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Limited Coverage
Few insurance plans cover vision correction surgery like conventional
or wavefront custom Lasik, Bladeless Lasik, PRK, LASEK, Epi-Lasik, or RLE, however there are methods to maximize your existing insurance
coverage.
Some managed care plans, especially vision and medical HMOs and PPOs, will contract with selected doctors or facilities to provide
refractive surgery at a discounted rate. The HMO or PPO does not
provide any money to the doctor, but you may receive the benefit
of a lower negotiated cost. The problem with this scenario is that
many times the negotiated rate is actually higher than the current
market rate. Sometimes the plan's negotiated rate is higher than
the current market rate from the same provider. Even if your HMO
or PPO provides "coverage", it may not be very valuable. Be sure
to check around.
Indemnity medical insurance plans - the ones that pay a percentage
of the bill - usually do not provide coverage for refractive surgery.
These types of plans normally exclude what they consider to be cosmetic
or elective surgery. However, this is not always true. Some indemnity
insurance plans will cover refractive surgery, so it is in your
best interest to determine exactly what your plan will cover. If
your insurance is through your employer, talk to your human resources
people. If you have an independent insurance policy, talk to your
agent or broker.
Exclusions and Limitations
All types of insurance plans have exclusions and limitations.
Normally, anything that is considered cosmetic and most elective
surgeries are either limited or excluded. There are conditions when
refractive surgery may be considered a necessary medical procedure.
We have a position statement that may be of assistance at Refractive Pathology. You will probably need to argue your point
to your insurance company and you will need the cooperation of your
doctor, but it may be possible to have coverage.
Flexible Spending Account
Some employers have medical flex plans that allow you to spend
a certain amount for any medical care, including cosmetic and elective
procedures. You need to check with your employer's human resources
department. For details, read Flexible Spending Accounts.
Tax Deductible Medical Expense
Refractive surgery is a medical expense, and under certain circumstances
it is deductible from federal income taxes. You need to check with
your tax advisor if this may apply to you. You may want to read
more information regarding deductibility
of refractive surgery.
When making a decision about refractive surgery, make the decision
as if you are writing the check yourself. You don't want your decision
about the quality of the doctor to be influenced by a reduction
of cost. A poor quality doctor is no bargain at any price. You also
will probably pay closer attention and give greater consideration
to whether or not refractive surgery is right for you if you will
feel the full brunt of the cost.
Lasik Related Difficulties Covered
If you are experiencing difficulties related to refractive surgery,
such as dry eyes, your medical insurance will probably pay for needed
care, even if it would not have paid for the initial refractive
surgery.
Battle Your Insurance Company
Read an excellent article by CNN.com provides tips on how to
effectively work through the process to get all available
coverage from your insurance plan. See Fight Your Insurance
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
Personalized Answers
If this article did not fully answer your questions, use our
free Ask Lasik Expert patient forum.
