Understanding Cats

Cataracts are a cloudy area on the eye’s natural lens caused by protein breakdown. The disease is usually age-related and worsens with time. As cataracts mature, an individual’s ability to see out of that eye can diminish until total blindness sets in. Surgery remains the only way at present to restore lost sight.

The detail’s in the procedure

During surgery, an ophthalmologist removes the cloudy lens through a small incision on the surface of the eye. With the old lens gone, the surgeon implants a clear artificial lens that allows the eye to focus light again.

Four operation options

At present, there are four main surgical techniques for removing cataracts. The most common is called phacoemulsification and involves using an ultrasonic probe to break apart and remove the cataract. Laser cataract surgery relies on an infrared (femtosecond) laser to make incisions rather than handheld tools. Intracapsular and extracapsular cataract surgery involve larger incisions and are only used when other methods aren’t available.

Breaking down the costs

No matter the type of surgery, costs for the procedure are typically split multiple ways. Expect to see fees for the doctor, surgery center, and anesthesia needed to relax the body. Clinics may also include pre-operative exams and biometric imaging in the overall surgical fee.

Medicare numbers

Medicare Part B covers 80% of the cost of medically necessary cataract surgery, regardless of the type of procedure performed. That leaves 20% for patients to cover. Often, a supplemental insurance from a private carrier will cover the remainder. If not, Medicare estimates average out-of-pocket costs at $328 for ambulatory surgery centers and $539 for a hospital setting.

Private insurance

Most private insurance providers will cover cataract surgery as well. As with Medicare, there are visual requirements a patient must meet for payment. Expenses for cataract surgery vary significantly from one insurance company and policy to the next. The best way to understand coverage and out-of-pocket costs is to call the provider directly. Ask about copay amounts, deductible costs, and any stipulations about a particular doctor or surgery center.

Surgery luxuries

The type of lens implanted during cataract surgery can make a difference in a patient’s final bill. Medicare and private insurance providers usually pay at least a portion toward a fixed-focus monofocal lens. Specialty lenses for correcting astigmatism or for multifocal purposes are viewed as a luxury and are rarely covered. Depending on the surgeon, these lenses can cost thousands of dollars each.

The insurance-free zone

Patients without insurance have to pay for the entire cost of surgery out of pocket. The average cost of the procedure in today’s market is $3,500 but can reach double that amount. Some clinics or surgery centers will work with individuals doing self-pay and may adjust the price accordingly.

Know what to know

Be sure to take the time to understand all the costs regarding cataract surgery before going through with the procedure. Consider also any options given regarding types of cataract surgery and lens types available that can affect the final bill. Knowing exactly what to expect upfront can lead to a less stressful surgical experience.