Will insurance pay for my cataract surgery?

On to the question at hand, will insurance pay for cataract surgery? They will. Begrudgingly.

Joel Hunter, MD
Joel Hunter, MD
Refractive Surgeon, Hunter Vision Updated 01/25/21 11:00 AM

If there’s one thing I can be sure of in social situations, it’s that it’s safe to complain about insurance companies. There are a lot of touchy subjects in the world, and complaining about them isn’t always safe. For instance, I’d never in a million years say something about politics in a social setting. But health insurance? I’d be happy to walk up to a stranger and say, “Insurance companies are a bunch of blood-sucking thieves, aren’t they?” There’s a 100% that person will ask to be my best friend.

On to the question at hand, will insurance pay for cataract surgery? They will. Begrudgingly. The adverb matters there because I’ve watched firsthand — more times than I can count — how hard it is to convince your health insurance that you can’t see. I’ve had patients in clinic that don’t meet the health insurance requirement for vision loss to be eligible for cataract surgery. And I also make sure not to be in the parking lot when that same person will be driving in it.

The general rule for an insurance-covered cataract procedure is that your vision is 20/40 or worse with your best pair of glasses. That is some seriously bad vision. There is one silver lining to the cataract cloud, though. The subjective findings. Sometimes, if you notice that you are having trouble driving because of glare, that’s enough.

I’d never counsel someone to make up symptoms to get insurance coverage. Partially because I’m an honest person, and partially because I would do poorly in prison. But I will say, any visual symptoms you have — even if you don’t know whether the cataract is causing them — are very worth mentioning at your eye exam. For a lot of people, the difference between insurance coverage or not is just complaining about the right thing.

Folks who are getting to an age where cataracts are more common were generally raised not to complain. It’s an admirable trait. People who don’t complain are some of the best people on Earth. But for this one situation — at your eye doctor’s office, when they’re asking how you see — feel free to let loose with all the complaints you’ve avoided. It helps us when we’re talking to your insurance company.

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