How can I convince my insurance that it's time for cataract surgery?
FEB 21, 2014
I'm 56 years old and was diagnosed with a cataract in my right eye in 2010 and one in my left eye in 2011. My right one is bad enough that I have to get new glasses every six months but my ophthalmologist said it's not ready for cataract surgery yet. I can't read street signs and I almost didn't pass the eye exam last November when renewing my driver's license because I had a hard time with the vision test. What can I say or do to convince him I want it done now? I have spent $1,000 in the last two years getting eye exams and new glasses every six months.
Insurance companies have criteria that determine when an ophthalmologist can remove a cataract. While the main criteria is best-corrected visual acuity of 20/40 or worse, other parameters such as debilitating glare or double vision can allow for a cataract to be removed in special circumstances. If your visual acuity and glare scores do not qualify you for insurance-approved cataract removal, you can choose to have a refractive lens exchange which is not covered by insurance and requires you to pay a lump sum in most situations that covers surgeon expense, facility fees, anesthesia fees, and lens implant fees. This is a self-pay procedure and not a covered procedure under any insurance carriers.