Is cataract surgery insured?

Often patients are confused whether cataract surgery is covered by their health insurance policy? It's a relief for them to know that most of the health insurance polices cover cataract and implant surgery, as it is a medical condition that has to be treated.

There are several companies that cover the cost of cataract surgery. However, the companies often require the patient to be cleared by their own practitioner. in some cases, they might also seek a second opinion.

The most common insurer for patients with cataract over the age of 65 years is Medicare. the company provides health insurance cover for cataract surgery only if the condition interrupts with the daily activities of the patient. Medicare covers the facility fee (surgicenter or hospital) as well as the anesthesia services. However, they don't cover the surgery if the patient has a visual acquity of 20 / 40 or below.

Most cataract operations also involve intraocular lens implant. The standard implants allow focus for distance. Majority of insurance companies cover the cost of standard implant and not for the multifocal implants. Clearly, for an expensive lens the you have to pay from your pocket.

How would you determine whether your medical insurance covers cataract surgery?

  1. The first step would be to check general list of surgeries included in the brochure. Cataract surgery is related to vision problems, so look into the broad category of vision corrective surgeries.
  2. Seek information about the coverage. See whether it covers you surgery if you are treated by a certain doctor. Look into the list of surgeons from your insurance and set up consultations with them to find out the one who can serve your purpose.
  3. Call the insurance company and talk to its representative about the insurance claims for the surgery
  4. See the documents you would need to produce before the health insurance company to get the coverage. You might also require a referral from an eye doctor. Some companies require documentation to ensure severity of eye problems.

Some companies are reluctant to cover cataract surgeries. In that case you must argue for the coverage. For instance if the cataract has resulted from an acute eye injury, or any other disease, and you need surgery to continue working insist the company to cover the cataract surgery.

It needs to be mentioned that without health insurance a cataract surgery might cost around $3,000, having said that, the cost may vary depending upon several factors. The severity of the cataract has to be considered when estimating the cost of surgery. Moreover, type of cataract removal surgery, maturity of the cataract and choice of lens replacement determines the cost of cataract surgery. In order to avoid bearing the cost of cataract surgery you must seek an insurance cover.


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