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John C. Hagan III, MD, FACS John C. Hagan III, MD, FACS
Editor, Missouri Medicine medical journal; Board Certified Ophthalmologist, Discover Vision Centers
Roy S. Rubinfeld, MD Roy S. Rubinfeld, MD Ophthalmology, Georgetown University Med Ctr/Washington Hospital Center/Washington Eye Physicians and Surgeons
James J. Salz, MD James J. Salz, M. D. Clinical Professor, Ophthalmology; University of Southern California, Los Angeles
The American Academy of Ophthalmology

Cataracts, crystalens and insurance

Forum: The Ophthalmology Forum
Topic: Cataracts

From ToPost
h2oskier
11/24/2007
.I'm 45 years and and very active. I had Postsubcapsular cataracts in both eyes. Last week I had a crystalens implanted into my dominant left eye which I previously could barely see out of. So far so good. At the post op appt. the next day I had 20-20 in all fields of vision. My question is, I have submitted the surgery to insurance and noticed on the form that the office did not mark "cataracts." They marked Myopia OS. I called the office and they said that my cataracts had not progressed to a point where surgery was "medically necessary." I had previously gone to two other eye doctors for opinions prior to finding this one. All three said I had cataracts and not one of them mentioned that I was NOT ready for surgery. I had the surgery done in the doctors surgery center. I know that my insurance is out of network, so I expected that insurance would pay at 60% minus the crystalens, but now it looks like they won't pay at all? Any thoughts? Has anyone had any experience with this? I am scheduled to have my right eye done next Wednesday and I am having second thoughts, as this one is less "medically necessary" than the first one!

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Cataracts, crystalens and insurance - Ophthalmology Forum