Q: Does my insurance cover Cataract Surgery?
A: If you have Medicare or private insurance, your surgery will be covered if your doctor diagnoses you with operable cataracts that are affecting your daily activities. However, it is possible to have cataracts that are not developed enough for insurance to consider surgery necessary. Your surgeon will let you know when your cataracts have developed to a point where cataract surgery is an option for you. At this point, insurance will cover the surgery.
Q: What is my out-of-pocket cost for Cataract Surgery?
A: Out of pocket costs for cataract surgery vary depending on the your insurance. When you have cataract surgery, 3 claims are submitted to your insurance company: A claim from the surgeon, a claim from the surgery center, and a claim from the anesthesiologist. If you have Medicare and a secondary insurance, Medicare will automatically cover 80% of all of these claims. The remaining 20% is then sent to your secondary insurance. If you have private insurance as your primary insurance, your out of pocket costs will depend on the possible deductibles, coinsurance, and copays of your specific plan. To determine your out of pocket costs, you can contact your insurance company and let them know that you are having cataract surgery at an outpatient hospital, and they can give you your out-of-pocket costs based on your plans details. If they ask for a procedure code for cataract surgery, give them the number 66984.
Q: What are the costs of the different types of lens implants?
A: Standard Lens or Monofocal Lens, which correct your vision for either distance or for reading vision, are covered by your insurance as insurance companies consider this medically necessary. Toric or Astigmatism correcting lenses, which may decrease the dependence on glasses for distance vision for patients with astigmatism are not covered by your insurance, as this premium option is not considered medically necessary by insurance. Multifocal Lenses, such as the PanOptix Trifocal lens, are designed with the goal of giving the patient a continuous range of vision from near to far and decrease the chance that a patient needs glasses after surgery. If you are interested in either the Toric lens or Trifocal lens, one of our surgeons or surgical coordinators can give you idea of the out of pocket costs.
If you have any further questions about cataract surgery or would like to set up a cataract evaluation with Dr. Krespan or Dr. Jahnle, reach out to our surgery department by phone (610-446-2260 extension 4) or email ([email protected])