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Does Cigna Insurance Cover LASIK or Laser Eye Surgery?

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Unfortunately, a traditional Cigna plan does not provide coverage for LASIK surgery. That is because Cigna considers LASIK to be a cosmetic surgery that people undergo because they want it, not because they need it. (Learn more)

Every year, Cigna processes thousands of claims for health benefits. Many of those claims have to do with eye health conditions. A traditional Cigna eye insurance plan provides coverage for routine examinations, along with fittings for glasses or contacts.

Cigna does offer a discount program, however. That can provide slight cost savings if you need surgery.

Facts About Cigna You Should Know

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Cigna is a health insurance company that provides plans employers can offer to their workers, as well as plans people can buy on their own if they have no employer-based insurance coverage.

Cigna covers a wide swath of people in the United States. In 2017 alone, according to the organization’s website, 168 million medical claims were processed by the company’s employees.

Cigna’s primary focus is medical care. The programs the company offers help people to both understand and treat medical issues that could hurt their chances of long-term health.

Cigna does offer some coverage for vision issues. According to the organization’s website, there are 89,800 vision health care providers in the Cigna system.

But not every Cigna plan gives members access to these vision providers. In fact, some Cigna plans offer no vision coverage at all.

Traditional Cigna Eye Insurance Plans

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Cigna is similar to other large insurance companies in that it offers coverage to people living in almost every state in America. Each state has a form of health insurance governance that deems what must be included in plans sold within the state.

Cigna also offers a variety of plans that appeal to different types of consumers. As a result, there are literally hundreds — if not thousands — of different Cigna plans available in different parts of the United States.

In most cases, a basic Cigna plan offers coverage for medical conditions that might impact the eye. If you develop an infection in the tissues of your eye, you are in an accident and cut your eye, or you develop an eye issue caused by diabetes, all of these issues would be covered under a standard medical plan offered by Cigna.

The company offers supplemental plans that are designed to provide an enhanced level of coverage for eye health issues. According to Cigna, these group vision plans are designed to cover at least some of the cost of vision exams as well as some of the costs associated with glasses or contacts. This form of routine care would not be covered by a medical plan, but this additional plan can help to address those costs.

Some plans allow people to show a card to an eye health professional, and then pay a bill only after the provider and Cigna have determined the final amount that falls under the responsibility of the patient. But other plans, such as Indemnity Vision Care Plans from Cigna, require patients to pay the bill and then send in a claim form after the bill is paid.

Cigna PPO plans are designed to entice consumers to work within a network of approved providers for cost savings. One such plan, provided to employees of universities in Virginia, has severe penalties for moving outside of the network. Here, an in-network single vision eyeglass lens was 100 percent covered after a copayment. An out-of-network benefit was only $32. No LASIK benefits are covered on this plan.

A second and similar plan offered to employees of Dartmouth College came with similar penalties. An exam from an in-network doctor was 100 percent covered, but those moving to an out-of-network doctor had only 70 percent coverage. No LASIK benefits are covered in this plan either.

Cigna offers a Vision Network Savings Program with some individual and family plans, and that program can provide discounts of up to 20 percent to help with costs associated with getting glasses or contact lenses. This plan could cut costs significantly, but no LASIK benefits are included here either.

Why Doesn’t Cigna Cover LASIK?

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It’s clear that a traditional Cigna plan, along with supplemental plans and vision discount plans, offers consumers no relief from the cost of LASIK surgery. That might seem surprising, given that LASIK is a trusted and well-known solution for people who would like to see clearly without the constant use of glasses or contact lenses. If the procedure is clearly medical, shouldn’t it be covered?

According to Cigna, LASIK is considered a cosmetic procedure. That means LASIK is a solution that people can choose to access in order to change the way they look. It is not a solution that people might use in order to solve a health-related problem.

This is a very strict definition, and it is very difficult for consumers to move past. If the company considers LASIK to be totally optional and cosmetic, there are few to no exceptions that might apply here. Anytime a consumer might ask Cigna for help in paying for this kind of surgery, the company could respond with verbiage about how the procedure is not really required. Trying to fight back might not be fruitful.

Cigna Does Offer Discounts

While Cigna may not cover the entire cost of LASIK surgery, the Cigna Healthy Rewards program does offer some cost savings. With this program, people can access 15 percent cost savings, along with free enhancements for one year.

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People who choose to access this program must go to a provider who has a relationship with Cigna, as the discount does not apply to any provider a person might want to use. The flyer for the program notes that some restrictions apply to pricing, so it may not apply to all people.

According to Cigna, this Healthy Rewards program is available to any person with Cigna medical, vision, or dental insurance. To take advantage of the discounts, members must call Cigna to find a covered provider, and they must show their Cigna card before paying for services.

It is important to note that any payment made for LASIK through this program would not apply to a member’s required deductible. These are separate payments to a separate entity, and they do not work toward a deductible. Those hoping to pay down a deductible first by having LASIK may be disappointed by that fact.

Should You Change Insurance Companies?

If you are disappointed that Cigna will not pay for the LASIK surgery you want, you might be tempted to look for insurance coverage elsewhere. That is understandable, but unfortunately, you may not find the solution you want by switching your coverage.

Most insurance companies will offer benefits to help you pay for:

  • Eye exams.
  • Vision tests.
  • Eyeglass lenses.
  • Contact lenses.
  • Some plans may even offer coverage for eyeglass frames, and others may provide coverage for special eyeglass lens coatings. In the eyes of insurance companies, this is complete coverage that can help you to see clearly, so no additional coverage is required. To them, if you cannot see clearly, you should use glasses or contacts.

Changing insurance plans is not the answer. Finding a LASIK provider that works with you can be a smarter option.

Reputable companies can help you to understand your financial obligation if you choose to move forward with LASIK, and they can help you find a way to pay for the care you want. Discounts, financing, payment plans, and more can all help you to care for your eyes without breaking your budget.

At NVISION, we believe in the power of LASIK. But we know many consumers struggle to find coverage for the care they want. That is why we make it easy to get surgical care.

We can help you understand what your insurance company is likely to pay, and we can look for ways to make your LASIK surgery affordable. We’re easy to talk to, and our doctors are true professionals. Contact us to find out more about how we can help.

Financing Your LASIK Procedure

We believe every patient should have access to the life changing procedures NVISION® offers. Since LASIK is considered an elective medical procedure or advantageous to the patient but not urgent, it is typically not covered under insurance plans. Our financing options ensure that you are not held back by cost. Read on to learn more about CareCredit®, FSA/HSA, Insurance Discounts and other options.

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