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How Much Does Cataract Surgery Cost In Ft. Worth, Texas

The costs of cataract surgery in Ft. Worth, Texas depend on various factors, such as eye health, age, medical history, or past eye surgery. A primary factor, however, depends on your health insurance plan through Medicaid, Medicare, or even private medical insurance. From a recent report, patients without any medical insurance had an out-of-pocket cost between $3,600 and $6,000 for each eye.

Other Common Cost Factors Include

The type of technology used during surgery.
The type of intraocular lens (IOL) implanted in the eye during the surgery.
The years of experience, skill, and competency of the cataract surgeon.

Fortunately, the majority of cataract surgery procedures carried out in the U.S. are either partially or fully covered by medical insurance. This is to help the patient save on the overall cost of the procedure and help people get back to their daily lives. Cataract surgery is categorized as a medically necessary procedure.

Affordable Or Low Cost Cataract Surgery in Ft. Worth

Patients who are relying solely on their medical insurance will likely opt for cataract surgery at the lowest cost. The industry standard for a low-cost cataract surgery is to replace the natural lens with a monofocal intraocular lens (IOL), which often requires little to no added cost. A monofocal lens will often correct either nearsightedness or farsightedness in the patient. The patient may only be required to pay their deductible and/or co-payments as specified in their insurance policy.

However, for patients seeking to improve their vision further, opting for a presbyopia-correcting IOL or a premium Toric IOL for astigmatism will require that patients pay the additional cost incurred as a result of these advanced techniques. However, the benefits are well worth the added costs.

Determining The Cost Of Cataract Surgery Without Insurance

While most patients who undergo cataract surgery in , Texas have some form of medical insurance, a patient without insurance will need to pay the cost out-of-pocket. Fortunately, a number of payment plans and options for monthly options are nearly always available through the clinic or a 3rd party creditor.

Similarly, some patients who aren’t candidates for LASIK can elect for a quasi-cataract surgery procedure referred to as refractive lens exchange (RLE).

The refractive lens exchange procedure is carried out the same way as cataract surgery. The only difference is that the natural lens of the eye which is removed in RLE is not yet clouded like that of cataract. The natural lens of the eye will be replaced with an IOL. A refractive lens exchange like any cataract surgery will help correct eye defects such as near or farsightedness. Thus, reducing patient’s dependence on eyeglasses or contacts.

The refractive lens exchange procedure with a standard monofocal IOL implant costs the same amount as cataract surgery. Plus, a procedure that uses a Toric IOL for astigmatism or presbyopia-correcting IOL will increase the cost of the surgery as well.

Cost Of "Out-Of-Pocket" Cataract Surgery With Insurance

“Out-Of-Pocket” expenses for cataract surgery can also refer to any additional costs of the procedure, which may not even be covered by your medical insurance policy. Medical insurance covers procedures that are medically necessary, but any product or add-on involved might not be considered as medically necessary, which means, no coverage.

What's Covered?

For instance, implanting a standard monofocal IOL during cataract surgery would be considered medically necessary because it is the standard of eye care. Since the natural lens of the eye is removed during the procedure, there is a need to replace it with an artificial lens. If not, your vision may not be restored.

Vision Correction, Covered?

Your visual acuity will vary based on the type of IOL you use. Standard monofocal IOL gives patients excellent distant vision, but only for one distance — near vision or distance vision. This type of vision correction is usually covered by insurance, but when patients opt for both, better near & distance vision, patients may need a premium IOL that carries an out-of-pocket expense.

Alternatively, when a standard monofocal IOL is used for patients that have astigmatism before their cataract surgery, they will still require prescription eyeglasses to correct their astigmatism after the cataract surgery. But, if the patient wants an IOL that corrects their astigmatism, it's up to their insurance provider to decide if that's a medical necessity or an additional out-of-pocket expense.

Premium IOLs, Covered?

When patients want to be able to see without using any eyeglasses or contact lenses, premium IOLs are the clear way to go. Advancements in the intraocular lens and surgical technology has allowed patients to experience clear vision at near and far regardless of their age and prior visual sharpness.

Premium IOLs often lead to additional costs that are not covered by medical insurance, yet their benefits are permanent and effective.

Why continue to wear prescription eyeglasses or contacts after cataract surgery? The one-time additional cost from advanced procedures for cataract surgery may be a suitable alternative that can be budgeted effectively.

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Why Won’t Medical Insurance Cover These Advanced Procedures?

Medical insurance only covers cataract surgery because a person can end up blind without the surgery, so it's considered medically necessary. However, any advanced cataract surgery procedure (like a premium IOL) can be argued:

Other Options

While less convenient than a premium IOL, medical insurance providers argue that a patient can simply wear reading glasses to see up close. If they want a premium IOL or multifocal IOL for better near vision, that's an added expense.

Vision Correction Isn't The Problem

Medical insurance, in general, doesn't cover vision correction. Patients who wear eyeglasses and contacts already know that to see well that they must pay for their eyewear. Or, they use their vision insurance to cover these costs. So, just like in eyewear, health insurance policies will not cover advanced cataract surgeries that merely correct your vision further.

Premium IOLs Are Like LASIK

Laser vision correction does provide a permanent solution for myopia or presbyopia. However, almost the entire cost is out-of-pocket. This is due to the fact that LASIK surgery is considered an elective procedure, thus, medically unnecessary. The same goes for any premium IOL.

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About Advanced Cataract Surgery Procedures & Premium IOLs

Presbyopia-Correcting IOLs

Presbyopia-correcting IOLs are advanced intraocular lenses that can help expand your range of vision. The lenses are very effective at correcting your farsightedness caused by presbyopia. You can see clearly and read prints without using reading glasses! Examples of presbyopia-correcting IOLs include multifocal IOLs and accommodating IOLs.

Toric IOLs

Toric IOLs are intraocular lenses that correct astigmatism. Astigmatism often makes our vision less crisp or even blurry. After correcting an astigmatism through a Toric IOL, patients will experience clearer vision that they never had from eyeglasses!

Often, patients post cataract surgery will be able to perform activities such as driving, operating the computer, reading books, and sports.An astigmatic patient who chooses to use a monofocal IOL may require eyeglasses if they have a severe astigmatism as their vision will remain blurry.

Laser-Assisted Cataract Surgery

This advanced procedure is often referred to as laser cataract surgery. In the procedure, a femtosecond laser is used instead of the manual surgical tools that are used in typically cataract surgery.

The procedure relies on a similar approach as LASIK. Laser cataract surgery also helps in reducing the stress on the retina and other delicate eye tissues while the cataract is being extracted. Laser cataract surgery is usually performed after implanting a premium astigmatism-correcting or presbyopia-correcting IOL. The additional cost of the procedure can be included in the cost of the premium IOL.

Limbal Relaxing Incisions (LRI)

LRI, also called corneal relaxing incisions, is a supplemental surgical procedure which is used to correct astigmatism.

The procedure is performed during cataract surgery. During the procedure, the eye surgeon makes one or more small, arc-shaped incisions in the periphery of the cornea. This will help the cornea to form a spherical shape while the incisions heal.

Laser Arcuate Incisions

The minor surgical procedure is similar to Limbal Relaxing Incisions (LRI). The only difference is that a femtosecond laser is used to make the incisions instead of a hand-held surgical tool.

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Standard Medicare & Health Insurance Coverage For Cataract Surgery

Medicare coverage is very straightforward when the procedure is uncomplicated. Reimbursements are paid directly to the eye surgeon or surgical center. For cataract surgery, medical insurance providers usually follow the standard coverage given by Medicare to determine which charges that will be covered.

However, reimbursements from private medical insurance usually vary widely. It depends on your copay as well as the annual deductible of your insurance policy. A patient may be required to pay other related costs which may not be associated directly with the cataract procedure.

For Example, The Patient May Need To Pay About 20% Of The Following Types Of Fees

An EKG to determine your heart health before the procedure can be carried out.
A comprehensive eye exam. This may include precise measurements to determine the extent of the refractive errors in your eye.
Costs that will be charged by the person administering the anesthesia. This can be the nurse anesthetist or anesthesiologist.
The cost of standard prescription eyeglasses that will be used to improve near vision after the surgical procedure.
Any follow-up procedures or medical care as a result of any complication in the cataract surgery that occurs after the standard 90-day period set aside for postoperative care.

An Excellent Example Of A Common Complication Is Posterior Capsule Opacification (PCO)

This is a situation whereby the residual membrane left in the eye will become clouded after the cataract surgery. You may need a YAG laser capsulotomy procedure to fix this and restore your clear vision. The procedure will cost about a few hundred dollars.

Questions For Your Insurance Provider

Before you have the cataract surgery, it is advisable to speak in-depth with your insurance provider. Some of the questions you may consider asking include:

Ask about copays, eyewear coverage, deductibles, pre-surgery approvals and other details.
How much is the copay?
How much is the deductible?
Does your plan also cover eyeglasses?
Is there any particular arrangement with between the insurance company and the cataract surgeon?
Does the insurance company have a preferred provider of cataract surgical procedure?
If your eye surgeon is not "preferred," does your insurance company need to approve the surgeon before the procedure can be covered?
Will the insurance company need advance approval to determine whether the procedure is medically necessary?

Ensure that the insurance company provides suitable and satisfactory answers to all your questions and concerns. With this, you will be able to understand how much will be covered by your insurance policy.