Medical Insurance and Cataract Surgery Fees

Cataracts that impact the visual acuity and quality of life of an individual can be removed with a relatively painless operation that is usually covered by medical insurance (e.g. Medicare, Blue Cross, etc.).  Depending on whether you have any upfront deductible or co-insurance costs, at the present time, medical insurance fully covers:
  1. The surgeon’s fees for cataract surgery
  2. The anesthesiologist’s fee
  3. The hospital and/or the surgery center facility fee
Medical insurance NEVER covers anything related to glasses wear, measurement for glasses (i.e. refraction), post-cataract surgery need for glasses, post-cataract surgery LASIK, or any time spent with the patient discussing these options.  The discussion and the wish to not wear glasses is ALWAYS considered an elective/cosmetic option by medical insurance companies and the time that you take from your doctor and/or any premium options (see below) you choose that address needing or not needing glasses is always charged to the patient directly and not to the insurance company. At Eye Center of La Jolla, additional out-of-pocket costs around cataract surgery for minimizing glasses wear fall into the following premium option plans:
  1. Optiwave Refractive Analysis (ORA)- a more precise method of calculating the intraocular lens power of your choice that is used LIVE at the time of surgery. This method of calculating intraocular lens power during the surgery is more advanced than the current standard method of doing the lens selection prior to the time of the surgery.  Every time the ORA is used, 40 extra measurements are taken by your surgeon after the cataract is removed, and a judgment is made to select the best possible lens per your wishes.  This option requires extra technologies and time on the part of your surgeon and is directly billable to the patient and not to medical insurance.  Patients that elect this option will not be charged any required post-cataract surgery refraction fees that we normally charge in our office.
  2. Multifocal lens implants- these designated advanced technology lens implants that replace cataracts provide a range of vision. They are best for those who wish to have good reading vision post-cataract surgery.  Although they typically require good light in the surroundings, they can significantly reduce a patient’s need for reading glasses.   These lenses have additional costs associated with them that is not covered by medical insurance and is directly billed to the patient.
  3. Accommodating (i.e. Crystalens)—this designated advanced technology lens that replaces cataracts is best for intermediate range vision and unless set for monovision, patients that elect this lens still require glasses for reading fine prints. These lenses have additional costs associated with them that is not covered by medical insurance and is directly billed to the patient.
  4. Blended Vision-This is a unique method of providing good distance to intermediate vision with adequate near vision for most daily activities. The lens used for this method in our office is not considered an advanced technology lens, but the results can be equal to the multifocal and the accommodating lenses in minimizing the need for glasses post-operatively at a fraction of the cost.   Although theoretically any standard lens could be used for a blended vision option, we exclusively use the collamer lens manufactured by Staar Surgical for patients that choose Blended vision.  We also always employ ORA in all of our blended vision cases and take extra time and steps to minimize glasses wear post-operatively.
Our premium options have additional out of pocket fees associated with them (see our fee schedule).  The fees are for the possible extra cost of the lens that you choose and for the extra amount of time and special consideration that is given to your particular case to address your wishes to minimize glasses.  It is important to understand that at the present time and with the available current technologies, there is no guarantee that glasses will not be required following cataract surgery.  This is ESPECIALLY TRUE IF YOU HAVE HAD PRIOR LASIK OR OTHER REFRACTIVE PROCEDURES.  The above 4 options are to MINIMIZE the need for glasses, not to completely eliminate them. As part of our premium package selections, patients that choose the premium packages get unlimited face to face time with the surgeon to discuss their wishes about glasses wear.  Remember, medical insurance does not cover any part of the examination and/or surgery that is spent to discuss glasses options and ANY extra effort by our office to address glasses wear is billable directly to the patient. In addition, premium package patients will receive extra polish time during surgery.  Polishing involves cleaning every individual lens cell fiber possible during cataract surgery.  This step is not part of routine cataract surgery that is covered by medical insurance.  However, polishing and cleaning the capsular membrane that holds the intraocular lens has been shown to improve the clarity of the vision and decrease future refractive changes that lead to increased need for glasses wear.    This step requires extra time by the surgeon and is provided to all premium package patients.