I am Moving to Wyoming

Hey everybody,

I am giving you my two weeks notice that I will no longer be working inside the North Logan Walmart Vision Center. I expect my last day seeing patients here is Saturday December 13, 2015. I found a job with the Indian Health Service in Wyoming.

I understand the district manager for Walmart vision centers in the Northern Utah area is already in talks with some optometrists to take over. When I know who it is, I will contact him/her about negotiating a transfer of patient records.

It has been a great eight years, and I have worked with great people inside this Walmart. My family and I will miss Cache Valley. My new employer offers many attractive benefits like retirement and student loan repayment.

I will maintain this website URL for 2016 just in case you need to contact me.

Sincerely,

David J. Langford, O.D.

Now Participating with Aetna (but don’t get too excited)

A few years ago, I tried to become a participating provider with Aetna, but I was told the panel was closed. Recently, Aetna and Altius/Coventry have begun the process of merging. Since I am an Altius/Coventry provider, that makes me automatically an Aetna provider as well, BUT only on certain plans.

For routine vision coverage, Aetna farms the benefit out to a third party called EyeMed. I am not allowed on the EyeMed network since they are owned by Lenscrafters.

Sometimes your medical policy with Aetna might include a routine eye exam, but for me to be able to accept it, you need to make sure that I am assigned to your Aetna panel. The full list is here (click the “Plan and Network Information” tab), but the main ones are:

  • Aetna Choice POS (Open Access and Aetna HealthFund)
  • Aetna Health Network Only (Open Access)
  • Aetna Health Network Option
  • HMO (Open Access)
  • Aetna HealthFund Aetna Health Network Only/Option (Open Access)

If you are with Aetna, the easiest way to tell which eye doctors can take your panel/plan is to login to Aetna’s website doctor-finder.

Utah Medicaid Changes

I am a Utah Medicaid provider BUT if you elected to allow a managed care organization to administer your Utah Medicaid policy, then you need to find out some information before you call to schedule an appointment.

When you look up your policy information, find where it says “Coverage Information” and then “Health Plan”. If the health plan is:

  • “any Utah Medicaid provider” Yes I can bill for routine eye exams and medical eye visits pertaining to your eyes.
  • Health Choice Utah” No. I cannot perform any exam if you are on this plan.
  • Healthy U” No. I cannot perform any exam if you are on this plan.
  • Molina Healthcare” Yes* I can bill for routine eye exam since this benefit is administered through March Vision, which I participate with. *However, I cannot bill for Medical eye visits (red eyes, painful eye, etc) since that would be billed to Molina, and Molina does not allow optometrists on their panel.
  • SelectHealth Community Care” No. I cannot perform any exam if you are on this plan because SelectHealth does not allow optometrists on their panel.

Why does Molina and SelectHealth not allow optometrists on their panel in Cache Valley? The only reason I can think of is that their organizations are prejudiced against us1. They are run by MDs who only want to help other MDs. I think it is unfair for a state-run health program to allow the businesses they contract with to exclude optometrists from their panel. Other states have “any willing provider laws” to counter such cronyism and prejudice.

Please contact your state legislators and ask them to amend Utah Medicaid rules to only support Managed Care/ Accountable Care Organizations that allow any willing provider to be paneled. You can send them this link.

Footnotes

1. They cannot be excluding eye care from optometrists because we are more expensive to pay claims than ophthalmologists. Quite the opposite because ophthalmologists’ exam fees are universally higher than optometrists’.
They cannot be excluding optometrists because of lack of interest. I and several other optometrists have tried to become paneled with SelectHealth, and they always turn us down.
It cannot be that optometrists are somehow less able to give eye care services because #1 look at our training. It is excellent. #2 SelectHealth allows optometrists to be paneled in rural areas, but not in the Cache Valley to Provo corridor. Optometrists practicing in St. George, Vernal, Tremonton, or Preston are allowed on SelectHealth, but optometrists in Cache County with the same training are excluded from participating.
No good reason exists, so we must assume their reason is irrational, or more likely, based on cronyism and prejudice.

How to Submit Out of Network Claim to Your Insurance

I am no longer taking BlueCross insurance, and there are several other insurances that I can’t take, so I wanted to walk you through the process of getting reimbursed from your insurance company.

First, I still take several insurances on this list.  If yours isn’t on the list, many insurances will allow you to be seen by an out-of-network provider (with the notable exception of SelectHealth).  Your reimbursement will usually be a little less than an in-network provider visit.

When you go out-of-network, you pay for your eye exam and save the receipt.  Then you fill out your insurance company’s Out-Of-Network Claim Form and mail it in along with the receipt.  You should receive your check in the mail within 2-3 weeks. Here are some of the more common claim forms:

For others, you may need to call your insurance company or go on their website to find out if they allow going out-of-network and if so, whether there is a special form to send along with a receipt.

Allergy Eyes

Allergy eyes usually present with itching and redness and may include watering, stringy, mucous discharge, and even light sensitivity. Allergy eyes are serious because eye rubbing can worsen degree of astigmatism and keratoconus. Scarring from AKC and VKC can cause loss of vision or blindness!

Main Types:

  • Seasonal Allergic Conjunctivitis (SAC)
  • Perennial Allergic Conjunctivitis (PAC)
  • Atopic Keratoconjunctivitis (AKC)
  • Vernal Keratoconjunctivitis (VKC)

Tips for helping with allergies:
Look at your gut, specifically your large intestine. Bad microbes in your intestines release copious amounts of histamine and neuropeptides which bind to mast cells in your mucous membranes, causing more histamine release. The net effect is worse than simply exposure to allergens like dust or pollen. You have bad microbes over-running your gut because of past antibiotic use, chronic aspirin/ibuprofen use, and the Standard American Diet being so high in carbohydrates. In addition, carbohydrate metabolism is also inflammatory. Also limit Omega-6 oils (most vegetable oils) and yeast. Begin an Atkins/Paleo/LowCarb diet and take probiotics along with fermentable fiber.

Non-Pharmaceutical- limit allergen exposure:

  • Run a high-efficiency particulate absorption (HEPA) filter 24/7 in bedroom and other rooms where you spend time.
  • Wash hands more often.
  • Showering and washing or rinsing the hair at night before bed minimizes the allergen load that may be in hair.
  • Wearing sunglasses to protect the eyes from additional allergen loads while outside.
  • Although difficult, avoiding eye rubbing because it mechanically induces histamine release from mast cells.
  • Many people are allergic to dust mites which accumulate in pillows and bedding. Use hypoallergenic bedding, change your sheets frequently, and wash them in hot water. Put your pillow in hot dryer for 20 minutes to kill mites.
  • Keep the windows and doors closed at home; take shoes and outerwear off at the door. Consider replacing carpets with wood/laminate flooring. No pets in your bedroom.

Non-Pharmaceutical- ease symptoms:

  • Refrigerated Artificial Tears 4x/day
  • Cold washcloth for 10 minutes, 3-4x/day

For Contact lens wearers:

  • Switch to daily disposable contacts.
  • If using a two or four week lens, stop using multipurpose solution and begin using Clear Care system.
  • Consider severely restricting wear time or altogether discontinuing contact lenses certain times of year.

Pharmaceuticals:
Never use “get-the-red-out” or decongestant eye drops (tetrahydrozoline, naphazoline, phenylephrine) because they only constrict the blood vessels, making them look less red, but not treating the problem. Chronic use will cause inflammation and rebound hyperemia because the blood vessels widen out, and your eyes look more red than they would have.

Duel-acting antihistamine/mast cell stabilizers:

  • OTC ketotifen (Alaway, Zaditor) 2x/day
  • Rx Pataday or Lastacaft are 1x/day while Rx Patanol or Bepreve are 2x/day.

NOTE: If using contacts, apply first dose ten minutes before insertion. Second dose ~10 hours later applied over top of lens is usually okay as long as replacing contacts on manufacturer recommended schedule.

Weigh carefully whether to take an oral antihistamine (Claritin, Zyrtec, Allegra, Benadryl). Use more than four days can dry out your eyes, making inflammation and itching worse. If you also get allergy nose, ask your doctor about Flonase nasal spray.

Steroids:
Rx Alrex 4x/day or (Rx Lotemax for severe cases). If taking a steroid eye drop, you should have a follow-up visit after two weeks to check for possible side effects like eye pressure spiking. Refills are usually not needed because of transition to Alaway/Patanol/Lastacaft/Pataday once the eyes are calmed down.

For severe cases of allergies, consider referral to an allergist or immunologist. They can help identify the exact allergen causing your reaction. Immunotherapy exists to help your body develop tolerance to certain allergens; however, in my opinion, changing to Paleo/Atkins/LowCarb diet and taking probiotics along with fermentable fiber will probably be more effective and less costly.

I Will No Longer Take BlueCross Insurance Soon

Effective June 26, 2014, I will no longer be an in-network eye doctor for BlueCross BlueShield plans. If you have BlueCross, I still value your patronage and hope I won’t lose your support.

If you have BlueCross through Utah State University, you can send in your receipt and get 70% reimbursed for a routine eye exam done out-of-network. Not bad.

Other BlueCross beneficiaries will have to examine your own policy to find out how much reimbursement you can obtain for going out-of-network. Most BCBS plans don’t reimburse for the contact lens evaluation part, but it varies. Also, your reimbursement might be different for a medical visit vs a routine eye exam visit. Consult your policy.

If you are wondering about the reason for this change, here is the letter I sent to BlueCross today:

Dear BlueCross,

It is with regret that I inform you that I wish to terminate my contract with BlueCross and no longer be in your network. I understand that I have to continue seeing BlueCross patients for 90 more days.

If you are interested in why I am leaving you, my accounts receivable with BlueCross patients is unacceptably high.

Since I am an optometrist, I need fast, easy access to whether a member has a routine eye exam benefit (S0620, S0621) and whether a contact lens evaluation is covered (92310).

For non-Regence plans, I have to make lengthy phone calls and navigate through terrible phone trees before finally talking with a representative. This process takes longer than performing the actual exam.

While Regence has a nice website for explaining benefits and is good about paying what I expect, every other BlueCross association is unpredictable about paying what I’m expecting. I often have to send out statements or refunds. Usually statements. Hence the high accounts receivable.

I know this will hit you in the wallet as well since I am the lowest-fee eye doctor in Cache Valley. If in the future BlueCross comes out with a website that allows an optometrist to see vision benefit details for any BlueCross member from any state/association, then feel free to let me know, and I’ll reconsider. I would also reconsider if a new rule allowed one to participate only with Regence and exclude all other BlueCross associations.

Sincerely,
David J. Langford, O.D.

Changes to Utah Medicaid Vision Services in 2014

Exam room equipment with VHEC logo.

Schedule an appointment today!

According to the latest Medicaid Information Bulletin, there will be changes for Utah Medicaid copays for routine eye exams effective January 1, 2014.

For Non-Traditional (Blue Card), they used to only cover the first $30, then you would pay the balance. Now, at my office your routine eye exam is covered without any copay since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Primary Care Network, a.k.a PCN (Yellow Card), you used to have a $5 copay. For 2014, there is no copay on the routine eye exam at my office since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Traditional (Purple Card), there is still no copay for 2014 on a routine eye exam.

Feel free to schedule an eye exam today for the new year.

Note: if a contact lens Rx is desired, you still have to pay out of pocket for the contact lens evaluation, unless you have a purple card and are under 18 or stated as pregnant on your card.

FYI: Yes, a contact lens evaluation is charged even if you have worn contacts before since contacts require more work and expertise.

Corneal Arcus and Cholesterol

Corneal arcus is a ring-like clouding at the outside edge of the clear cornea. It is composed of lipid (fat) and cholesterol. It is a normal, age-related finding after age 40. There is no treatment to undo the clouding.

Medical Establishment Party Line:
If you have cornea arcus before age 40, there is ~20% chance that you have hyperlipidemia. See your PCP to get your blood checked for a cholesterol/triglyceride imbalance. If the blood work shows hyperlipidemia, then you may try eating less fat/cholesterol and exercise, but most people take a pharmaceutical drug in the “statin” class to lower cholesterol.

The Real Deal as per Dr. Langford:
(Warning: the following is controversial, so do your own research…but I feel confident.)
What we are really concerned about is atherosclerosis, where hard plaques line the inside of arteries, which puts people at risk for death or disability via heart attack and/or stroke.  DO NOT LET ANY DOCTOR GIVE YOU A STATIN DRUG EVER! They have terrible side effects and haven’t even been proven to lower risk of heart attack or stroke. It’s a big scam! Don’t worry about dietary cholesterol. Let’s back up.

Starting around the Eisenhower administration, bad science via political agenda named dietary cholesterol and fat as the cause of plaque in the arteries. THIS IS FALSE. Cholesterol is awesome! It is found in every cell membrane in your body! We need it. Dietary fat is awesome, especially saturated and monounsaturated (animal fats, coconut oil, butter, avocados, olive oil)! It is a wonderful source of energy that helps you feel full, so you eat less overall. There are some bad fats out there, like trans-fat, and most vegetable oils (high polyunsaturated) are poor choices due to high omega-6 content which causes inflammation.

So, what causes plaques? It is actually chronic inflammation. What gives us chronic inflammation? It’s our standard American diet, which is high in carbohydrates. Carbohydrates spike insulin. Chronic insulin response leads to insulin resistance and a fatty liver. Those lead to increased belly fat, high blood pressure, high blood triglycerides, lower HDL, and inflammation. Now our bodies are chronically stressed, which weakens our immune system. The cause of the rise in obesity, diabetes, high blood pressure, stroke, heart attack, and even cancer has nothing to do with not enough pharmaceutical drugs to treat these conditions. It has everything to do with our diet. Even if our genes predispose us for those things, these genes are only being activated secondary to the changes our bodies experience because of our diet.

What to do?

I suggest changing your diet to low carbohydrate intake. The only carbs you need are from vegetables and some fruit. We can save sugar, corn, potatoes, rice, wheat and other grains for times of famine and feeding the pigs to fatten them up instead of ourselves. Please consider switching to what they call paleo diet, primal diet, atkins diet, ketogenic diet, or low-carb lifestyle. If you are taking diabetic, cholesterol, or high blood pressure medications, you will want to work with your doctor to rapidly taper off these drugs while eating paleo/primal/low-carb.

Please see visionhealtheye.com/lowcarb for a complete list of websites, podcasts, and books you can read to more fully explain this new paradigm in diet and health.

As an aside, consider steering clear of fungus (yeast/mushrooms/candida).

Now, let’s get back to corneal arcus. Will eating primal/paleo/atkins/low-carb help someone not get arcus? No one knows. A thin link was made between cornea arcus and blood cholesterol/triglyceride imbalance, but no one has tested incidence of arcus in populations eating low carb lifestyle. I am going to guess that it can only help.

Reading at the Harmon Distance

I frequently tell people to remember three rules for good visual hygiene: good lighting, good distance, and 20/20/20 rule of rest breaks. Today we’re going to talk about good distance, specifically the Harmon distance.

Tilt reading material to be perpendicular to line of sight (or parallel to head tilt).

Tilt reading material to be perpendicular to line of sight (or parallel to head tilt).


It turns out that when we read there is a specific distance that allows your visual system to be as least stressed as possible. To determine your ideal reading distance (Harmon distance), make a fist and hold it to your cheek. The location of your elbow is now at the Harmon distance.

Allowing reading material to be too close to your eyes, like when hunching over, causes your eyes to overly converge (turn inward) which causes unnecessary strain. Also with the print too close, the eyes have to focus more than they normally would, which causes strain. These sources of strain can cause tiredness, headaches, and even lead to more myopia (nearsightedness) than one would would naturally receive through genetics.

To learn more about why the Harmon distance is really neat, read this and this.

Stay tuned for why good lighting and rest breaks are also important.

Annular Solar Eclipse May 20, 2012

Annular-Solar-Eclipse-2005

Annular Solar Eclipse courtesy Wikipedia

On May 20, 2012 at 7:32 PM many of us here in Utah will have the opportunity to see an annular solar eclipse. those in Southern Utah near Kanarraville will get to see the “Ring of Fire” effect. (For more information, see ksl.com.)

What ever you do, don’t look at the sun without proper protection. Using regular sun glasses, even polarized, WILL NOT WORK. You can buy special solar filter glasses at Clark Planetarium. You can also make a pinhole projector. You can also use #14 Welder’s glass.

So please exercise caution, because while I shine bright lights in your eyes during an exam, it’s not nearly the intensity of the sun. The sun will cook your retinas, which causes loss of vision.

For more information, watch the video at ksl.com and visit Clark Planetarium’s website.