Will my medical insurance pay for refractive surgery?

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Some insurance plans cover refractive surgery. Most do not. Here is what to look for:

Some managed care plans, especially vision and medical HMOs and PPOs, will contract with selected surgeons or facilities to provide refractive surgery at a discounted rate. The HMO does not provide any money to the doctor, but you receive the benefit of a lower cost for refractive surgery. The problem with this is that many times the negotiated rate is actually higher than the current market rate. Sometimes the plan's negotiated rate is higher than the current market rate from the same provider. Even if your HMO provides "coverage", it may not be very valuable. Be sure to check around. Indemnity medical insurance plans - the ones that pay a percentage of the bill - usually do not provide coverage for refractive surgery. These types of plans normally exclude what they consider to be cosmetic or, at the very lease, elective. However, this is not always true. Some indemnity insurance plans will cover refractive surgery and so it is in your best interest to determine exactly what your plan will cover. If your insurance is through your employer, talk to your human resources people. If you have an independent insurance policy, talk to your agent or broker.

All types of insurance plans have exclusions and limitations. Normally, anything that is considered cosmetic and most elective surgeries are either limited or excluded. There are conditions when refractive surgery may be considered a necessary medical procedure. We have a position statement that may be of assistance at http://www.usaeyes.org/faq/subjects/refractive_pathology.htm . You will probably need to argue your point to your insurance company and you will need the cooperation of your doctor, but it may be possible to have coverage.

Some employers have medical flex plans that allow you to spend a certain amount for any medical care, including cosmetic and elective procedures. You need to check with your employer's human resources department.

Refractive surgery is a medical expense, and under certain circumstances it is deductible from federal income taxes. You need to check with your tax advisor if this may apply to you.

When making a decision about refractive surgery, make the decision as if you are writing the check yourself. You don't want your decision about the quality of the surgeon to be influenced by a reduction of cost. A poor quality surgeon is no bargain at any price. You also will probably pay closer attention and give greater consideration to whether or not refractive surgery is right for you if you will feel the full brunt of the cost.

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