Is LASIK Covered by Insurance?

If you’re here because it is time to sincerely pursue having LASIK, you may be asking yourself a very common question: “Is LASIK covered by my insurance?” So, in this post, we’ll explain how insurance works with LASIK, so that you can know how that all works and make the most of your vision insurance when you have LASIK.

Generally speaking, health insurance works this way: you visit the doctor, you pay some sort of co-pay or deductible and the insurance company pays that doctor for the other portion of your care. And that is how the majority of vision insurances work for eye exams, glasses and contact lenses – you visit your eye doctor, and the vision insurance company pays the eye doctor for a certain amount towards your exam and glasses and/or contacts, based on the specific provisions of your vision plan.

When it comes to LASIK, vision insurance works differently.

It is extremely rare for an insurance plan to have coverage for LASIK; in the same sense that we are accustomed to when we visit regular doctors or receive routine eye care, glasses and/or contacts. For the vast majority of patients, LASIK is not “covered” by vision insurance, as LASIK costs are not billable to an insurance company.

This is most likely because the vast majority of insurance companies currently do not view LASIK the same as they view eye exams, glasses, and contacts. Perhaps it’s because LASIK is an elective procedure, meaning no one has to have it, and glasses and contacts “work” in the sense that they help you see when you wear them. Many people have wondered why that is, especially from the standpoint of the insurance company – “Why would they continue to pay for eye exams, glasses and contacts, but they won’t pay for my LASIK?”

While a reasonable question, there are many factors which make up this answer. However, here is one of the primary reasons: insurance companies prefer to payout as little money as possible to provide benefits within a plan’s given coverage year. By example, if an insurance company pays a lump sump fee for LASIK and then that individual changes insurance carriers the next year, the insurance company loses in the long run.

 “LASIK Benefits” and Vision Insurance

While it is exceedingly rare for an insurance company to actually pay for LASIK, there are many vision insurance companies that provide a “LASIK Benefit” as a part of the vision plan. Sometimes, this “LASIK Benefit” is presented to the patient as “coverage” of a certain percentage of the LASIK fee, but the important point to distinguish is that, the vast majority of the time, the LASIK provider does not receive reimbursement from an insurance company for any portion of the services rendered. It is simply a reduction in the fee for LASIK honored by the LASIK provider.

For some LASIK providers, vision insurance is another way to invest in marketing their practice. A LASIK provider may choose to pay a fee to the vision insurance company to be listed as an In-Network LASIK Provider so that when people contact their vision insurance to inquire about LASIK, the vision insurance company refers the patient to the providers who have paid the fee. In turn, the provider agrees to reduce their fees for LASIK. Customarily, the fees for LASIK are reduced by 5% on “Promotional Fees” for LASIK, and 15% for “Standard Fees.” So, when that LASIK provider is running a sale, the fee is reduced by 5%, and when they aren’t, the fee is reduced by 15%.

The way that 20/20 Institute has chosen to approach this is to honor all vision insurances with a fee reduction so that our patients can take advantage of the vision insurance benefits in which they have invested. As our goal is to provide our most advanced LASIK technologies to every single patient that wants to have LASIK at 20/20 Institute regardless of their insurance carrier. We have also chosen to not invest in appearing on the referral lists of vision insurance companies. We prefer an open free market system that allows all patients to choose us based on the merit the of our work and customer service.

Of course cost is a consideration for anyone considering LASIK, which is why patients commonly wonder about if their vision insurance helps with the costs. We accommodate vision insurance benefits for every patient however our primary focus is to maximize the safety and efficacy in every 20/20 Institute patient’s LASIK procedure.

3 Important Factors To Understand

Before deciding where you have your LASIK performed, the LASIK Specialists at 20/20 Institute recommend understanding the answers to three important sets of questions that will help you understand the factors that may impact your safety and probability of outcome in your LASIK procedure:

• In Depth Specialized Testing. The most important first step of having LASIK is making sure that you are a good candidate for LASIK. As different LASIK providers utilize somewhat different testing and criteria to determine a patient’s candidacy for LASIK, the first set of questions you should understand is related to the testing that is done by the LASIK provider to determine your candidacy. “What technologies are used, what tests are done and why? How stringent is the candidacy criteria? How frequently patients advised to NOT to have LASIK?”
• Advanced LASER Technology. LASIK has been available in the US for nearly 20 years, and most LASIK technologies that have ever been FDA Approved are still available for use by a LASIK surgeon. Even though the majority of LASIK Specialists agree that advanced technology improves the safety and accuracy of the LASIK procedure, not all doctors choose to utilize the most advanced technologies. So the next set of questions to understand surrounds the treatment technology. “What technology will be used on your eyes? How old or new is it? Are there multiple technologies on site, and, if so, how is it decided what will be used on your eyes? What percentage of LASIK Specialists in the US chooses to use that same technology?”
• Short and Long Term Costs. The cost of a LASIK procedure is largely determined by the providers testing, technology used for the procedure as well as the commitments made to you for long term care. Therefore, the last set of questions to understand are tied to understanding all the deliverables you receive for the price quoted.  “What is included in your procedure fee? Are there any additional costs now, or in the future, for you? How does that fee compare to the fees for LASIK at other providers?”

At 20/20 Institute, we understand that the choice to have LASIK is a decision that most patients do not take lightly. So we share these three sets of questions to help any person considering LASIK, and we hope that they are helpful to you – regardless of where you are in your thought process and what it was exactly that brought you here today.

If today is your day to start pursuing LASIK, you can know that ALL vision insurances are honored here at 20/20 Institute. Just give us a call to discuss the details, and we will happily share with you the exact fees for 20/20 LASIK – including your vision insurance benefit – even over the phone.