Cost for laser eye surgery, does insurance pay for it?

If you’re considering vision correction surgery, be advised that it is typically an out-of-pocket expense. Fees vary depending on the technology and experience of the surgeon. According to St. Louis, Missouri-based Marke Scope (a leading source for data in the ophthalmic marketplace) the average cost in 2007 of LASIK and PRK was $2025 per eye, but can range from $1500 to $3000 per eye. The average price for and ICL and IOL were approximately $4000 per eye. New technology lenses such as presbyopic and toric IOL’s cost even more.

Finance plans are generally offered by vision correction practices.

Most vision correction practices offer payment plans for the procedure through one or multiple finance companies. Both 0% interest as well as extended payment plans are typically available that can make monthly payments quite affordable for most potential patients.

FLEX plans can bring many benefits to you!

A helpful mechanism (and tax break) that makes surgery more affordable to many individuals is the FLEX plan, which is essentially a government-allowed, tax-free medical account that is administered as a benefit through many employers. The employee simply specifies the year before the plan goes into effect how much money they would like deducted on a monthly, tax-free basis from their paycheck to cover the cost of a medical procedure or product. The employee can undergo surgery at any point during the year, paying for the procedure with the tax-free funds, essentially saving up to 40% of the price of the procedure, depending on their tax bracket.

Getting your Medical Insurance to help is very unlikely.

Unless a patient has a visually significant cataract, which requires a lensectomy/ IOL, medical insurance will typically not pay for vision correction procedures because it is considered cosmetic. Under no circumstance (except for a cataract) is an elective vision correction procedure considered medically necessary. I have written many letters to insurance companies to attempt to get LASIK covered as medically necessary when a patient is contact lens-intolerant and/or can’t wear glasses (due to allergy to the frames, a small nasal bridge, or high prescription with thick lenses causing distortion). To my knowledge, in no case has medical insurance covered the procedure. The only instance where medical insurance covers LASIK or other vision correction procedures is in situations where they are specifically written into a policy at a higher premium, typically for the benefit of high-level executives of large companies.

HMO plans can put you and your doctor into an unwanted financial pit.

If you have an HMO policy, coverage is even less likely than a PPO plan, since HMO payments to your doctor are usually based on a concept known as capitation. Capitation is when the HMO pays the doctor a lump sum of money per month to cover all of the care for a given patient, regardless of how much care the patient requires. If the patient needs surgery or specialty care, the doctor or medical group providing treatment pays the cost. This is why it is typically so difficult to get surgery or a specialty referral in a capitated HMO setting, as the insurance company who owns the HMO policy financially pits the doctor and the patient against one another.

Many vision insurance plans will not pay for your procedure.

Vision insurance plans also do not typically completely cover LASIK and other vision correction procedures. These plans (i.e., Vision Service Plan (VSP), Davis Vision, or Eyemed) may have negotiated discounts with various surgeons or groups, but rarely directly pay for any portion of the surgery. One notable exception to this is Southern California Edison and certain unions that have plans through vision insurances that pay for up to 90% of vision correction costs. Prospective patients are encouraged to clarify any benefits with the benefits department at their company before undergoing any surgery.

When compared to the costs of contacts, vision correction surgery is less expensive over a patient’s lifetime. While a patient might spend $4,000 to $5,000 initially for LASIK, there is no cost for upkeep or maintenance of the
results.

Look for part 2 of this article soon.