Is LASIK Surgery Covered by Health Insurance?

Vision impairment is a prevalent concern among a substantial portion of the Indian populace, prompting many to seek solutions like LASIK eye surgery. Yet, a lingering question persists among policyholders: does health insurance cover LASIK? This uncertainty has sparked confusion and upheaval when navigating health insurance policies tailored to LASIK procedures. With the increasing prevalence of such surgeries, it becomes imperative to look into the details of Mediclaim policies that may encompass the expenses associated with LASIK eye surgery. Clarifying these uncertainties is crucial in empowering individuals to make informed choices concerning their eye health.

So, let’s get started!   
 

What is Lasic Eye Surgery?

 LASIK surgery, also known as Laser-associated in Situ Keratomileusis, is a widely sought-after procedure aimed at correcting various vision issues. In individuals with conditions like farsightedness (hyperopia), nearsightedness (myopia), or astigmatism, the natural bending of light through the cornea is disrupted, resulting in blurred vision. Traditionally, glasses or contact lenses have been the go-to solutions for such vision impairments. However, LASIK offers an alternative path to clear vision by reshaping the cornea itself.

During LASIK eye surgery, laser technology is employed to precisely reshape the clear, dome-shaped tissue at the forefront of the cornea. This reshaping process ensures that light bends correctly, restoring clear vision without the need for corrective eyewear. The entire procedure typically lasts around 30 minutes to address both eyes and the best part? It's virtually painless.

While minor side effects like temporary dryness or irritation may occur post-surgery, they typically dissipate within a few days, leaving you with improved vision with complete freedom from contact lenses or glasses. Now, let’s see what health insurance plans cover this procedure for you.
 

Health Insurance Plans That Provide LASIK Surgery Coverage

Several health insurance plans are present that cover LASIK eye surgery. A few are mentioned below.

• Aditya Birla Health Insurance
• Bajaj Allianz Health Insurance
• Care Health Insurance
• ManipalCigna Health Insurance
• Start Health Insurance
• Oriental Insurance
• Niva Bupa Health Insurance
   

What Benefits Are Provided By A Health Insurance Plan During LASIK Surgery?

LASIK surgery is often considered to be a cosmetic or elective procedure and not a medically necessary surgery. This is why basic health insurance often does not cover for LASIK surgery. However, there are special circumstances where a few health insurance plans will cover LASIK surgery. If it is determined that vision problems are affecting the overall quality of life of the individual, LASIK surgery can be deemed a medically necessary procedure.

The health insurance plans covering LASIK surgery usually come with certain conditions and restrictions like documentation of medical necessity, pre-authorization requirements and coverage limits. This makes it vital to undergo a thorough consultation with your insurance provider by reviewing each of the terms and conditions of your health insurance policy. This will assist you in understanding how LASIK surgery can be covered under your plan.

Now, let us determine the factors concerning the cost and procedure of the surgery.
 

LASIK Cost & Procedure

You need to be aware of certain elements, which will help to get the best out of the surgery. They have been discussed below.

• Pre-Surgery Guidelines And Consultations: Before opting for the procedure, always consult your doctor to determine whether the surgery is best for you. You may have to follow important guidelines, such as not wearing contact lenses before the procedure. Your eye health should also be checked properly to ensure you are the right fit for LASIK surgery.
   
• Overview Of The Procedure: Generally, the entire procedure can be completed within 30-45 minutes. Your vision will improve when the laser will reshape your cornea. Thus, during the entire procedure, your eyes will be numbed. It can be completed within a day for both eyes.
   
• Post-Surgery Care: It is normal to experience itchy eyes after your surgery. To treat it, it is necessary to water frequently. But remember that it might take a few months to restore your vision entirely. For managing irritation or pain, you may have to apply eyedrops. On the other hand, you can also be instructed to shield your eyes for protection during the night. There will also be a few restrictions, such as going in for a swim or using cosmetics near your eyes for a few weeks after the procedure.
   
• Insurance Coverage: The entire cost of the procedure can be between Rs 20,000 to Rs 1,50,000 in India. However, the current condition of the patient and the doctor will allow for determining the actual cost. This can make the entire procedure to be expensive as it is not a medically essential surgery for many people. Thus, it is vital to understand whether your health insurance can cover the cost of the LASIK surgery. 
   

Types of LASIK Eye Surgery With Cost

We will now be discussing the different types of LASIK eye surgeries currently available.

• Conventional LASIK Eye Surgery
  Conventional LASIK eye surgery is also known as standard or traditional LASIK. It was invented in the 1990s, and it is generally utilised for treating refractive issues like nearsightedness, farsightedness, and astigmatism. Conventional LASIK eye surgery is a corrective procedure throughout the affected eyes. The cost of the treatment is between Rs 20,000 to Rs 30,000. This surgery has the same process for prescription eyeglasses and contact lenses.
   
• Customized LASIK Surgery/SBK (Sub Bowman’s Keratomileusis)
  The procedure utilises a Moria SBK or Su-Bowman-Keratomileusis blade. This creates a corneal flap, which can be applied to change the corneal structure through a multi-point laser. This is also known as the Carl Zeiss Mel 90 system. The total cost of the procedure is between Rs 30,000 to Rs 40,000.
   
• Customized Femtosecond
  It is also known as All-Laser LASIK  or Bladeless LASIK or Femtosecond LASIK to permanently clear the imperfections and shape of the cornea. This laser is utilised for the correction of a wide range of vision problems. The cost of the treatment is between Rs 80,000 to Rs 1,00,000.
   
• Reflex Smile Treatment
  This is one of the best minimally invasive procedures for people suffering from short-sightedness. The surgery works by utilising the innovative form of keyhole laser eye surgery. It utilises the Small Incision Lenticule extraction or SMILE, making the entire procedure bladeless. The treatment cost is between Rs 80,000 to Rs 95,000.
   
• Contoura Vision Lasik Surgery
  Compared to traditional LASIK, this surgery is a revolutionary development for laser eye surgeries. It is used to cure all refractive errors with a better customized and precise approach. The cost of the treatment is between Rs 95,000 to Rs 1,05,000.
   

Inclusions Under Mediclaim Policy For LASIK Eye Surgery

Now, we move on to discuss the conditions under which LASIK eye surgery coverages can be facilitated thoroughly.

• Any accident or injury caused a refractive error requiring eye surgery.
• Refractive error caused due to another surgery requiring LASIK surgery.
• IRDAI has mentioned that eye surgery will be beneficial when the refractive error is more or equal to 7.5 diopters.
• Persistent pain and physical deformity are causing issues with wearing glasses, requiring surgery.
• Requirement of LASIK surgery due to lack of tolerance and physical limitations for contact lenses. 

Always make sure to clarify the limits of severity for LASIK eye surgery coverage through the terms and conditions of your health insurance policy.
 

Claim Process For LASIK Surgery Insurance

Both reimbursement and cashless procedures can be enabled for claiming the health insurance policy for LASIK eye surgery. They have been described below.

• Cashless Claim Process
  • Step 1: In the first step, the clinics and network hospitals under the insurance provider should be checked thoroughly by the patients who offer LASIK eye surgery.  Patients should choose only the network clinics and hospitals.
  • Step 2: In the following step, the insured should look into an effective document submission process. Initiating this health insurance claim settlement requires the valid ID proof and health insurance card of the patient.
  • Step 3: The initiation of the pre-authorization request should be looked into in the next course of action. Pre-authorization requests from the insurance provider and the policy details of the patient will be verified by the clinic or hospital.
  • Step 4: The insurance company will look into the eligibility of the patient as well as the policy terms of the request. Approval or denial of the pre-authorization will be ensured through this process.
  • Step 5: Lastly, the provision of direct payment will be enforced by the insurance providers. Payment to the clinic or hospital will be performed directly upon the pre-authorization by the insurance provider. The patients only need to bear the cost of co-payment and deductible as mentioned in the policy.
• Reimbursement Claim Process
  • Step 1: In the first step, the patients must choose the most appropriate hospital or clinic that is covered by their insurance providers. Patients will be choosing the clinic or hospital for the LASIK eye surgery, along with collecting and submitting discharge summaries, medical bills, and diagnostic reports to their insurance provider.
  • Step 2: Secondly, the process of document collection and submission will be implemented. Approval and denial of the claim by the insurance provider will depend on the terms and conditions of the policy.
  • Step 3: Lastly, reimbursement will be provided after the approval of the claim for the specified amount, conditional to the co-payment and deductible mentioned in the terms and conditions.

However, there are certain age constraints associated with LASIK surgery. Let’s look at them below.
 

When is The Best Time To Get A LASIK Eye Surgery?

LASIK eye surgery is considered ideal for the age group of 18-40 years old. According to the medical professionals, the laser surgery can be facilitated after wearing glasses for over a year. However, the visual and health needs of people above 40 years old need to be determined before proceeding with the surgery. 
 

Factors Affecting The LASIK Eye Surgery Cost In India

We need to be aware of the several elements that influence the LASIK eye surgery cost in India. They have been discussed below.

• Technology Used
  The cost of vision correction will depend on the technological advancements and procedures. The advanced LASIK techniques are costlier than the conventional procedures.
   
• Expertise Of The Doctor
  The cost of LASIK eye surgery increases with the expertise of the doctors. A higher fee will be charged when a highly experienced doctor performs the surgery.
   
• City/Location
  Since metro cities have the latest technologies, infrastructure, and amenities, the location and city of the hospital plays a major role in increasing the cost of the treatment.
   
• Diagnostics And Evaluation
  The cost of the surgery will also depend upon the different diagnostic tests conducted on the patient.
   
• Aftercare
  Hospitals with aftercare packages will have increased surgery costs. The patient has the right to deny aftercare, but any post-surgery complications or infections will not be taken care of by the hospital.
   

Wrapping Up!

Navigating the domains of LASIK surgery requires knowledge of a multitude of factors. An in-depth insight into the terms and conditions of your health insurance provider is one of the pivotal factors in claiming coverage for LASIK surgery. These financial components are not only cost-effective strategies but also necessary to enhance your eye health for a healthy life. Thus, the intricacies of your health insurance coverage should be checked minutely for a healthier future.

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