​​​​Medical Insurance options for treatment of Keratoconus in USA

Medical Insurance options treatment of keratoconus disorders can be confusing.We are very excited that insurance has started covering the procedure needed desperately by so many young people.There are many kinds of insurances in USA. It is a complicated landscape. Our goal is to clear as much confusion as possible so that our our patients can benefit from what insurance plans offer them. There are two broad categories of insurance. Medical and Vision insurance.

Medical Insurance options treatment Keratoconus

Medical insurances are which cove your entire body for medical treatment. They do not cover interventions whcih they think are for vanity like lasik. They are legally required to cover FDA approved non experimental procedures.Over the last few years may keratoconus patients have benefitted by the coverage they provided for intacs corneal ring segments. Now they are also covering FDA approved cornea cross linking with riboflavin. 

Since the c3R coverage just got approved we are seeing a lot of patients with thin corneas. They have patiently waited for insurance to cover. If you are one of them don’t be afraid that it is too late for treatment. We can do cornea cross linking even in thin corneas.

List of Insurance options treatment Keratoconus

Blue Cross, Blue Shield, Aetna, UHC and Cigna cover surgical procedures for keratoconus by a keratoconus expert like Dr. Khanna. The insurance coverage may vary state by state.Coverage is plan specific. So it is best to get preapproved. You may still be responsible for your copay, deductible and if there are any non covered expenses.

Augmented to this is some coverage by most insurance companies, most coverage by some insurance companies and sometimes entire reimbursement for FDA approved keratoconus treatments. So this what we do.

  1. Clinical Exam
  2. Advanced diagnostic tests confirming progressive keratoconus or post lasik ectasia. Check measurements meet insurance criteria
  3. Discussion with keratoocnus doctor
  4. Precertification with an insurance company becomes a prerequisite. For people coming from different parts of the country, precertification can be obtained by obtaining their medical records from their treating eye care specialist. These eye doctors usually do not perform treatment of keratoconus and are happy to refer their patients to a keratoconus expert, in the best interest of their patients.
  5. Cross linking or intacs procedure
  6. Submission of claim
  7. Appeals x3 if necessary
  8. Happiness

To obtain clearance for your keratoconus surgery a keratoconus expert needs to review the clinical history with vision data, corneal colored maps called corneal topography, Pachymetry maps and a history showing decrease of vision. Intolerance to contact lenses, poor vision with glasses and frequent change in glasses are usually present. Please send these documents with a nominal processing fee before booking your air tickets. Once an approval is obtained from the insurance company copay, deductible, coinsurance can all be discussed. So help for your treatment is close by. After your precertification is obtained we can even skype with you to dispel your fears about keratoconus treatment options.

Vision Insurance options treatment Keratoconus

Vision insurances are the biggest misnomer. They include spectra, VSP insurnace, Davis and Eyemed. Almost a play of words. They only cover glasses and contact lenses. They DO NOT cover vision surgeries like cross linking for keratoconus eye disorder or intacs or ICL. They do not even cover cataract surgery. Our suggestion is they should rename themselves as Spectacle insurance.

To summarize VSP insurance does not cover cornea cross linking.

If you dont have insurance, you need not worry. Other option is loan for keratoconus treatment. To keep up to date with latest options please subscribe to our Keratoconus newsletter.

Avedro epi off cornea cross linking Procedural

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