Finding the right doctor, asking the right questions?

Sorry for the open-ended question and lack of being conversant on the issue of eyecare.  I'm 51 and spent the last seven years going through six optometrists trying to get clear distance vision for driving. Note that not one did a pupil dilation. My initial visit with the first office was because I complained of double vision at night.  This was after having worn Ortho-Ks for 12 years with tremendous satisfaction with 20/10 correction.

Last year I was finally been diagnosed with cataracts of both eyes.  She said that it would cost me out of pocket near $5000 per eye to have the surgery done.  Phew!   Or I can wait "'till whenever it gets worse".   She said my cataracts were immature and did not meet my insurance criteria of 2.5 or something along that?  It's been a year since my last visit. I will not return to that clinic for many reasons; one being that the Ophthalmic Tech would finish her smoke break then immediately perform my tests without washing her hands!  Secondly, I also overpayed on my contacts purchase and requested a refund to my credit card but they refused and said it would be applied to my account?!  Finally, I did get a referral properly from my health care center which doesn't have a eye doctor on staff specifically for this in-network doctor but her office charged me for a full office visit as if I didn't have a referral. They refused to submit the referral to my insurance.  

I currently wear Coopervision Hydrasoft Toric Options: the left BC 8.6; DIAM 15.0;SPH -04.5; CYL -01.75; AX 090      the right BC 8.6; DIAM 15.0; SPH -04.50; CYL -01.00; AX 086  With those my vision is still variable and on occasion for a brief period get extremely cloudy.  Not as sharp of course as those Ortho-K gas perms from Contex provided me.

I want to have both cataracts removed and will be satisfied with sharp distance vision while using cheaters for reading and computer work.  Or I may consider the blended vision mentioned on this forum.  I did make an appointment with a different MD for the middle of this month.  Is it me not using the eyecare community including insurance company right?  Once I go for that exam with eyecare pro #7 and say find dissatisfaction again I'll be back in the same boat screwed for another year since my insurance covers one exam per year?  Any way to avoid that 'groundhog day' syndrome.

What questions about cataract surgery would you ask an office?
Though diagnosed with cataracts why doesn't insurance cover there removal? Friends have told me they are in the same boat.
Do you think at $5000 per eye for surgery that office was playing me?  Being an elective surgery could and is being completely taken advantage by excessive charges readily apparent in the eyecare community.  

[John C Hagan III, MD, FACS, FAAO]

Since you have a cataract  1. you should be seeing an Eye MD ophthalmologist surgeon NOT A NON-MD optometrist  2. Because of the cataract and seeing an Eye MD your health insurance should cover your visits just like seeing any other MD like a cardiologist.  3. The timing of cataract surgery depends on how much it bothers you. A very small cataract in a truck driver, pilot or person that works at night may cause much more trouble than a big cataract in a 90 year old non-driver, non-reader.
4. You would be the fool to pay that much out of pocket money because if it doesn't bother you that much why spend the money if it does bother you that much then your insurance should cover it. Even if your best vision is 20/20 your glare testing might be 20/400 that approximates what driving at night in the rain might be. If you think your cataracts are a big problem and their is any question that the insurance might not cover them you can ask for pre-certification and with the help of the surgeon petition your insurance carrier with a list of things that you need to do but can't because of the cataract.

JCH MD

[bigislandjeff]

I am grateful for your speedy response.  Thanks too for showing light on another direction like a pre-certification.  

Yes, the last one who diagnosed me with cataracts was an MD.  Forgot to add that.  

I know there is a ton of good info in this forum about lens choices but am a little concerned with the high degree of astigmatism I have. Would there be other questions to pursue with a new doctor?  

TIA

[JodieJ]

It was my experience that if you have a valid reason for wanting cataract surgery (and impaired ability to drive at night seems valid to me), the surgeon's office knows how to do the paperwork so that your insurance will pay for it.  Try to find a board-certified surgeon who is experienced with cataract/refractive procedures.  (You can check board certifiction by using the doctor directory at www aao org.)  You'd probably want a doctor who is experienced doing limbal relaxing incisions to correct your astigmatism.  (Alternatively, you might consider getting toric IOLs--especially in your right eye--to correct your astigmatism, although this would involve an out-of-pocket charge.)

It sounds to me like some of the eye care professionals you've seen in the past were not, shall we say, among the finest.  (I've seen a couple of these doctors myself, and you wouldn't believe some of the crazy things they told me.)  It's even possible that your double vision at night is unrelated to cataracts.  I think you need a complete exam by a board-certified ophthalmologist.  Best of luck.

[John C Hagan III, MD, FACS, FAAO]

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[bigislandjeff]

Thank you for that info JodieJ.  I researched and found the new doctor I have an appointment with the middle of this month is board certified.  I will call the office this week to find out about three items: LRI, IOLs they use and of course fees.  The biggest question is why the first doctor said my insurance wouldn't cover cataract removal due to their criteria.  So a call to my insurance will come first.

[John C Hagan III, MD, FACS, FAAO]

Very frankly most insurance companies and medicare don't set minimum standards of visual acuity since it varies according to the circumstance. Many require the patient to fill out a sheet listing the things that the cataract is preventing them from doing or other symptoms.

JCH MD