199 you'd pay only the extra $70...not such a bad deal.

star

[Atb]

Btw justice or wasn't aware of any cases where ODSP would pay for
multiple pairs of glasses. Did you win your SBT hearing? If so did the
ministry choose to appeal the SBT's decision?

Sorry for hijacking your post rents. I'm just really curious about
this. Thanks in advance for being understanding.

ATB

[justice4odsp]

I won.  Here is the story (if you don't want to read the whole thing, just read the bold text):

More Costly Mistakes in ODSP Office

I just went through a 4 month nightmare to get glasses. I wear tri-focals and they work great for just about everything. However, they're useless to use in stores where price tags, sizes, and the other things I need to look at, are way above my head because I use a wheelchair. I can't tip my head back far enough to see out of the right tri-focal lens. This means, I need 2 pair of glasses; the second being bi-focals that have the mid-range and reading lens combined.

I knew I needed a letter to prove medical need, so the eye-doctor wrote it right away and I gave it to the ODSP office. I also offered to get a second letter from my Family Doctor to explain the extent of the neck problem.

ODSP said they didn't need the second letter but if it later turned out that they did, they said they would call me and ask for it. They didn't. Instead they rejected the application because I didn't prove there was a medical need.

I asked for an Internal Review, and I again offered them a letter from my Family Doctor. Again, they wouldn't take it, and again, they rejected the application to buy a 2nd pair of glasses.

I now had to go to the Social Benefits Tribunal if I wanted to get them, so I applied and then waited 3 months for the case to be heard. It was supposed to take longer, but because I agreed to take part in an early resolution conference, the time got boosted up by a few months.

In the early resolution conference, I read the letters from the eye doctor and family doctor. By this time, I had a hard copy of a letter from my Family Doctor because I figured it would eventually come in handy. If it didn't, I would throw it out.

They asked why I didn't give them those letters in the first place. I told them the office said they weren't needed; that the one from the eye-doctor was enough. The Tribunal told me to fax both letters to the Kingston Office. I did.

The Kingston Office then phoned to say they needed another copy of the prescription; one that was the exact prescription for the 2nd pair of glasses. I knew the original prescription prescribed 2 pair of glasses, but to humour them, I phoned the eye-doctor and asked them to send another prescription; this time for the 2nd pair of glasses only. They sent me a copy of the original prescription, the one that prescribed 2 pair of glasses.

Frustrated, I went down to the place where I would be filling the prescription and I asked them to explain to me how to read and interpret the prescription. My intention was to go to the ODSP office, figuratively take them by the hand, point out the relevant lingo for each pair of glasses, and then hope that they 'get it'. Thankfully a 2nd worker at the local ODSP office was brought in to help on the case, and she knew how to read the prescription. However, it's not over yet.

The Kingston office then called to say they needed the letters from my doctors to prove there was a medical need. I told them they had them; that I handed in the letter from the eye-doctor twice, and I'd faxed them a copy of the letter from my Family Doctor once. They said they didn't have them; that I would need to fax them in again. I couldn't believe it. I took up the a habit about a year ago of phoning them immediately after sending a fax so I could make sure the fax had been received and that it was legible enough to read it. I wanted to remove any doubt in my mind about whether they had received it or not. This time was no exception so I knew it was there. Besides, after receiving the fax with the medical letters, my worker had phoned me to ask questions about it.

Therefore, when I was asked to fax it yet again, I refused. I said it was too much hassle to put the wires back into my computer so I could connect the dial-up modem. (I have an external dial-up modem that's a lot easier to connect, but I wasn't going to tell them that). I told her to look for it on Marjorie's desk. Marjorie is my worker.

They phoned back a short while later and said that they found it. It was not on Marjorie's desk. It was in another folder. They then approved the glasses and offered to mail the approval forms to me. Finally, after all this, I have what I need. I can go down to fill the prescription as soon as I can book the Access Bus.

In the meantime, I have questions; lots and lots of questions.

For closure I got a final letter from the Social Benefits Tribunal that says,

The above-referenced appeal concerns a decision of the Director, Ontario Disability Support Program to deny the Appellant's request for a vision care benefit to cover the cost of a second pair of eyeglasses.

Following an Early Resolution Process teleconference the Appellant provided the Director with verification that the second pair of glasses were required for medical reasons. As a result of the information the decision has been reversed.

It is my respectful opinion that the issue in this appeal has been resolved.

This letter basically absolves them of all responsibility, makes it look like I failed to give them what they needed, and now people are back to blaming me for the mess. This happens all the time and I'm sick of it. Yet, despite my best efforts to get the local office investigated so these mistakes can be fixed once and for all, it appears that there is nothing I can do.

I can handle the 800 rules for ODSP and, in fact, I am often educating them by printing the directive and taking it to them, but I can't handle being effectively blamed for the amount of incompetence that goes on at their end. A letter of apology, or one that at will admit that ODSP didn't take the letters and then later lost 2 copies, would at least restore my reputation and dignity. As it stands now, service providers and others blame me for being the master of my own demise because I supposedly didn't give ODSP what they needed.

NOW FOR A QUESTION:

How many others have to deal with the fall-out of mistakes like these?

Can anyone suggest how to get the ODSP offices investigated, or who to share the proof with, so they will clean up their act?

The rules are bad enough, but the bungling is worse.

When you think about it, it was very costly for the government to clean up this mess. For this case alone, they had to pay extra wages for 2 people in the Local Office, 1 person in the Regional Office, 3 people at the Tribunal and an Investigator. I was mailed a 20 page legal document that explained why the Kingston Office turned me down and then included the legal rationale, so I suspect a lawyer might have been involved as well. All these costs could have been saved, if the ODSP office just took the letters that I offered them and proved there was a medical need.

I want to know if this problem is widespread or unique to Kingston.

I will close by saying I am thankful for ODSP and, for the most part, I can survive on it. I just can't deal with the stress of these mistakes because when they happen too often, they come close to sending me into a depression again. I can't stand having to do extra work to fix up their mistakes, and I can't stand losing my reputation by being effectively blamed for the mistakes by ODSP with their diplomatically worded letters. It's time they stop the blame game, accept some responsibility, and fix the mistakes.

With any luck the new AODA (Accessibility For Ontarian's With Disabilities Act) Customer Service Law, that is now enforceable for the public sector, will one day catch the mistakes and put an end to it because this is not, what I call quality, or even fair and respectful, customer service.