Is Eye Surgery Covered By Health Insurance?

For some people, age brings forth a host of lifestyle diseases and severe vision impairment. In fact, in the United States, there are roughly 12 mission people aged 40 years old and above who have a vision impairment. The Centers for Disease Control elaborated further that a good 8 million of these statistics have a correctible impairment.

Some vision impairments are correctable using eye surgery. However, the truth is, not everyone can undergo the knife right away. There are things to look out for before signing our waiver.

For example, does your insurance coverage include the procedure that you are about to undergo?

The Snappy Answer to the Question

There is a lot to unpack regarding the intricacies of invasive vision corrective procedures. The quick answer is YES. Insurance can cover eye surgery.

For instance, generally, cataract surgeries are covered by health insurance. But this does not mean that you can get out of the hospital without shedding a few dollars. Most of the time, there is still a substantial amount that would come from your pocket.

The Catch

Outside of cataract surgeries, some procedures are generally not covered by your health insurance. The list includes refractive or laser eye surgeries.

Some health insurance does not pay for laser eye surgery. Usually, insurance companies list them as an unnecessary procedure. However, there are certain caveats wherein they are covered.

Here is a sample list of instances wherein health insurance covers refractive correction surgery:

  • When the error is a result of an injury.
  • When the error is a result of prior surgery.
  • When the error is severe.
  • When the person with refractive error cannot wear corrective lenses due to allergy or physical incapacitation.

In reason (c), which pertains to severe refractive error, usually varies with the patient situation. The term “severe” itself is ambiguous. Different health insurance providers have different definitions of ‘severe’.

The End

Insurance coverage is a tricky subject to dissect. There are several instances wherein procedures of different types are treated differently in varying insurance companies. You must check with your provider regarding your coverage for a clear answer.

For vision surgeries, the longstanding answer is that not all insurance companies treat all vision impairment surgeries the same. Some provide full coverage for necessary surgeries like cataracts. But, surgeries like LASIK are elective. Hence some insurance companies forego including them in their list of coverage. Some only provide partial payment.

The best course of action is to prepare before the procedure by consulting your eye doctor and the insurance company.