Frequently asked questions regarding medically necessary contact lenses

What's a medically necessary lens?

Medically necessary contact lenses provide vision improvement in patients with corneal disease or corneal injury. Patient with irregular corneas often see poorly with eyeglasses, but can see quite well with unique contact lenses, which is why the contact lenses in these cases are considered medically necessary, not cosmetic. Oftentimes, medically necessary lenses are highly customized lenses, but can sometimes be conventional soft or rigid gas permeable lenses.

How is a medically necessary lens prescribed?

Because patients needing medically necessary lenses often have irregular corneas, the process involved with fitting these lenses can be a difficult, expensive, time-consuming experience, that requires patience and perseverence from both the practitioner and the patient. Every eye is different and in most cases, many lenses will need to be tried before attaining a good fit.

A good fitting medically necessary lens will achieve three goals:

  1. Optimal vision correction
  2. Good comfort and wearing time with the lens
  3. Ability to wear the lens without compromise to the health of the eye

If these three goals are achieved, the fitting process is complete.

Who pays for the prescribing of the lenses and the actual contact lenses?

If you have a comprehensive vision plan, such as Vision Service Plan or Eyemed, the fitting process and the medically necessary lenses are often covered in full. The fitting process includes the initial visit and the dispensing visits. Other office visits required to monitor the health of the eye or for unrelated medical eye problems will be billed to your medical insurance plan.

If you only have medical insurance, we will call your insurance plan to see if any benefits are available. If we are unable to reach a representative, we may ask you to contact your insurance company as well. You must always ask for a reference number when you call your insurance company and document the date of the call and information given carefully, as it is not uncommon for different representatives to give different information. Patients who only have medical insurance will be asked to pay for their fitting and contact lenses at the time services are rendered. If the medical insurance pays for the services and lenses after the claim is processed, you will be reimbursed.

If you do not have insurance, you will pay the practice directly at the time of service and will be required to pay for the lenses only when a good fit has been achieved and the lenses are dispensed to you. We do our best to provide an accurate estimate of the fitting and lens cost when seeing you for your initial consultation.

Ultimately, each patient is responsible for the charges incurred in prescribing medically necessary lenses. We do everything we can file these claims with your insurance company, including writing letters of medical necessity and submitting chart notes and invoices, but these claims can still be denied, in which case, you are responsible for the charges.