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Your insurance card is not meant to stay in your wallet. It is meant to make an appearance in any doctor's office when you need medical care. In theory, your insurance should help you to pay for the services you need. When it comes to laser-assisted in situ keratomileusis (LASIK), the reality is a little different.
LASIK surgery is an elective procedure, and insurance will very rarely cover the cost. While there are some vision plans that offer some LASIK coverage, most standard health insurance plan do not. Reading your policy closely can help you understand your financial responsibility, and if you have no LASIK coverage, you may still have payment options available.
LASIK From an Insurance Perspective
During a LASIK procedure, you will be awake but sedated. You will look closely at a bright light, and a small incision will be made in your cornea. That incision will allow a bit of your cornea to flip up, so eye tissue beneath the cornea can be removed. This reshaping process is designed to help light move efficiently through your eye, so that light is focused on the proper part of the retina in the back of the eye.
Insurance companies can be wary of offering coverage for an expensive form of care when there is another, less expensive, form of care that does much the same thing. Glasses and contact lenses, when applied properly, can help to correct vision loss problems. Since those solutions are in place, surgery might not seem like a medical necessity, even if it provides significant lifestyle and long-term financial benefits to the patient.
Since LASIK is not always considered a medically necessary procedure, according to the American Refractive Surgery Council, it is rare for insurance companies to cover the cost of care. These companies are likely to consider LASIK a cosmetic procedure you might use to eliminate the use of glasses and contacts — not a vital and last-chance hope of regaining your vision. Just as your insurance company might require you to pay for lip filler or breast enhancement surgery, you might also be expected to pay for your LASIK surgery.
How Specific Insurance Plans Cover LASIK
Every insurance plan is different. Some offer benefits or protections that others do not. To help provide some clarity on how plans differ, we will explore LASIK protections provided by several different insurance companies. This is not an exhaustive list of all health insurance companies and all plans, but provides some examples of how some major insurance plans work and what is typically covered and what is not.
Humana offers a form of insurance with vision benefits. As part of that vision program, Humana offers a discount program for LASIK. The company is careful to point out that this is not a covered insurance benefit. People who want LASIK will still be required to pay for a portion of their care. But with enrollment in this program, people can receive a discount on the cost of LASIK with providers that have contracts with Humana. People can also work with independent providers and get a smaller discount. An eye examination is included within the fee paid as part of surgery. Discounts are available to patients who show their identification card.
Kaiser Permanente in Northern California does not offer benefits for LASIK, as this is not considered a covered procedure. People who want to access LASIK can get the surgery performed at a Kaiser facility with a discount. The fee includes the exam and follow-up care, and Kaiser Permanente is willing to quote the cost of services in advance of the surgery.
Emblem Health considers LASIK a cosmetic procedure, similar to an eyelid lift or a breast implant surgery. As a result, LASIK is "not usually" considered eligible for insurance coverage. People who have this form of insurance and want to have LASIK would be required to cover the entire cost of the procedure, including examinations, follow-up care, and lab work, without the use of insurance.
Tricare covers services the organization considers both medically necessary and clinically proven. LASIK is explicitly excluded from Tricare, although the organization does not offer a detailed reasoning behind that decision. It could be that administrators want their patients to use proven techniques like glasses instead, or it could be that administrators consider low vision to be an issue that does not demand a surgical correction.
United Healthcare offers a vision benefit to members, including coverage for glasses and contacts. The coverage also includes examinations, but there is no direct coverage for LASIK involved with this vision benefit. Members can, with proof of coverage, get a discount at a specified vendor that offers LASIK vision care. The amount of that discount is not specified, and the company reports that not all locations owned by that vendor participate in the program, but it offers a way for people who have this type of insurance to get at least some cost savings.
Clearly, insurance plans vary quite a bit in what they cover in terms of LASIK and what additional benefits they provide to their customers. Each program has different limits, different vendors, and different rules. As a result, making blanket statements about how insurance works with LASIK is difficult. Every company is different.
Using Your Health Care Benefits Wisely
When you enroll in a health care plan, you are given a great deal of information about what is and what is not covered. Sometimes, that information is given to you in printed form, and sometimes that information is available to you through an online portal. You can look over that information and see if your company specifically excludes all forms of LASIK or if there are loopholes in which your surgery might be covered.
For example, some plans offer coverage for LASIK for people who had another form of eye surgery and now have difficulty seeing clearly. If this is your background, you might be able to file for an exemption, and your handbook should provide you with details about how to go through that process. If your plan offers no such loophole language, you might stop considering use of your insurance and think of other ways to pay for the help you need.
Your insurance plan may not even cover eye health at all. This is not a benefit that is considered mandatory for all health plans. According to Healthcare.gov, only some plans that are included in the Health Insurance Marketplace cover adult eye health. Since many private plans follow rules set up by the marketplace, this means many private plans also offer no vision protection.
If your plan offers no vision protection, loopholes may not ever apply to you. Protecting your vision and the health of your eyes is not a mandate of the plan you have, so you may not have the coverage you can lean on to help when your visual abilities begin to fade.
If you do have vision coverage, you may be able to use that coverage to help you get the examination that starts your LASIK journey. Your ophthalmologist could do all of the screening you need in order to prepare for surgery, and you could bring those records with you to the surgery center for your consultation. This may not be a major source of cost savings if your surgeon bundles your exam with your surgery fee. But if these are separate fees, using your insurance to pay for screenings could help you to save a bit of money.
In addition to a health plan, you may also have a health savings account (HSA). According to America's Health Insurance Plans, about 22 million Americans have an HSA to help them pay for unexpected medical expenses. An HSA allows you to set aside pre-tax dollars that you can use to cover expenses that fall outside of your health insurance coverage. LASIK surgery, if it is not covered by insurance, could be an expense you could cover with your HSA fees.
You can talk with your LASIK provider about payment plans, financing, and other special offers that can help to reduce your costs. These can be excellent ways to save money even if you cannot use your insurance.
If you do not use your benefits, you are shopping for a doctor outside of the protections of your insurance company. In most cases, insurance companies vet the doctors they provide to their customers, ensuring that the care given is of a high quality. If you are not pulling from a network of approved doctors, you will need to perform your own quality checks to ensure that the care you are given meets your standards and protects your eyes. The surgeon who offers you the lowest price may not be the safest one for you.
Find a Surgeon You Can Trust
It can be a little intimidating to find a professional who can perform a delicate surgery on your eyes while preserving your health. We can help. We have a network of doctors across the country who can give you the care you need, at a price you can afford, with a safety profile you can trust. Contact us to find out more about the trusted providers near you.
We Promise Our Patients Peace of MindConsultation
During the consultation, we will ask you about your eye health history and your medications, and perform some tests. You will then be examined by the surgeon who will discuss your treatment options. Your personal Patient Counselor will help you throughout the process.
Your Counselor can review payment options and schedule you for surgery and related appointments, such as pre- and post-operative exams. Prior to your procedure you will have a dilated eye exam, and you should discontinue wearing your contact lenses and begin taking eye drops as instructed.Procedure
Plan to be at the center for two to three hours the day of your procedure. ICL eye surgery is a fairly brief outpatient procedure. Your surgeon dilates your eyes, and gives you a local anesthetic to numb the area. A tiny incision is made, and the clear lens is slipped between your iris and your eye’s natural lens. The day of your procedure should be a day of rest.Post-Procedure
Your Patient Counselor will give you detailed post-operative instructions and eye drop regimen for your recovery. After ICL surgery, you’ll need several follow-ups with your eye doctor. Visual recovery is rapid, and you can expect noticeable improvement within a day or two. Most patients are generally able to return to their normal activities within two or three days following their procedure.
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Let the Buyer Beware: A Closer Look at Ordering Eyeglasses Online. (August 2014). American Optometric Association.
LASIK Eye Surgery. Mayo Clinic.
How Insurance Covers LASIK and Other Laser Vision Correction Procedures. (July 2017). American Refractive Surgery Council.
Humana Vision LASIK. Humana.
Kaiser Permanente Laser Vision Correction: Cost and Payment Options. Kaiser Permanente.
Emblem Health: Cosmetic Surgery Procedures. (December 2017). Emblem Health.
Covered Services: LASIK Surgery. Tricare.
Vision. United Healthcare.
Vision Coverage. Healthcare.gov.
More Americans Choose a Health Savings Account With a Consumer-Directed Plan for Their Financial Security. (April 2018). America's Health Insurance Plans.