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**Reggie** · 13-Oct-2006, 11:49

I live in Toronto so whenever I visit a dr in the states I have to pay out of pocket. Things have been so desperate that within the past two months I have visited New York and Boston and have seen by both Dr. Latkany and Dr. Jacobs. Dr. Latkany seems very knowledgeable on the subject of dry eye, he is very compassionate, and I highly recommend him. Dr. Jabobs examined me with Dr. Rosenthal for the Boston Scleral Lenses which they did not feel was suitable for me (I feel they may have given up on me prematurely). When I asked them if they could recommend any other courses of treatment for my condition, they pretty much pushed me to the side, and left me disappointed. I have heard nothing but good things about the BFS so I was very surprised. That was my experience with both of the doctors but I hope others share their experiences with you so can determine whether it's worth the travel and money. Good luck.

**Lucy** · 13-Oct-2006, 12:26

Jellybean, just a general observation by me which has nothing to do with specific doctors...........

It is common for any doctor to be non-participating provider with any given HMO. I recently had to visit an oral surgeon and was told upfront I'd have to pay cash for his services as he was a non-participating provider. They did file the insurance papers for me and I was reimbursed directly by the insurance company for about one-third of the costs. I needed/wanted this particular doctor, so I bit the bullet and opened my pockets.

It is very frustrating to know what to do. If you feel strongly about seeing a particular doctor, I'd pay the price and not try to weave in and out of insurance policies. Something seriously could go wrong (nothing to do with your eyes) and you might be caught in a not-so-good position. Probably everyone reading this will have a different opinion. We will see this more and more as medical insurance tightens up. It has been happening for the past 10+ years and is reaching new heights. Not good for the patient or the doctor.

Looking at your comments about being self-employed, it is probably good to pay out of pocket. Good luck.

**Rebecca Petris** · 13-Oct-2006, 14:00

I have a lot of respect for both Drs. Latkany and Jacobs.

Reggie, I don't know if you saw Dr. Jacobs just in the context of an evaluation for sclerals or if you scheduled a separate appointment for her as part of her own cornea practice. To get a thorough workup with general recommendations it would mean the latter. I am sorry you did not have a good experience but I think that if the context was an evaluation for sclerals, from their standpoint I would guess that to have been the purpose (as that is the focus of the Foundation) of the examination, as opposed to providing a broader service of investigating all your dry eye treatment options. Can't speak for them of course, just trying to offer perspective on possibilities.

Jellybean, just some stray thoughts: Some of the things I look for personally in a doctor is that they are thorough, methodical and conservative; that they are not overly focused on one specific treatment methodology (the you're-a-nail-for-my-hammer approach already discussed); and that they consider lifestyle factors, natural treatments etc. in addition to the conventional therapies. I am not personally affected too much by the range of tests they do but rather the quality of the tests they do perform and how they use the information they get. I also do not place nearly as much emphasis on how much is accomplished in a single examination as the methodical approach to prescribing therapies and evaluating results over time. Chronic dry eye is a complex puzzle and I don't personally believe it can often be sorted out quickly no matter how skilled the physician So, my expectations from a consultation from a specialist might well simply not match those of other patients.

**Delilah** · 13-Oct-2006, 18:46

Strings Are Getting Worse

Hey everyone, I thought I'd just drop by to tell ya'll that my mucus in my eyes is getting worse? At work I am constantly pulling these mucus strings out

Does anyone know if any new drops have came out for MGD? Im so sick of this, I am not sure if this is the right spot to relieve my self pity but I am just in agony. On the 27th I go in for my big foot operation

I am just wishing I could get some new Meiboiman glands lol. Hope everyone is doing good and sorry I don't post as often but work has me chasing my tail round and round. God bless your friend D

**Lucy** · 13-Oct-2006, 22:20

Delilah-
Here's hoping for some mysterious reason that the anesthetic you have while having your foot surgery will just stop those damn strands in your eyes! Maybe even give you new meibomians, too. One can always imagine.

**Delilah** · 15-Oct-2006, 00:50

Made Me Laugh

Lucy that was funny lol, but wouldn't that be something huh, I'll ask Dr. Howard when I go in to get my foot surgery just for the giggles lol. How are you doing? I just put my Muro 128 drops in and now Im ready for bed

Take care D.

**kitty** · 15-Oct-2006, 08:45

Back to the topic of Insurance....

Looks like this thread got a bit off track from the original post. At any rate, I will always pay out of pocket if I cannot find an in-network provider that meets my needs. I have also been known to complain to the insurance company about the quality of their providers. In fact, my vision insurance carrier contacted me and wanted to know why I went to an out-of-network provider. I told them that my previous visit with an in-network provider failed to diagnose my DES, and that I refused to pay even a nominal co-pay to go to any doctor who was more interested in selling me contacts and glasses than was interested in the health of my eyes.

Keep in mind that if you itemize on your taxes, out of pocket medical expenses are often tax deductible. So be sure to consider that when calculating your out of pocket expenses.

**neil0502** · 15-Oct-2006, 09:23

I'm with Kitty....and it's not because I have unlimited resources....it's just that--if I HAVE reached the point where I think a doctor is worth my time and trouble--I do whatever it takes to see that person....including my trip to Dr. Baudouin, in Paris.

The original question is a good one, but keep in mind how different each person's situation will be for this particular issue: severity of the problem, limitations that the problem imposes on the person's life, financial resources, financial demands, etc., etc., etc.

I've been working this eyeball thing (not just the ocular surface stuff) for decades, literally, so....I've decided that--when it comes to the appropriate "expert--" it's really not a matter of choice. I have to do what I have to do. Usually something else has to give.

All the best,

Neil
Who has access to a laptop at a hotel in Coimbra, Portugal for the next two days

**jellybean** · 16-Oct-2006, 11:31

Thanks everyone for the very helpful feedback. I will bite the bullet and go see Dr. Latkany, he sounds worth it. Too bad I'm semi-unemployed, hopefully I won't need too many follow-up visits!

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