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Femto/LRI for 82 year old

I would like your opinion on doing an LRI procedure during catatact surgery. I wanted to post this to possibly help others to make an informed decision when getting cataract surgery. I now know that a person on Medicare cannot be charged if the doctor chooses to use the Femto laser unless...using a specialty lens or performing an LRI procedure. My mom just wanted her cataracts removed. She did not want specialty lenses or anything extra. The doctor had my Mom sign an ABN and charged her 2800-. He never explained what LRI was. In examining her he just said in passing that there was a little astigmatism and he would fix it while removing the cataract. We thought nothing of it and certainly would not have agreed if we knew what that procedure entailed and that it would cost 2800-. I really feel this was dishonest/underhanded.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
You've posted before.  There are some things you can do.  1. Ask for a meeting with the surgeon explain the situation and ask that the additional costs of LRI and other add on like femtosecond laser be written off. If you can't get in to see Dr. Wonderful ask to speak to the office manager and make the same complaint. If that doesn't work you can make a complaint to: his hospital, local medical society, state medical society, better business bureau and even Medicare as "informed consent" needs to be in language a patient understands.

That being said I don't think limbal relaxing incision is a good way to correct corneal astigmatism in 2018-2019.  In my opinion a much better way would be a toric IOL (these add out of pocket costs) or femtosecond laser,  or post operative lasik.   Unless you persist it is likely the surgeon will continue business as usual.    In our practice the surgeon does NOT explain the costs.  The patients (and we try and get family in with them) has a thorough explaination by an insurance specialist, the costs estimates are written out this includes:  List cost of procedures/ discount to Medicare or insurance company,  yearly deductibles that have not been met, and the insurance/medicare co-payment.  If the person has secondary insurance (medicare) we estimate what that will be.  The person leaves knowing exactly what the procedure will cost them. For medicare we even tell them Medicare does not cover the cost of glasses testing after the surgery is healed and we cannot legally write it off (right now we charge $40).   If their are extras (toric or multifocal IOLs,  femtosecond laser, ORA technology) we clearly tell them this not a regular part of the cataract surgery and they are solely responsible for those costs.   We do not LEAN on people to upgrade.  I posted my wife (non-medicare) had surgery on both eyes this year, we did not opt for any extras.  Physicians can no longer be discounted surgical costs.  Our out of pocket was about $475/eye.  (Compare that to the $1500-$3000 dentists charge for a 2 visit crown on a tooth).
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Thank you, Dr.Hagan. I think I am going to send a letter to the Doctor. I just feel I let my Mom down. I am supposed to protect her and do the right thing. My Mom prefers me not to say anything in case she needs to go back to him. She wants to just let it go. I have trouble doing that when I feel strongly what the Doctor did was wrong. I wish I knew what the right thing to do is.Anyway, I appreciate your input.
Okay best of luck.  OTHERS READING THIS TAKE WARNING. ASK THE RIGHT QUESTIONS, GET APPROPRIATE ANSWERS, KNOW WHAT YOUR OPTIONS ARE, KNOW WHAT YOU WILL BE CHARGED, KNOW THAT CATARACT SURGERY IS ALMOST ALWAYS 'ELECTIVE'  IF YOU FEEL PRESSURED OR THE DOCTOR IS NON-COMMUNICATIVE THERE ARE LOTS OF CATARACT SURGEONS OUT THERE, GET A SECOND OPINION OR CHANGE SURGEONS.
Dr. Hagan,

What is your opinion on use of a Toric IOL and post-op LASIK for astigmatism management versus LRI for a patient diagnosed with Fuchs’ dystrophy? We opted for a traditional monofocal IOL and LRI in my wife’s case.
Mr P:  Thanks again for your contribution. Our practice no longer does LRI, too crude and variable, works by scaring the cornea, if residual astigmatism much hard to fix than toric IOL.  We correct astigmatism primarily with toric IOLs. they are not excessively expensive, the % that require a second operation to rotate is about 1-1.5%.  There are all grades of Fuchs dystrophy think very mild, mild, moderate and severe.    Moderate or severe usually reduce the final visual acuity to less than 20/20 and still have night vision and glare problems.  So we would not put in a multifocal or accommodating IOL "Premium" lens.  If a lot of astigmatism and patient is intelligent enough to grasp the risks of toric IOL we would put in a toric IOL for more than 1 D of cornea astigmatism.
One of options for astigmatism management was use of a premium IOL along with LASIK as needed for two years following. The Fuch's diagnosis was one of the reasons we chose to not pursue that line of treatment, we'll find out how it does over the coming months. Her vision was 20/25 (I think) without glasses a week after the surgery, close up/small print reading requires reading glasses.  
Good luck
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