Shore Eye Associates

Latest news and promotions from Shore Eye Associates with offices in Monmouth and Ocean County.

Why Do I Have to Pay Out of Pocket for Cataract Surgery?

premium cataract surgery

Why Do I have to Pay Out of Pocket for Cataract Surgery?



You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying extra out of pocket it for it.




Where did this come from? Why should I have to pay out of pocket for cataract surgery?  Shouldn’t my health insurance just cover cataract surgery?



In trying to answer those questions, you will first need a little history of both cataract and refractive (correcting errors of refraction such as nearsightedness, farsightedness and astigmatism) surgery.



Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness.  It was invented in 1974, by Svyatoslav Fyodorov, a Russian ophthalmologist and it was the primary refractive procedure done until the mid 1990’s. Then it was surpassed by the laser procedure called PRK and then eventually LASIK which are still the predominate pure refractive surgeries done today.



Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching.  In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.



The next big advance was implants to replace the removed cataract.  The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981.  The implants have improved over the years and most implants today are foldable so they fit through a tiny incision of around 3mm.



Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances.  There is no reason to remove a cataract just because it is there.  It needs to be causing a problem to make it medically necessary to remove it.



Medicare and most other insurance do not cover refractive surgery (Lasik, PRK etc. ) at all.  The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by means other than surgery, such as glasses and or contact lenses.



Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone.  This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.



The merging of cataract and refractive surgeries is why there are now options not only to get  your cataract removed but also to have your astigmatism (irregular shape to cornea) and presbyopia (the inability to see well up close that hits everyone in their 40’s) corrected.



This is where the “paying for cataract surgery” comes in.  Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.  Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY to fix the cataract and your insurance will pay for that component of your surgery.  What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.



If you want to address your astigmatism and or presbyopia at the time of cataract surgery to be less dependent on wearing glasses after surgery then paying for those components is going to be an out of pocket payment for you.



Now that I have explained why you may want to consider paying out of pocket for a combination of cataract and refractive surgery look for my next blog when I’ll discuss if you should pay out of pocket for cataract surgery and in the third installment what those charges are in our practice.

Part 2- Should I Pay out of pocket for Cataract Surgery?


The Videos below explain some the issues involved with refractive cataract surgery.





View Video
Are Daily Contact Lenses My Best Choice?
Should I Pay out of Pocket for Cataract Surgery?

Related Posts

Comments

 
No comments yet
Already Registered? Login Here
Guest
Saturday, 23 September 2017

Captcha Image

Search Shore Eye

Patient Resources

facebook yelp google+ youtube twitter pintrest

Order online button-patient-portal

  • Toms River +

    530 Lakehurst Road Suite 206
    Toms River, NJ 08755

    Phone: 732-341-4733

    View Map

    • Mon. Tues.: 10:00am - 7:00pm
    • Wednesday: 8:00am - 4:00pm
    • Thursday: 9:00am - 5:00pm
    • Friday: 8:00am - 4:00pm
    • Saturday: By Appointment
    • Sunday: Closed

                               

  • Spring Lake Heights +

    2018 Highway 71
    Spring Lake Heights, NJ 07762

    Phone: 732-359-8380

    View Map

    • Monday: 10:00 am- 6:00 pm
    • Tuesday: 8:30 am - 4:30 pm
    • Wednesday: 10:00 am - 6:00PM
    • Thursday: closed
    • Friday: 8:00 am - 4:00 pm
    • Saturday: By Appointment
    • Sunday: Closed

       

    Contact Spring Lake Heights Location

  • Brick +

    445 Brick Blvd
    Brick, NJ 08723

    Phone: 732-920-3737

    View Map and Directions

    • Monday: 10:00 am - 5:00 pm
    • Tuesday: 8:00 am - 4:00 pm
    • Wednesday: Closed
    • Thursday: 10:00 am - 7:00 pm
    • Friday: Closed
    • Saturday: Closed
    • Sunday: Closed

       

    Click for more information about our
    Brick location

  • Whiting +

    Route 530 and Schoolhouse Rd, Suite 19
    Whiting, NJ 08759

    Phone: 732-350-3344

    View Map

    • Monday: Closed
    • Tuesday: Closed
    • Wednesday: 8:00 am - 4:00 pm
    • Thursday: 8:00 am - 4:00 pm
    • Friday: 8:00 am - 4:00 pm
    • Saturday: Closed
    • Sunday: Closed

       

    Click for more information
    Whiting Location

  • 1

Video Education

Click To View Larger Video in a Popup