Laser Eye Surgery – Will Insurance Pay? Determining the Medical Necessity of “Cosmetic” Treatments
We are seeing an increasing number of circumstances where refractive eye surgery is determined to be medically necessary and, therefore, payable by the insurance provider. For example, if conservative therapy treatments fail or if a patient is intolerant of contact lenses and cannot wear glasses because they might pose a risk in their job (e.g. police or firefighters), refractive eye surgery may be the most medically viable treatment option.
Conservative Therapy Options:
Examples of conservative therapy treatments include the following:
Stromal puncturing – a procedure involving the physician puncturing the anterior corneal stroma – can also be used but can fail or result in permanent vision loss. In such cases, PRK is the best alternative for removing the damaged cells (or membranes) and possibly correcting the vision problems.
Physicians can help patients who are in medical need of laser eye surgery make a stronger case by initiating the following:
Document a full medical history of the patient’s eye complaints
Show proof that the patient has not responded to conservative treatments and that the purpose of the surgery is for medical reasons other than simply improved eyesight
Still, even when the physician does this, each decision is taken on a case-by-case basis and is subject to the extenuating circumstances clearly noted in the patient’s medical record.
By AllMed Healthcare Managemen
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