Popular topics on this page: What are Medically Necessary Contacts Will My Health Plan Cover It What Conditions Qualify Do I Qualify for Medically Necessary Contacts Medically Necessary Contact Lens FAQ
What are Medically Necessary Contact Lenses
If contact lenses are the only method that can improve your vision then contact lenses are usually considered as medically necessary. Most keratoconus treatment services will qualify as medically necessary contact lenses. Some vision plans refer to this same benefit as visually necessary contact lenses. Most often, vision plans consider traditional contact lenses an elective benefit. The medically necessary requirements vary slightly between vision plans.
The degree of coverage varies widely. Some vision plans offer up to 100% coverage. Vision plans with a medically necessary contact lens benefit are;
- VSP – Vision Services Plan
Does My Health Insurance Plan Cover Medically Necessary Contact Lenses?
No, your medical insurance does not have a medically necessary contact lens benefit. However, we will try to coordinate your plan benefits between both your vision plan and medical plan.
What Conditions are Treated With Medically Necessary Contact Lenses
This varies between vision plans. Medically necessary contacts are most often used in keratoconus treatment and pellucid marginal degeneration. However, we often use medically necessary contacts to help patients experiencing complications after eye surgeries such as LASIK and corneal transplants. Scleral contact lenses are the most common medically necessary contact lens treatment used; however, SynergEyes hybrid contact lenses are also commonly used.
Here is a list of the most common conditions treated with medically necessary contacts;1
- pellucid marginal degeneration
- post-refractive surgery complications (such as LASIK and PRK)
- corneal transplants (penetrating keratoplasty)
- dry eye syndrome
- high refractive error
- irregular astigmatism
- corneal ectasia
- corneal scars
- corneal transplant failure/rejection
- bullous keratopathy
How Can I Find Out if I Can Benefit From Medically Necessary Contact Lenses
We have a lot of experience in treating patients with medically necessary contact lenses and have dealt with virtually every vision plan. Please call the Total Eye Care Colleyville office at (817) 416-0333 for more information. You can also schedule a complimentary consultation with Dr. Driscoll where he can discuss which treatment options may be best for you. If you prefer to schedule your appointment online you can do so here.
About Dr. Richard Driscoll
Dr. Driscoll is a therapeutic optometrist and keratoconus specialist at Total Eye Care in Colleyville, Texas. A 1988 Graduate of the Illinois College, Dr. Driscoll has been treating patients with keratoconus for over 30 years. Following Dr. Driscoll’s graduation from the Illinois College of Optometry, he joined the residency program at the Tuscaloosa VA Medical Center in Tuscaloosa, Alabama.
Dr. Driscoll likes to write. He wrote An Eye Doctor Answers: Explanations To Hundreds Of The Most Common Questions Patients Wish They Had Asked, available on Amazon.com, and The Patient’s Guide to Keratoconus.
1Harmon H, Caswell J. Vision insurance FAQ: frame, lens & contact lens benefits. VSPdirect.com website
Medically Necessary Contact Lenses FAQ
If contact lenses are the only method that can improve your vision then contact lenses are usually considered as medically necessary. Conditions such as keratoconus, dry eye syndrome, corneal scarring, and irregular astigmatism will qualify for medically necessary contact lens benefits.
Vision plans such as VSP (Vision Service Plan), EyeMed, and Spectera have this benefit. Medical insurances do not have a medically necessary contact lens benefit.
No, your medical plan will not cover the fitting of contact lenses for medically necessary conditions; however, most vision plans do offer coverage. Your medical plan will cover the diagnosis and monitoring of your condition. They will also cover surgery should that become necessary.
Keratoconus is the most common; however, other common conditions are high refractive error, corneal scarring, dry eye syndrome, pellucid marginal degeneration, irregular astigmatism, post-refractive surgery complications, and keratitis.