How do I get insurance to pay for my scleral lenses?
If you have medical or vision insurance, they may contribute toward the cost of scleral lenses.
Some insurance companies such as VSP or Eyemed will reimburse eye doctors quite well for scleral lenses, and many offices accept this insurance for scleral lenses.
Other insurance plans reimburse eye doctors poorly for scleral lens fittings. Some of them reimburse less than the cost of the lenses! In this case, it is not feasible or realistic to expect your doctor to fit you into scleral lenses.
One way to get your insurance to cover scleral lenses is to have your doctor write you a letter of medical necessity.
This letter should include”
- Patient’s name
- Patient’s date of birth
- Date patient was seen
- Patient diagnosis
- Patient’s vision (uncorrected)
- Patient’s vision (corrected with glasses)
- Patient’s vision (corrected with scleral lenses)
- Abnormal findings
- Recommended treatment and plan
- ICD 10 codes
- CPT codes
- V codes
The letters we write for patients explain to the insurance company why the patient needs scleral lenses. Usually, our patients suffer from a medical eye condition such as keratoconus, corneal scarring, corneal transplants, RK scarring, post LASIK, etc so the reason they need scleral lenses is to improve their vision. Other patients have medical eye conditions such as extreme dry eye, graft-vs-host disease, sjogren’s, stevens-johnson and other disorders related to the ocular surface. Whatever the reason is, we will write a letter explaining to the insurance company the need for scleral lenses.
Our patient who has extreme dry eye. Notice the major difference in her eyes before and after scleral lenses.
You can also have your doctor give you a list of diagnosis codes, ICD-10 codes, CPT codes, and V codes, along with the pricing for each service. This will allow the insurance company to see what is being requested, and the specific dollar amount needed.
Your insurance company may also request to speak with the doctor. In this case, your doctor will set up a meeting with the insurance company to explain your medical eye condition and explain why scleral lenses are necessary.
With some help from your doctor, you may be able to get a portion or the entire scleral lens fitting covered through your insurances.