Refractive Laser Eye Surgery – Will Insurance Pay?

PORTLAND, Ore. Eye wear may be a fashion accessory, but when you depend upon it for seeing the world, it’s a lot more. Today, many people are turning to refractive laser eye surgery, such as Lasik surgery, to improve their vision. The cost of Lasik is high and is normally not paid for by insurance because it’s fails to meet the conservative therapy test and is classified as cosmetic surgery. According to Independent Review Organization (IRO), AllMed Healthcare Management (http://www.allmedmd.com), this trend is shifting.

“We are seeing an increasingly number circumstances where refractive eye surgery is determined to be medically necessary and, therefore, payable by the insurance provider,” explains Dr. Skip Freedman, medical director at AllMed Healthcare Management. “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.”

Photorefractive keratectomy (PRK) is a refractive laser surgical procedure that is often covered by a patient that suffers from recurrent corneal erosion (e.g. diabetics). With PRK, a surgeon uses a laser to remove corneal tissue to correct vision problems. Conservative therapy approaches, such as patching, epithelial debridement (mechanical removal of faulty tissue), and bandaged contact lens placement often don’t work. Stromal puncturing, a procedure involving the physician puncturing the anterior corneal stroma, can also be used but can fail or result in permanent visual loss. In such cases, PRK is the best alternative for removing the damaged cells (or membranes) and possibly correcting the vision problems.

According to Freedman, 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 laser eye surgery is for medical reasons other than simply improved eyesight

Still, Freedman cautions, that 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.

Find more information about the medical necessity review services offered by IROs on AllMed’s web site at http://www.allmedmd.com.