Why the "Contact Lens Fitting Fee" Exists

You can basically thank 1-800-CONTACTS. As I've blogged before, in the 90's 1-800-CONTACTS made it unprofitable for OD's to sell contacts. We still do it, mostly as a courtesy. Everyone knows we make most of our money on glasses sales. We don't even try to hide it. We make no money on CL sales. Ok so how, then, can we afford to fit contacts? After all we're taking on the liability for your eyes/vision and our liability goes WAY UP when you're wearing contacts. In fact we have to purchase malpractice insurance just for this purpose. Enter the fitting fee. We basically charge you to write you a CL Rx. Of course we don't change our exam a whole lot, so this confuses the heck out of patients. They don't understand why we charge more to hand you a CL Rx if we didn't do anything different. The answer, of course, is that we *ARE* doing something different: we're taking on the responsibility and liability of you wearing contacts. I got in a discussion (argument? a polite one, maybe) in the comments section of a Washington Post article this week over this. The author, obviously a spurned CL wearer who was opposed to the fitting fee among other things, basically considered it his right to buy cheap contacts whenever he wanted wherever he wanted with just a regular "eye exam". One of his arguments was that people in Japan & Europe don't have this problem - there are no "fitting fees" in a lot of those countries. And to that I replied basically that unfortunately the US is a litigious society/culture. The malpractice insurance is driven up by all the lawsuits and settlements, a problem that really doesn't exist too many other places. So in my opinion you can blame 1-800-CONTACTS for making optometrist contact lens sales unprofitable, and the 205 or so US law schools and 1.22 MILLION US attorneys for making expensive malpractice insurance necessary.