Because the IOL manufacturers devoted years of research to develop the Crystalens, ReSTOR and ReZoom IOLs, the purchase price for the lenses is higher than what many surgery centers and hospitals are paid by Medicare to provide cataract surgery. Medicare, Medicaid and all other major insurance companies pay for traditional lens implants after cataract surgery, but few payers have indicated they will pay for these more expensive lenses.
In May 2005, the Centers for Medicare and Medicaid Services (CMS) announced that it would allow Medicare patients to pay out-of-pocket an additional amount to eye surgeons to have access to these new lenses. The CMS announcement reversed a 2003 ruling that prohibited Medicare patients from paying for the lenses; that ruling had effectively prevented Medicare patients from taking advantage of the new technology.
After contacting most major local insurers, Midwest Eye Care has developed the following fee schedule for new-technology cataract surgery. The patient financial responsibility must be paid one week prior to the surgery.
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Coverage
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Patient financial responsibility
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Medicare, Medicare Complete, Medicaid, Mutual of Omaha, United HealthCare, Coventry
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Standard surgical co-pay, deductible, and an additional $1,750 per eye for the lens cost
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Blue Cross Blue Shield of Nebraska
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Standard surgical co-pay and deductible
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Blue Cross Blue Shield of Iowa
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Self-pay (no insurance coverage)
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$3,850 per eye
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