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Insurance reimbursement for Rezoom?
Hi,
Has anyone had success in having an insurance company pay for a re-zoom lens? I had my left eye done in June, 2007 secondary to cataracts. I paid $1500 for the lens.
I appealed the insurance company's declination of my claim. They replied they do not consider this an effective treatment. I need to re-appeal with the explanation that if they will pay 100% for a monofocal lens, then they should at least allow that amount toward replacing a lens after my natural lens is removed.
I am due to have the second eye done in 3 weeks. I had a lot of problems with halos, which have gotten better over the past 6 months. I had a phagoemulsification performed in Sept which seemed to have helped. Still have dry eyes, but it is in both eyes, so it may be a condition of age - 52. Have been on Restasis for 5 months with no discernible improvement in dryness.
TIA,
Karen
Has anyone had success in having an insurance company pay for a re-zoom lens? I had my left eye done in June, 2007 secondary to cataracts. I paid $1500 for the lens.
I appealed the insurance company's declination of my claim. They replied they do not consider this an effective treatment. I need to re-appeal with the explanation that if they will pay 100% for a monofocal lens, then they should at least allow that amount toward replacing a lens after my natural lens is removed.
I am due to have the second eye done in 3 weeks. I had a lot of problems with halos, which have gotten better over the past 6 months. I had a phagoemulsification performed in Sept which seemed to have helped. Still have dry eyes, but it is in both eyes, so it may be a condition of age - 52. Have been on Restasis for 5 months with no discernible improvement in dryness.
TIA,
Karen
I am definitely no eye expert. But I have worked for those managed care companies for 17 years. Claims adjudication system automation to greviences and appeals. I do not know anything about this procedure but was it "restorative"?
Now, I can assure you Karen, the doctor's office definitely does not have time to work on this one. But if you have some free time, get the doctor's office to write a simple form letter saying this procedure was medically necessary. If it wasn't then I agree with "give it up". If it was, then send copies of your appeal to 1.) your greviences and appeal process coordinator 2.) the president of the insurance company and 3.) the department of insurance in your state. I only suggest this if this is a medically necessary procedure that these fine doctors think should be covered. Then wait until you get a response. If no luck, then do the process again (certified first class letters of course) no overnight or priority (first class letters have set precident in courts), same letter only from the doc - they are busy - but this time offer them a partial payment as if this was a "reasonable and customary" discount. That gives them an out to at least give you part of the money back. You get to decide how much to ask for and how long you want to pursue. It is time consuming but it is how change is payment procedure is accomplished. Also, this may be covered by a cafeteria plan you have at work?? This just a process not legal advice in any way.
Now, I can assure you Karen, the doctor's office definitely does not have time to work on this one. But if you have some free time, get the doctor's office to write a simple form letter saying this procedure was medically necessary. If it wasn't then I agree with "give it up". If it was, then send copies of your appeal to 1.) your greviences and appeal process coordinator 2.) the president of the insurance company and 3.) the department of insurance in your state. I only suggest this if this is a medically necessary procedure that these fine doctors think should be covered. Then wait until you get a response. If no luck, then do the process again (certified first class letters of course) no overnight or priority (first class letters have set precident in courts), same letter only from the doc - they are busy - but this time offer them a partial payment as if this was a "reasonable and customary" discount. That gives them an out to at least give you part of the money back. You get to decide how much to ask for and how long you want to pursue. It is time consuming but it is how change is payment procedure is accomplished. Also, this may be covered by a cafeteria plan you have at work?? This just a process not legal advice in any way.
MEDICAL PROFESSIONAL
How ironic but true.
MJK MD
MJK MD
The insurance did not pay for the Rezoom lenses; however they did pay to have them explanted.
MEDICAL PROFESSIONAL
You will not get reimbursed for Rezoom. Give it up. The lens costs around $875 - $900 so the rest of the money went for extra testing and to cover any necessary touch up surgeries. You will not get reimbursed for those costs either.
MJK MD
MJK MD
MJK MD
MJK MD
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