What Are Medically Necessary Contact Lenses?

Most contact lenses worn by individuals are classified as an elective vision correction option by insurance companies. Insurance companies consider standard contact lenses a cosmetic choice rather than a medical need. However, for some individuals with specific vision conditions, contact lenses are considered a medical necessity.

Function

Insurance companies use the phrase "medically necessary contact lenses" to determine payment levels for contact lenses. Typically, medically necessary lenses are covered at a higher rate than cosmetic contact lenses.

Identification

Medically necessary contact lenses are usually needed for individuals with aphakia, pseudophakia, anisometropia and keratoconus. Conditions can be the side effect of an operation, or can be a genetically related condition.

Considerations

Each health care plan has different coverage levels and qualifications for medically necessary contact lens coverage. Many health insurance companies will cover medically necessary contact lenses, even if the policy does not cover standard contact lenses.

Benefits

Medically necessary contact lenses usually offer the wearer greater visual acuity than eyeglasses can provide. Contact lenses may be used as an alternative to replacing the lens of the eye for some eye conditions and may be needed after some optical surgical procedures like cataract removal.

Misconceptions

Individuals who require some sort of vision correction can misunderstand the phrase medically necessary contact lenses. The phrase is only applied to individuals where standard glasses are not a medically accepted alternative to contact lenses.

References

• Aetna Contact Lenses and Eyeglasses Clinical Policy Bulletin
• Superior Vision Contact Lens Information

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Photo Credit

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