Medicare normally pays toward the first pair of eyeglasses after cataract surgery. But some patients do not qualify for Medicare because of the patient’s age or their spouse is still working under a qualified benefit plan, and billing needs to be made to their medical insurance carrier. Of course, the medical insurance would cover it, right? Wrong.
Some medical carriers do not pay toward the first pair of eyeglasses after cataract surgery if the patient has an IOL (intraocular lens) implant. Once such Michigan-based company, Priority Health, states “Coverage for aphakia is available only if an intraocular lens (IOL) is not present and lenses are paid at the prosthetic benefit level.” (Priority Health, medical policy #91538-R2)
What this means is that the patient can get glasses after cataract surgery if an implant was not done. Almost all ophthalmologists will do implants during cataract surgery.
Check with the medical insurance carrier to see if they will cover it. We don’t want to surprise our patients with a large out-of-pocket bill if they are expecting it to be covered.
Do you know of any other medical insurance carriers that follow this rule? Please share your information here and list what state you are from as it may not apply to all states…
Guest Post by Sandra Durant CPOC, a certified Paraoptometric Coder. Sandra has been working in insurance for over 18 years and the past 5.5 in Optometry. She earned her certification as a CPOC (Certified Paraoptometric Coder) last year and is a member of the AOA’s CPOC Committee in which she assists in the design of the CPOC exams.