Does Blue Cross Blue Shield Cover Lasik Eye Surgery?

Blue Cross Blue Shield is a nationwide health insurance provider that offers coverage for a wide range of medical services. One popular question that many people have is whether or not their insurance plan covers Lasik eye surgery. In this article, we will explore the details of Blue Cross Blue Shield's policy on Lasik and provide you with all the information you need to know.

What is Lasik Eye Surgery?

Lasik, also known as laser-assisted in situ keratomileusis, is a type of refractive surgery that corrects vision problems such as nearsightedness, farsightedness, and astigmatism. It involves using a laser to reshape the cornea - the clear front part of the eye - to improve the way light is focused onto the retina. This results in clearer vision without the need for glasses or contact lenses.

Lasik is a popular choice for individuals looking to permanently correct their vision, as it has a high success rate and minimal recovery time compared to other types of refractive surgery.

How Does Lasik Work?

Lasik surgery involves two main steps: creating a flap and reshaping the cornea. During the first step, a thin flap is created on the outer layer of the cornea using either a special cutting tool called a microkeratome or a femtosecond laser. This flap is then lifted to expose the underlying corneal tissue.

In the second step, an excimer laser is used to reshape the cornea by removing small amounts of tissue from its middle layer. The laser uses cool ultraviolet light beams to precisely remove tissue and reshape the cornea according to your specific vision correction needs.

After reshaping the cornea, the flap is put back in place and acts as a natural bandage, helping to heal the eye quickly and reducing discomfort. The entire procedure typically takes less than 15 minutes per eye and most patients experience improved vision within 24 hours.

Does Blue Cross Blue Shield Cover Lasik Eye Surgery?

The short answer is yes, Blue Cross Blue Shield does offer coverage for Lasik eye surgery. However, as with any medical procedure, some certain requirements and limitations need to be considered.

Blue Cross Blue Shield offers several different insurance plans, each with its own specific coverage options and policies. Therefore, it is important to check with your specific plan to determine the details of your coverage for Lasik.

Requirements for Blue Shield Coverage

To be eligible for coverage, Blue Cross Blue Shield requires that individuals meet certain criteria. These may include:

• Age: Most insurance plans require that the individual is at least 18 years old before they can undergo Lasik surgery.

• Stable Prescription: The individual must have a stable vision prescription for at least one year before the surgery. This means that their prescription has not changed significantly in that period.

• Medical Necessity: Blue Cross Blue Shield considers Lasik eye surgery to be an elective procedure and therefore may only cover it if there is a medical necessity. This determination is made by your eye doctor and must be supported by documentation.

Limitations on Coverage

Even if an individual meets the requirements for coverage, there may still be limitations on what is covered. Some common limitations include:

• Provider Network: Blue Cross Blue Shield may only cover Lasik surgery if it is performed by an in-network provider. Therefore, it is important to research and choose a surgeon who is within your insurance network.

• Type of Surgery: While Lasik is the most commonly performed type of refractive surgery, other procedures such as PRK and LASEK may be covered under certain plans. It is important to check with your plan to determine which type of surgery is covered.

• Enhancement Surgery: In some cases, individuals may require a second procedure known as an enhancement surgery if their vision has not fully corrected after the initial Lasik surgery. Blue Cross Blue Shield may not cover this procedure unless it is deemed medically necessary.

How to Determine Your Coverage?

To determine your coverage for Lasik eye surgery, it is important to contact Blue Cross Blue Shield directly or check your plan's information online. You can also speak with your eye doctor and have them submit a pre-authorization request to your insurance company to determine coverage.

It is important to note that even if your plan covers Lasik, you may still be responsible for certain out-of-pocket costs such as deductibles, co-pays, and any fees associated with using an out-of-network provider.

Tips for Maximizing Your Coverage

If you are considering Lasik eye surgery and have Blue Cross Blue Shield insurance, here are some tips to help maximize your coverage:

• Choose an in-network provider: As mentioned earlier, Blue Cross Blue Shield may only cover Lasik surgery if it is performed by an in-network provider. Be sure to research and choose a surgeon who is within your network.

• Get pre-authorization: Before scheduling your surgery, have your eye doctor submit a pre-authorization request to your insurance company. This will help determine your coverage and any potential out-of-pocket costs.

• Consider other options: If Lasik is not fully covered under your plan, you may want to explore other types of refractive surgery such as PRK or LASEK that may be covered.

Benefits of Using Blue Cross Blue Shield for Lasik Eye Surgery

Blue Cross Blue Shield has been a trusted health insurance provider for over 90 years and offers many benefits for individuals seeking Lasik eye surgery coverage. These include:

• Nationwide Coverage: With over 36 independent and locally operated companies, Blue Cross Blue Shield provides nationwide coverage, making it easier to find an in-network provider.

• Reputation: Blue Cross Blue Shield is known for its high-quality coverage and customer service, giving individuals peace of mind when undergoing a medical procedure like Lasik.

• Flexibility: Blue Cross Blue Shield offers a variety of insurance plans with different coverage options, allowing individuals to choose the plan that best fits their needs.