Refractive Laser Eye Surgery – Will Insurance Pay?
Independent Review Organizations (IROs) Help Determine the Medical Necessity of “Cosmetic” Laser Eye (Lasik) Treatments
(PRWEB) June 29, 2005 -- Eye wear may be a fashion accessory, but when you
depend upon it for seeing the world, it’s a lot more. Today, many people are
turning to refractive laser eye surgery, such as Lasik surgery, to improve their
vision. The cost of Lasik is high and is normally not paid for by insurance
because it’s fails to meet the conservative therapy test and is classified as
cosmetic surgery. According to Independent Review Organization (IRO), AllMed
Healthcare Management (http://www.allmedmd.com), this trend is shifting.
“We
are seeing an increasingly number circumstances where refractive eye surgery is
determined to be medically necessary and, therefore, payable by the insurance
provider,” explains Dr. Skip Freedman, medical director at AllMed Healthcare
Management. “For example, if conservative therapy treatments fail or if a
patient is intolerant of contact lenses and cannot wear glasses because they
might pose a risk in their job (e.g. police or firefighters), refractive eye
surgery may be the most medically viable treatment option.”
Photorefractive keratectomy (PRK) is a refractive laser surgical
procedure that is often covered by a patient that suffers from recurrent corneal
erosion (e.g. diabetics). With PRK, a surgeon uses a laser to remove corneal
tissue to correct vision problems. Conservative therapy approaches, such as
patching, epithelial debridement (mechanical removal of faulty tissue), and
bandaged contact lens placement often don’t work. Stromal puncturing, a
procedure involving the physician puncturing the anterior corneal stroma, can
also be used but can fail or result in permanent visual loss. In such cases, PRK
is the best alternative for removing the damaged cells (or membranes) and
possibly correcting the vision problems.
According to Freedman,
physicians can help patients who are in medical need of laser eye surgery make a
stronger case by initiating the following:
Document a full medical
history of the patient’s eye complaints
Show proof that the patient has not
responded to conservative treatments and that the purpose of the laser eye
surgery is for medical reasons other than simply improved eyesight
Still, Freedman cautions, that even when the physician does this, each
decision is taken on a case-by-case basis and is subject to the extenuating
circumstances clearly noted in the patient’s medical record.
Find more
information about the medical necessity review services offered by IROs on
AllMed’s web site at http://www.allmedmd.com.
About AllMed Healthcare
Management:
Founded in 1995, AllMed is a URAC-accredited Independent Review
Organization (IRO) serving insurance payers, providers, TPAs and claims managers
nationwide. Reviews are conducted by board-certified physicians in active
practice. AllMed's growing customer base includes premier organizations, such as
Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation,
HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare
Alliance, Allianz and many other leading healthcare payers.
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Source : http://www.prweb.com/releases/2005/6/prweb254379.htm