Contacts: Cosmetic Or Medical Necessity?

Whether or not contact lenses are considered a cosmetic procedure by insurance providers depends on the type of contact lenses and the insurance plan. Generally, most vision insurance plans include some coverage for contacts, but the level of coverage depends on whether the contacts are medically required or elective. Medically required contacts are typically prescribed to correct errors in vision that glasses can't fix, due to very poor eyesight, an irregularly shaped cornea, or a disease that affects the eye's surface. On the other hand, elective contacts are chosen by the patient for cosmetic reasons, even though their vision could be corrected with eyeglasses. While most insurance plans do not cover the full costs of elective contacts, some vision plans do offer yearly allowances for standard contact lenses.

Contact lenses are a recognised medical device

Medically necessary contact lenses are not elective and are often the only treatment option that provides optimal vision for patients with ocular conditions. Contact lenses can improve visual acuity and reduce visual distortion in ways that glasses cannot, ultimately improving patients' quality of life. They are particularly important for those with conditions such as keratoconus or systemic conditions that cause severe dry eye, like Sjogren's Syndrome.

While elective coloured contacts/contact lenses are not the standard choice for treating refractive error, they are often covered by insurance plans as well. However, to avail of these benefits, you must have a valid prescription from an optometrist confirming that you need coloured contacts/contact lenses to correct your vision. It is important to note that eyeglasses are considered the professional standard of care and are usually more cost-effective, so insurance plans may offer less coverage for elective contacts.

When it comes to billing for medically necessary contact lenses, specific billing codes need to be used, such as CPT codes 92071, 92072, and 92313. These codes cannot be used simultaneously; it's one or the other. It is also vital for eyecare providers to diligently screen patients and fit contact lenses as medical devices, educating patients on why a medical device is covered through their vision plan.

Contacts are usually considered cosmetic if they are elective

Contact lenses are usually considered cosmetic when they are elective, meaning that they are chosen by the patient rather than prescribed by a doctor. In most cases, eyeglasses are considered the standard treatment for vision correction, and so contact lenses are seen as an elective or cosmetic choice. This means that insurance coverage for contacts may be more limited compared to medically necessary contact lenses.

Elective contact lenses are often chosen by individuals who require vision correction but prefer not to wear eyeglasses. While eyeglasses are typically the standard treatment recommended by eye doctors, contact lenses can offer a more appealing alternative for those who find glasses uncomfortable or inconvenient. However, it's important to note that elective contacts are typically not fully covered by insurance plans.

Most vision insurance plans provide some coverage for elective contact lenses, but the extent of this coverage can vary. Some plans may offer annual allowances or discounts for standard contact lenses, while others may require the individual to pay upfront and then claim reimbursement from their insurance provider. It's always a good idea to carefully review your insurance plan and discuss benefits with your provider to understand what costs may be covered.

It's worth noting that certain medical conditions may require the use of medically necessary contact lenses. These lenses are prescribed when eyeglasses cannot effectively correct vision due to conditions such as aphakia, anisometropia, or keratoconus. In these cases, contact lenses are not considered cosmetic and may be more likely to be covered by insurance.

Ultimately, whether contacts are considered cosmetic or medically necessary can depend on the specific circumstances and the individual's vision needs. It's always best to consult with an eye doctor and review your insurance plan to understand what options are available and what costs may be covered.

Medically-required contacts are often covered by insurance

Contact lenses are often considered a cosmetic choice, but in some cases, they are medically required. Most vision insurance plans provide some coverage for contact lenses, but the extent of this coverage depends on the insurance provider and the individual's plan.

Medically-required contacts are typically covered by insurance, whereas elective contacts may not be. Contacts are considered medically necessary when certain medical conditions hinder vision correction through regular eyeglasses, and contacts are the accepted standard of treatment. This can include conditions such as aphakia, anisometropia, keratoconus, or irregular astigmatism. In these cases, contacts are often the only treatment option that provides optimal vision for patients.

Even if your eyes don't need correction, modern life and digital screens can create stress and problems for your eyes. Regular eye exams are important for general health, as they can detect diseases like glaucoma and diabetic retinopathy. Vision insurance helps make these eye exams, as well as prescription glasses and contacts, more affordable.

It's important to understand the specific requirements and coverage of your insurance plan. Some plans may offer more coverage for medically necessary contact lenses, while others may have different requirements for what constitutes medically necessary contacts. Additionally, some plans may provide an elective contact lens benefit, allowing individuals to choose contacts over glasses for vision correction.

In summary, medically-required contacts are often covered by insurance, and it is important to communicate with your insurance provider to understand the specific coverage and requirements of your plan.

Glasses are the standard treatment for vision correction

When light doesn't bend correctly as it enters the eye, refractive errors occur, resulting in blurred images. Glasses use clear lenses to refocus light on the retina, allowing you to see clearly. The lenses can be single vision, correcting near or distance vision, or multifocal, correcting both near and distance vision.

The type of glasses you need will depend on your vision problem. For nearsightedness, a concave lens is used, while for farsightedness, a convex lens is prescribed. Astigmatism is corrected with a cylinder-shaped lens, and presbyopia is treated with bifocal or multifocal lenses.

Glasses can improve visual acuity, but they do not change the eyes physically. Therefore, vision correction may only occur while wearing prescription lenses. However, glasses are a convenient and effective way to improve your eyesight and enhance your daily life.

While glasses are the standard treatment, contact lenses and surgery are also viable options for vision correction. Contact lenses are thin clear discs worn directly on the eye, and they work similarly to glasses by correcting the way light enters the eye. They are typically disposable and can be soft, hard, or hybrid. Contact lenses may be preferred by those who lead active lifestyles or play sports, as they don't obstruct the field of vision and are more convenient for certain activities.

Vision correction surgery, such as LASIK, is another option for those who don't want to wear glasses or contact lenses. This procedure reshapes the cornea to change the way light reaches the retina. However, surgery is usually considered when other options are not suitable or in cases of severe refractive errors.

In conclusion, glasses are the standard treatment for vision correction, but contact lenses and surgery are also viable options depending on individual needs and preferences.

Contacts may be covered if they improve quality of life

Contact lenses are a great alternative to glasses and can be a more comfortable option for many people. While they are often considered a cosmetic choice, they can be covered by insurance if they improve the quality of life of the wearer.

Contact lenses are recognised as a medical device by the FDA and can be a necessary treatment option for people with certain eye conditions. For example, people with ocular conditions such as keratoconus or systemic conditions that cause severe dry eye may require contact lenses as glasses cannot provide sufficient correction. In these cases, contact lenses can improve visual acuity and reduce visual distortion, which can greatly improve a person's quality of life.

In addition, contact lenses can provide a number of emotional benefits that improve a person's quality of life. A recent international survey of more than 35,000 people found that over 80% of contact lens wearers felt more confident and attractive. Contact lenses can also improve physical appearance, athletic competence, and social acceptance, especially in children and adolescents.

When it comes to insurance coverage, most vision insurance plans include some form of coverage for contact lenses. However, the extent of coverage can vary depending on the specific plan and provider. Some plans offer a set annual amount for contact lenses, while others provide discounts or special promotions. It's important to review your plan details or contact your insurance provider to determine the specific coverage for your policy.

It's worth noting that contact lenses are typically considered medically necessary if they are prescribed to correct vision errors that glasses cannot fix. This may be due to very poor eyesight, an irregularly shaped cornea, or a disease that affects the eye's surface. In these cases, insurance coverage for contact lenses may be more likely.

Frequently asked questions