Does insurance cover LASIK eye surgery? It can be quite frustrating for people who are experiencing struggles to see clearly without contact lenses or eyeglasses. So, considering LASIK eye surgery seems to be a good option.
However, since it has been approved, there have been over 40 million successful LASIK eye surgeries performed across the globe according to the Refractive Surgery Council (RSC).
Conversely, the decision to have LASIK, also known as Laser-Assisted In Situ Keratomileusis eye surgery is usually affected by different factors. For example, its coverage by health insurance and possible costs.
For those who are not aware, LASIK is a very popular procedure performed to correct vision and reduce the need for contact lenses or eyeglasses by changing the shape of the cornea with a laser.
Although this surgery procedure is quite effective and common, its insurance coverage status is quite complicated and differs depending on the insurance provider and insurance plan.
Meanwhile, if you are curious about whether health insurance offers coverage for LASIK eye surgery, keep scrolling through to find out.
What is LASIK Eye Surgery?
LASIK, also known as Laser-Assisted In Situ Keratomileusis eye surgery is a common surgical process often used to correct vision problems like hyperopia (farsightedness), myopia (shortsightedness/nearsightedness), and astigmatism.
Furthermore, it is a form of refractive surgery that changes the shape of the cornea to enhance the way the eyes focus light in the retina.
Therefore, the vision of the person will be improved without the use of contact lenses or eyeglasses.
Here is a breakdown of how the process is performed:
- Cornea reshaping.
- Laser treatment.
- Flap replacement.
The success rate of this surgical procedure is high and the recovery speed is quite fast.
Does Insurance Cover LASIK Eye Surgery?
The answer to whether health insurance covers LASIK eye surgery differs depending on the type of insurance plan and the insurance provider. Most of the time, this surgery is usually considered elective and is not usually covered by insurance.
Nevertheless, some vision insurance policies and companies provide discounts or particle coverage for this vision procedure. This is why it is essential to confirm with your insurance company to find out the coverage options associated with LASIK if there are any.
When Does Insurance Cover LASIK Eye Surgery?
As a health insurance policyholder, you might get coverage for LASIK eye surgery in these scenarios or situations:
- Vision Insurance
Some vision insurance policies might provide discounts or partial coverage for LASIK eye surgery. Moreover, this is usually a part of your benefit package. It is essential to check with your insurance provider because coverage differs widely.
- Medical Need
If LASIK eye surgery is considered medically necessary because of a specific eye condition that cannot be corrected or managed with contact lenses or glasses, insurance might cover the cost of the procedure. Nonetheless, this is quite rare and only applicable where your vision impairment affects your daily performance and other forms of treatments are not working.
When Is Coverage Excluded?
Here are events or scenarios where coverage is typically excluded for LASIK eye surgery as a policyholder:
- Pre-existing Conditions
Insurance coverage for LASIK eye surgery might be excluded if the necessity of the surgery is a result of pre-existing eye conditions that are not qualified as necessary medically.
- Elective Procedure
Generally, this eye procedure is considered elective. This is because it is carried out to enhance or correct vision instead of treating a life-threatening medical condition. Hence, many health insurance policies do not offer coverage for elective procedures.
- Cosmetic Reasons
If the reason for the LASIK eye surgery is mainly for cosmetic purposes, like getting rid of the need and use of contact lenses or glasses for appearance or convenience, this procedure will not be covered.
- Certain Exclusions
Coverage for refractive surgeries like LASIK eye surgery is not included under the coverage options of many insurance quotes, except if it is medically necessary. The vision insurance coverage is not also considered.
How to File a Claim for LASIK Eye Surgery
If you are sure that your insurance company and plan cover LASIK surgery partially or fully and you would like to file a claim, here are the steps that you need to proceed with the claim filing process:
- Review your health insurance policy.
- Confirm your insurance coverage.
- Understand the conditions and requirements for coverage.
- Reach out to your Ophthalmologist.
- Get pre-approved.
- Get the cost estimate for the eye surgery.
- Find out how the payments will be managed.
- Prepare the documentation.
- Submit your claim.
- Add the documents you put together.
- Follow up on your claim status.
If your claim gets approved, go through the explanation of benefits, also known as EOB by your insurance provider. Feel free to appeal if your claim gets denied and follow up with the process as well.