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Is Cataract Surgery Covered By Insurance

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Does Blue Cross Blue Shield Cover Cataract Surgery

Cataract Surgery: Why doesn’t insurance cover Laser Cataract Surgery?
  • Blue Cross Blue Shield Medicare Advantage plans cover cataract surgery, as its covered by Original Medicare . Learn about the other vision benefits some BCBS Medicare plans may offer, how much cataract surgery costs with Medicare and more.

Cataract surgery can cost between $3,500 and $7,000 per eye, which should beg the question of whether its covered by insurance.

Blue Cross Blue Shield Medicare Advantage plans typically cover cataract surgery when its considered to be medically necessary treatment. Medicare Advantage plans are required to cover the same benefits that are covered by Original Medicare .

Because cataract surgery is covered by Original Medicare when performed using traditional surgical methods or with the use of lasers, all Medicare Advantage plans, like the ones from Blue Cross Blue Shield, at least cover the same type of surgery. Some plans may cover even more routine vision care costs than Original Medicare, such as prescription glasses, contacts, eye exams and more.

Blue Cross Blue Shield affiliate companies can vary by state, so its best to compare plans online or call to speak with a licensed insurance agent to find the specific plan benefits available where you live.

Cost Of Cataract Surgery In India

Like other surgeries, cataract surgeries are also a costly affair, especially when done from a reputable hospital in a metropolitan city. While average cataract surgeries for a single eye ranges between Rs.15,000 to Rs.30,000, surgeries that include advanced techniques requires a higher amount. Depending on the advanced treatment and the type of lens selected, the cost can go up to Rs.60,000 for each eye. Post-operative care such as prescription eye drops, and other medicines also add to the sum.

What Kind Of Cataract Surgery Does Medicare Pay For

Medicare covers cataract surgery that involves intraocular lens implants, which are small clear disks that help your eyes focus. Although Medicare covers basic lens implants, it does not cover more advanced implants. If your provider recommends more advanced lens implants, you may have to pay some or all of the cost.

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Are All Cataract Surgery Lens Options Covered By Insurance

No, Medicare and commercial insurance only cover what are called monofocal intraocular lenses for cataract surgery. Premium upgrades to advanced technology lenses must be paid for out-of-pocket by the patient, these include toric lenses and multifocal and extended depth-of-focus lenses. See this page regarding the various lens options available when someone has cataract surgery.

Does Insurance Cover Cataract Surgery

Medicare and cataract surgery: Requirements and coverage

A cataract is a painless, cloudy area in the lens of the eye. The lens is enclosed in a lining called the lens capsule. During cataract surgery in the Inland Empire, our surgeons separate the cataract from the lens capsule. In most cases, the lens is replaced with an intraocular lens implant . In most instances, with certain limitations, cataract surgery costs are covered under both private insurance plans and Medicare.

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Why Do You Need Health Insurance For Surgeries

With the rising cost of healthcare services, purchasing health insurance is a crucial aspect to consider when planning finances. Moreover, considering the growing needs of the policyholders, health insurance companies are extending various insurance plans aimed at specific requirements.Individuals can get financial coverage against various medical treatments, like cataract surgery, cosmetic surgery, congenital diseases, IVF treatment, and more by selecting the right insurance policy. Comprehensive health insurance plans offered by Bajaj Finance Limited are equipped to take care of medical expenses adequately.

Closing The Gap With Medigap

If a premium option is desired but there is a concern about the out-of-pocket costs not covered by Medicare, then there is the option to buy a separate Medigap policy from a private insurance carrier. Medigap plans supplement Medicare coverage and help to offset the out-of-pocket cost of care. They function very much like traditional insurance policies, just on a much more narrow scale. That means they have their own deductible that must be met before coverage kicks in.

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Does Medicare Pay For Laser Cataract Surgery In 2020

Medicare coverage and payment for cataract surgery is the same irrespective of whether the surgery is performed using conventional surgical techniques or a bladeless, computer controlled laser. Under either method, Medicare will cover and pay for the cataract removal and insertion of a conventional intraocular lens.

Table For Cataract Health Insurance Covers

Does Medicare Cover Cataract Surgery?

Company Name

Senior Citizen Red Carpet Policy

18 years

1. ICICI Lombard Complete Health Insurance

The complete health insurance plan by ICICI Lombard has the following benefits:

  • Cashless hospitalization
  • Maximum tax benefit up to RS 15,000

2. Care Health Freedom

Care freedom health insurance plan has the following benefits:

  • It provides 100 % restoration benefit
  • The room rent would be 1% of SI
  • The ICU charges would be 2% of SI
  • Pre and post hospitalization covers up to 75% of payable expenses
  • Lifelong renewability

3. Star Health Senior Citizen Red Carpet

The senior citizen red carpet policy has the following details:

  • The policy is available for 1 or 2 or 3 years which can be renewed.
  • The insured sum is available in the form of Individual and Floater sum basis
  • All daycare procedures are covered
  • The fees of the surgeon, medical practitioner, consultation, and specialist cover up to 25% of the sum insured per hospitalization
  • No third party administrator

4. Oriental Insurance Happy Family Floater

Happy family floater plan of Oriental insurance has the following details:

  • The maximum entry age is 65 years
  • The term of the policy is 1 year and can be renewed life long
  • A discount of 5.5 % is premium if TPA services not opted

5. SBI General Retail Health Insurance

The SBI retail health insurance policy SBI general have the following details:

6. HDFC Ergo Optima Senior

Optima senior plan of HDFC Ergo Health Insurance has the following details:

7. Bajaj Allianz Health Guard

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Cataract Surgery Cost Breakdown With Medicare

Medicare Part B will cover standard cataract surgery, along with ophthalmologist fees and surgery center fees. Although, this health insurance will only cover Medicare-approved amounts Medicare wont cover the complete cost of the procedure.

Patients are responsible for meeting their deductible, as well as a 20% Medicare Part B copay.

As a general example, a standard cataract surgery in a clinic or surgery center may cost about $3,500. A patient with Medicare insurance coverage will be responsible for $700 . The total out-of-pocket cost will also include the deductible amount, which depends on the patients specific insurance plan.

Without Medicare coverage or private insurance coverage, the average cost of cataract surgery can run a person the full $3,500 for surgical procedures at a clinic.

The total cost of cataract treatment for a patient who doesnt have an insurance provider can range:

  • $3,000 to $5,000 per eye for standard cataract surgery
  • $4,000 to $6,000 per eye for laser-assisted cataract surgery or procedures using advanced lens implants

Will Medicare Continue Vision Care Coverage After Cataract Surgery

As part of your surgical services, you will have a follow-up appointment with your doctor after your surgery to make sure there are no complications. If you have complications or vision care needs related to your surgery that are medically necessary, Medicare will cover those services. You will be responsible for coinsurance charges.

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Does Medical Insurance In India Cover Cataract

Medical insurance in India does cover cataract surgery. However, not all policies offer such a cover. Thus, you must have a look at the policys inclusions before purchasing. In case you have already purchased the policy and want to check if it covers a cataract surgery, you can go through your policy document for a detailed understanding of the coverage.

Cataract Surgery: Is It Medically Necessary

Does Medicare Cover Cataract Surgery? Here

Medicare will only cover your cataract surgery if it is deemed as being medically necessary. In the majority of instances, procedures like cataract surgery will be deemed medically necessary. However, it will be useful to make sure that this is the case before you proceed with the surgery. Otherwise, if you discover that Medicare will not pay for it after the fact, it could put you in a real financial bind.

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Claiming For Cataract Surgery Under Your Health Insurance Plan:

Mainly, cataract surgery does not require more than 24 hours of hospitalization, and thus it is covered as a day-care treatment. Claiming cataract surgery is quite like making any other health insurance claim. There are some standard procedures which all health insurance companies generally follow.

Cataract surgery would be a planned surgery, and therefore when your doctor prescribes you or a family member the surgery, you must inform the insurance company soon. Keep in mind that your claim must be registered with the company 3 to 4 days before the surgery.

There are two ways in which a claim may be settled:

  • Cashless Claim: In case you go to a network hospital for your treatment, you would be able to avail of the cashless facility wherein you need to submit your Pre-authorization form along with your company-issued Health Card. You would have to pay your share of co-payment at the time of discharge, if any, or for uncovered expenses.
  • Reimbursement Claim: In case you did not seek treatment in a network hospital, you can still request reimbursement. Inform the company about the surgery 3 to 4 days in advance. Post the surgery, and you need to make the payment yourself. Later you can claim by submitting the Claim Form, treatment-related papers, along with your KYC and bank account details. Once all paperwork is verified, your expenses would be reimbursed.
  • Everything You Need To Know About Cataract Surgery

    Have you been experiencing a hazy vision of late? If you are over 50 and your vision has gotten cloudy and blurry, cataract can be the reason. Cataract risk increases with age, and the condition is corrected with the help of a surgery. While this may be an expensive affair, you need not worry if you have ahealth insurance plan .Most healthinsurancepoliciescover the cost of cataract surgery and save the insured from medical expenses. Hence, check online health insurance plans today and cover yourself and your loved ones against cataract and other medical problems.

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    Cataract Surgery And Insurance Coverage

    Did you know cataract surgery is the most commonly performed, medically necessary surgery in Canada? In fact, according to the Canadian Ophthalmological Society, one and a half million people have this procedure every year in North America. Some surgeries, including LASIK and refractive aspects of cataract surgery, are considered convenience procedures, meaning they are primarily for the purpose of giving patients the same clear vision, but with reduced dependence on corrective contact lenses or glasses. These are much like cosmetic surgeries, which may not be medically necessary.

    In Canada, patients are able to have their vision restored with cataract surgery that is high-quality, safe, and publicly insured. Because cataract surgery is so commonly performed in Canada, costs are covered under health insurance plans. Patients who require this procedure are frequently offered optional services during their cataract surgery to provide additional refractive correction.

    Over the past few decades, there have been many technological advancements in cataract surgery adopted by publicly funded insurance plans in Canada. These have completely revolutionized the procedure by allowing for safer, faster surgery with more successful outcomes. The non-insured services aim to improve the overall refractive outcomes rather than reduce complication rates of surgery, so public healthcare coverage is ultimately deemed unwarranted.

    The Details Regarding The Cost Of Cataract Surgery

    You Should Avoid Insurance Based Cataract Surgery!

    If only there were a simple answer to this question. Every medical and surgical procedure is associated with a CPT code . The CPT code for cataract surgery is 66984, although 66982 is also a cataract surgery code used when the cataract surgery is complex, which can happen for any number of reasons.

    When it comes to the cost of any medical or surgical procedure, every doctor, medical office, and hospital comes up with a price for any given CPT code. Think of this as the sticker price. Keep in mind that hardly anyone ever pays the sticker price. When doctors decide to be in-network with any insurance company, they accept and/or negotiate rates for various CPT codes. Also keep in mind that many surgery CPT codes and their associated charges include post-operative visits in that one cost.

    As an example, the surgeon fee sticker price for cataract surgery may be $1500, but the surgeon has agreed to accept, say, $900 from Blue Cross Blue Shield . In that case, for a patient with BCBS, the surgeon fee is $900. Now whether it is BCBS or the patient that pays that $900 depends on the actual BCBS plan and any relevant deductibles, co-insurance, and co-payments. In my experience, the average patient would usually have to pay about $150 of this $900 based on the most common plans, with BCBS paying the rest.

    Cataract Surgery

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    How Much Does Cataract Surgery Cost

    Its not uncommon for a patient to ask how much does cataract surgery cost, and is cataract surgery covered by Medicare or commercial insurance? Regarding insurance coverage, the brief answer is that yes, cataract surgery is covered by Medicare and commercial insurance. The quick answer is it depends regarding cost, but about $3000 per eye is a reasonable ballpark figure for everything including the surgeon fee, facility fee, and anesthesia fee. However, its important to note that a patient would be financially responsible for this only if they have a high-deductible health plan when I perform cataract surgery in Traverse City the typical patient out-of-pocket costs run anywhere from zero dollars to $100 $200 based on a patients deductible, co-pays, and co-insurance. Bear in mind there are regional differences in cost across the United States, and this is just one perspective from an eye doctor in Traverse City, MI.

    Sbi General Health Insurance Plan

    This plan by one of the countrys oldest banks is available to all individuals, irrespective of their age and medical history. The claim limit corresponds to the sum insured amount with a maximum limit of INR 25,0000 that comfortably seeks to address the financial requirements of all Indian citizens.

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    Do You Have To Have Cataract Surgery To Get Coverage

    In order to receive coverage for this eye operation, first your doctor needs to deem cataract surgery medically necessary. It is highly probable that your doctor will do so and provide you with the required written clearance. Cataracts are a serious eye condition not to be taken lightly. In fact, the World Health Organization identifies it as the leading cause of blindness in the world.

    What Is Cataract Surgery

    Does Medicare Cover Cataract Surgery?

    Cataract surgery is necessary to treat cataracts that are significantly affecting a person’s eyesight and quality of life. Ordinarily, the lens of your eye is clear but the cataract causes it to become cloudy, which affects your vision. The procedure involves removing the lens of the eye and replacing it with an artificial one. Surgery is performed by an eye doctor , and is both common and safe.

    Cataract extraction was the most common surgical procedure in 2017-18 with over 70,000 patients receiving the operation through Medicare. The procedure is either performed on both eyes or one eye at a time, giving patients a few weeks for recovery in between procedures.

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    Does Cataract Surgery Come Under Health Insurance

    Yes, cataract surgery is included in health insurance coverage. With specific criteria, one can take a selected plan for their cataract surgery. These criteria include a waiting period of 2 years, the average expense of Rs. 15,000 to Rs 35,000 and given in sublimity.It is preferable to take senior citizen plans if the patient is of late adulthood. This coverage includes hospitalization, surgery, medical expenses, and post-surgery expenses as well.

    Does Medicare Cover Cataract Surgery

    Yes, cataract surgery is covered by Medicare and commercial insurance as a medically necessary procedure, granted that the patient meets certain criteria. While requirements vary, a patient needs to be symptomatic and express difficulty performing any number of activities of daily living. The most common symptoms from cataracts are constantly blurry or hazy vision, trouble driving at night from increased glare, and difficulty seeing in low light. Additionally, some insurances mandate that a cataract cause vision loss of a certain level to consider the surgery medically necessary.

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    Health Insurance Coverage For Cataract Treatment

    A health insurance plan with cataract coverage can help you save a huge amount of money in the prime of your life. Reputed health insurance companies offer health insurance scheme which cover the cost of cataract surgeries under their health plans. However, before availing a health insurance policy keep in mind the following terms and condition related to the coverage:

    Why Mann Eye Institute

    BCH Lecture: Latest Advances in Cataract Surgery

    Our surgeons are among the most experienced cataract surgeons in the country. For over 40 years, the accomplished refractive and cataract specialists at Mann Eye Institute have been at the forefront of vision correction. Our unwavering commitment to personalized patient care, advanced surgical expertise and outstanding results have earned us a reputation for excellence in eye care.

    Are you ready to See Life Better? Were ready to help. Schedule your cataract evaluation today.

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