LASIK, the groundbreaking laser eye surgery that corrects vision problems like nearsightedness and astigmatism, has transformed the lives of millions. California, whose residents are techie and health-conscious, boasts a multitude of LASIK candidates. But most residents’ question is whether the procedure will be covered by their insurance company.
Understanding Health Insurance in California
Prior to going out to explore LASIK coverage, having a basic understanding of health insurance in California is helpful overall. There are primarily Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) plans. HMOs typically require patients to visit in-network doctors and get a referral, but PPOs have greater freedom to visit out-of-network doctors without first getting a referral. Some Californians also buy health insurance through Covered California, the state exchange marketplace.
Although different plans provide a wide array of medical needs—from preventive care to surgery for late-stage disease—there are some treatments not covered. Treatments that are not medically necessary, quality-of-life-improving type, i.e., those not done in life-or-death situations, do not usually fall within policy coverage.
Common Exclusions in Insurance Policies
Insurance covers health care necessities that are necessary, typically medical emergencies, chronic illness, and preventive medicine. Procedures that are not emergency in nature but are designed for comfort, appearance, or convenience are not typically covered. Cosmetic surgery, certain dental work, and eye corrective surgery like LASIK are not covered under standard policies.
Vision coverage, if purchased as an add-on, typically pays for eye exams, glasses, or contact lenses but not surgeries such as LASIK. Even the plans that reimburse some of the expense of certain eye surgeries reimburse for treatments that fix medical conditions, such as cataracts or glaucoma, and not refractive issues.
Why LASIK is Usually an Elective Surgery
The reason why LASIK has been determined to be an elective procedure is its nature. In most people, the surgery isn’t necessary on a medical basis but rather is a life upgrade in the guise of freedom from glasses or contact lenses. As much as the results of LASIK may be nothing less than miraculous, LASIK falls into an elective category with insurance providers in much the same way as cosmetic orthodontic or cosmetic enhancement may.
Insurers also argue that lower-risk substitutes like glasses or contacts can adequately correct issues with sight. As these substitutes are cheaper and more common, they are more suitable for insurers’ focus on cost in the context of basic medical treatment.
Methods to Potentially Reduce the Cost of LASIK
While insurance does not typically pay for LASIK, the cost can be managed. One method is to utilize pre-tax savings tools such as a Flexible Spending Account (FSA) or Health Savings Account (HSA). Both accounts enable one to spend pre-tax dollars on medical purposes only, and this can make a big difference in the out-of-pocket cost of LASIK.
Financing is also an option. Most LASIK centers have agreements with financing companies to offer payment installments at minimal or no interest. Clinics also have promotions such as reduced fees for new patients or package deals to benefit from affordable LASIK in California.
Further, some insurance companies offer discounts or negotiated rates to some LASIK surgeons. Although these lower costs are less than desirable, they at least make it more affordable.
Making LASIK a Reality in California
LASIK is a revolutionary treatment offering never-before-seen convenience and vision for individuals fed up with the necessity of depending on contacts or eyeglasses. Having said that, just as with most states, LASIK in California is not generally insured because it’s not deemed an essential surgery. With knowledge of other avenues to pay the cost, such as using FSA or HSA money, investigating financing, or looking into provider rebates, clear vision is more than just vision.
For anyone considering LASIK but is unsure, seek out a qualified eye care professional to discuss both the procedure and the financing options with you. Investing in your vision may be one of the best things you ever do for your health.
