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Insurance and Laser Eye Surgery

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Will Insurance Cover My LASIK Surgery?

In the past, laser vision correction surgeries were not usually covered by insurance programs. Has anything changed? In some cases, yes! Many vision plans today have expanded their coverage to include LASIK and PRK. You may even be able to get your medical insurance plan to pay for the surgery under some limited circumstances, so it’s important to investigate your options.

Vision Care Plans and Laser Eye Surgery

insurance-and-laser-eye-surgeryIf you have a vision care plan provided by your employer (such as VSP, Spectera, EyeMed, DavisVision, Aetna, Blue Cross/Blue Shield, and others), it’s very likely that it offers some type of laser eye surgery benefit. In some cases, the vision plan has contracted with a network of “preferred providers” who, if you choose one of them, will offer a special price. In other cases, there may be a significant discount (percentage or dollar amount) off the cost of LASIK or PRK, whether you choose an in-network or out-of-network eye surgeon. Either way, you may be able to get partial coverage and reduce your out-of-pocket expense for the surgery.
 

Medical Insurance and Laser Eye Surgery

In general, most medical insurance companies consider refractive or laser vision correction surgeries, like LASIK and PRK, to be “elective” or “cosmetic”. In other words, they don’t think it’s “medically necessary” for you to have laser eye surgery when eyeglasses and/or contact lenses will solve your vision problem. Depending on the type of plan you have, there may be a few exceptions.

Your medical plan may cover all or part of the surgery if:

  • The refractive errors being corrected were caused by an injury or accident;
  • The refractive errors were caused by a surgical procedure;
  • The refractive errors are very severe and glasses or contacts will not give you adequate vision;
  • You cannot wear glasses because of an allergy or deformity, or contact lenses because of lens intolerance or another physical limitation. In other words, laser eye surgery is the only thing that can be done to provide you with functional vision.

Don’t expect your medical insurance plan to approve your surgery easily. Visit your ophthalmologist first. Enlist his or her help in documenting the history of your vision problems before you have surgery. Contact your medical insurance carrier only after you’ve gathered all of the information about what type of surgery you plan to have, whether it involves one or both eyes, and the anticipated cost. You may need to supply them with paperwork to back up your argument. If you get the automatic “No” answer at first, don’t give up. Ask for a supervisor and explain why your case is different from the rest. If they agree to pay some portion of your surgery expense, get it in writing.

And, never commit insurance fraud by providing false information to your insurance company; it’s a serious crime that is punishable by fines and/or imprisonment.

Flexible Spending Plans

If your employer offers a Flexible Spending Account, you can put aside pre-tax dollars to offset the cost of LASIK surgery. When you have enough funds saved, you can use them to pay for your LASIK procedure. Speak to your human resources representative to be sure LASIK is covered through your FSA. IMPORTANT: You must spend FSA money during the calendar year in which you save it or you will lose it. Even if your FSA won’t cover all of your LASIK expense, it may still be a great way to offset a large part of the cost.

Don’t Be Deceived

insurance-and-laser-eye-surgeryLASIK advertisements can be very deceiving; be sure to understand what, exactly, you are getting, who will perform your surgery, and what the final price will be.

If the ad says “$500 per eye”, it’s highly unlikely you will get it for that price unless you have no astigmatism, are not farsighted, and have a prescription below -1.0 (a small number of patients). Expect the price to increase another $500 for prescriptions between -1.25 and -2.0. Add $500 for prescriptions between -2.25 and -3.0. And add another $500 for prescriptions over -3.25. You won’t get Custom Wavefront LASIK and Intralase, or “bladeless”, LASIK at this low price either.

Don’t make a decision that will affect your eyesight for the rest of your life based on cost alone; the surgeon may be using sub-standard or old technology or may have very little experience to offer such a low price. Trust your eyesight only to the best surgeons for LASIK eye surgery in NJ & NYC.

Whether or not you have a vision plan or medical insurance to cover your laser eye surgery, Dr. Ilan Cohen and 5th Avenue Eye Center can offer you a variety of payment options to help make your surgery more affordable. Contact our offices at (212) 764-2020 for an appointment, bring your insurance information, and we will be happy to check into your coverage for you.

 


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Jettison the Jitters: How to Calm Your LASIK Surgery Fears
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