Are Intacs Covered By Medical Insurance?

Keratoconus frequently necessitates long-term management, which can be costly. This includes everything from therapies like cross-linking to medically prescribed contact lenses. Educating yourself on the many treatment options, keratoconus treatment prices, and which treatments are covered by insurance can help reduce out-of-pocket costs to a minimum.

Evaluating Keratoconus Treatment Options

Working with your doctor to determine the best treatment option for you is a good idea, however FDA-approved keratoconus treatments include:

Soft Contacts – While soft contacts do not address the underlying condition, they can improve your vision in many circumstances. If the degree of corneal distortion is not too severe, mild and early cases of keratoconus can be handled with standard non-specialty soft contact lenses. Soft astigmatism correcting contact lenses are usually necessary in these situations. Soft contact lenses for keratoconus may or may not be fully covered by your insurance plan. Soft contact daily disposables can cost anywhere from $55 to $95 each box (8 boxes/annual supply).

Intacs are thin, plastic semi-circular rings that are surgically implanted beneath the cornea’s surface. They flatten the keratoconic cornea and change its shape when injected into it. Major medical insurance companies frequently cover Intacs for the treatment of keratoconus. Patients should inquire with their eye surgeon and their health insurance company for more information.

Corneal Cross-linking (CXL) — The only FDA-approved minimally invasive cross-linking procedure for progressive keratoconus is CXL with Photrexa eye drops and ultra-violet light from Avedro’s KXL device. It works by forming new collagen cross-links, which causes the cornea to harden, slowing the disease’s progression. The FDA approved this corneal cross-linking technique in April 2016, and it is now covered by 50 insurance companies.

Rigid Gas Permeable Contact Lenses (RGPs) – RGPs are rigid contact lenses that can transfer oxygen and are composed of durable plastic. Scleral lenses are gas permeable lenses with a wider diameter that cover the entire cornea as well as a portion of the sclera, the white of the eye. RGPs are enclosed by a soft lens liner or skirt in hybrid contacts. RGP lenses must be fitted by an eye doctor, and the expenses can range from hundreds to thousands of dollars. RGPs are not covered by many insurance policies since they are considered ‘cosmetic.’ These lenses can cost anywhere from $75 to $325 per lens (2 lenses/annual supply).

Corneal Transplant Surgery – If the cornea becomes dangerously thin and/or contact lenses no longer restore vision, a corneal transplant may be the only therapy choice. The cornea is removed and replaced with a donor cornea during surgery. Most insurance policies cover corneal transplants, although they can cost anywhere from $13,000 to $27,000.

Understanding Your Options

The National Keratoconus Foundation and the Keratoconus Group are two support and advocacy organizations that provide extra resources and personal insights into managing keratoconus treatment expenses and insurance coverage concerns.

The National Keratoconus Foundation developed a Keratoconus Insurance Reimbursement Form to help insurance companies understand and explain keratoconus, as well as the treatment choices available to treat and manage the condition. When completed and presented by a doctor or their office staff, this document may assist in obtaining reimbursement for FDA-approved keratoconus treatment costs.

In addition, patients without health insurance, Medicare, or Medicaid coverage have a number of financial help options. Consult your doctor to see if they provide financial aid or are willing to set up a payment plan to help you manage the expense of your care.

Following a keratoconus diagnosis, it’s critical to communicate freely with your doctor and be honest about any insurance or payment concerns you may have, as they may have additional solutions to help you through your keratoconus journey.

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Does medical cover corneal cross-linking?

Regardless of the situation, we all know that navigating health insurance coverage can be a nuisance! When it comes to covering your cross-linking treatment to delay or stop the advancement of your keratoconus, however, it shouldn’t be. Despite the fact that iLink cross-linking is available to more than 95 percent of the commercially insured population, many consumers are unaware that the FDA-approved operation is commonly covered by insurance.

To clear up any misunderstandings, we’ve compiled a list of everything you need to know about insurance coverage for iLink FDA-approved cross-linking, including answers to frequently asked questions, whether you should seek a second opinion on the treatment you’re receiving, and how you could be eligible for up to $200 (per eye!) toward your copay expenses.

Insurance Coverage for iLink FDA-Approved Cross-Linking

The purpose of iLink FDA-approved cross-linking is to thicken the cornea and maintain your eyesight by slowing or stopping the advancement of keratoconus. As a result, insurance coverage for FDA-approved cross-linking with Photrexa Viscous (riboflavin 5′-phosphate in 20% dextran ophthalmic solution), Photrexa (riboflavin 5′-phosphate ophthalmic solution), and ultraviolet A (UVA) light from the KXL system is now widely available, with positive coverage policies from the largest national commercial payers in the United States, including United Healthcare, Anthem Blue Cross Blue Shield, In fact, the FDA-approved surgery is covered by more than six insurance policies in each of the 50 states.

Corneal cross-linking is medically necessary for someone with progressive keratoconus, according to most insurance coverage. It is also regarded medically important for patients with post-refractive surgery corneal ectasia and documented decreasing best spectacle-corrected visual acuity as well as irregular astigmatism.

Commonly Asked Questions

We understand that you may still have issues concerning insurance coverage, and we want to assist you! Here are some answers to frequently asked questions concerning FDA-approved cross-linking insurance coverage.

The FDA-approved cross-linking by iLink is generally covered by insurance. This potentially sight-saving procedure is available to more than 95 percent of the commercially insured population. Visit our Insurance Information page for more information on insurance coverage and to see the most up-to-date list of insurers with policies that cover the iLink cross-linking operation.

Products and treatments that have not been authorized by the FDA are often not covered by insurance. For example, the Blue Cross Blue Shield Association’s Technology Evaluation Center (Premera BCBS Technology Review) says “1. The technology must obtain final approval from the proper federal regulatory agencies” as one of their new technology evaluation criteria.

Glaukos’ products are the only FDA-approved cross-linking products, and they’re done epi-off. Many insurance policies specify that epi-off is the only FDA-approved treatment for progressive keratoconus that is covered, but epi-on is not.

United Healthcare, Anthem Blue Cross Blue Shield, Aetna, Cigna, Humana, and HealthNet are among the large national insurers reported to offer policies that cover cross-linking to treat progressive keratoconus. The whole list of companies that will be involved in the procedure may be viewed here.

Before undergoing treatment, check with your insurance provider to see if they cover iLink FDA-approved corneal cross-linking. Glaukos works directly with doctors’ offices and insurance providers to make the insurance reimbursement procedure as simple as possible. Before going through with the treatment, make sure your doctor is using the FDA-approved iLink cross-linking process. Using our finder tool, you may obtain a list of doctors who are knowledgeable with the operation.

No, most insurance companies demand FDA approval before determining coverage. In addition, clinical studies evaluating innovative procedures are usually provided free of charge to patients.

The iLink Copay Savings Program

If you’re thinking about getting iLink FDA-approved corneal cross-linking, you might get up to $200 (per eye!) towards your non-reimbursable cost. Anyone with commercial insurance coverage is eligible for the iLink Copay Savings Program, which applies to treatments performed between December 1, 2021, and December 31, 2022.

The initiative is designed to help patients who are undergoing the FDA-approved corneal cross-linking treatment, which can decrease or stop keratoconus growth.

If you qualify, the iLink Copay Savings Program can help cover some of the costs of the FDA-approved epi-off corneal cross-linking surgery using Photrexa medication formulations. Would you like to learn more about the program and check whether you qualify? Today, go to our website.

Should You Get a Second Opinion?

Your physician should not need you to pay for iLink out of pocket because it is widely covered by insurance. If your doctor says you’ll have to pay out of pocket, you should be skeptical and seek a second opinion. It’s likely that they don’t offer FDA-approved cross-linking through iLink. Instead, they can recommend an unapproved or experimental procedure.

Getting a second opinion does not always imply your doctor is completely wrong. However, it does imply that you are taking charge of your health and attempting to gather as much information as possible in order to make an informed and educated decision. Here are some pointers to consider when deciding whether or not you should seek a second medical opinion:

  • As part of his or her own trial, your doctor advises that you pay for treatment (clinical trials for FDA approval are typically free to patients).
  • Your doctor informs you that the operation for cross-linking is not covered by insurance.

Are you unsure if your doctor offers iLink? Check our physician locator to see whether your doctor is listed, or to discover another physician conducting the FDA-approved operation in your area!

Don’t Be Discouraged!

Don’t believe anyone who says FDA-approved cross-linking isn’t covered by insurance! Everyone’s insurance situation is different, and just because your insurance company hasn’t published a coverage policy doesn’t imply they won’t cover the treatment. Claims are frequently denied owing to missing or incorrect information when filed, such as failure to submit documentation of keratoconus progression.

Request that your doctor confer with your insurance company to determine coverage, or speak with a benefits representative at your insurance company directly. You can also ask your doctor to file an appeal, which can be done before or after treatment, depending on your situation. You can also talk to your doctor about payment options.

If you have questions about insurance coverage for iLink FDA-approved cross-linking, go to our Insurance Information page to see the most up-to-date list of insurance companies that cover the treatment, as well as links to their policies. Remember to keep up with Living with KC on Facebook, Twitter, and Instagram!

Is keratoconus treatment covered by insurance?

Treatment for keratoconus might cost thousands of dollars or more. A corneal transplant can cost anywhere from $13,000 to over $28,000, depending on the type of surgery and whether it’s done as an outpatient operation or requires a hospital stay.

In addition, the price of keratoconus eye checkups and contact lenses are recurring expenses year after year.

Fortunately, most keratoconus-related expenses are frequently covered by health or medical insurance. Medical insurance, in particular, usually covers the majority of the expense of corneal cross-linking or significant keratoconus surgery (less deductibles and copays determined by your policy).

Eye exams (or portions thereof) specifically for the diagnosis and monitoring of keratoconus are frequently addressed as well. Depending on your insurance policy, the cost of keratoconus contact lenses may or may not be entirely covered.

If you don’t have health or medical insurance and aren’t eligible for Medicare or Medicaid, financing firms that specialize in medical expenses offer programs that allow you to pay for keratoconus treatment charges over time at low interest rates.

If you’ve been diagnosed with keratoconus, talk to your eye doctor and insurance company about your perks and responsibilities when it comes to paying for your keratoconus treatment.

How much does Intacs surgery cost?

Keratoconus is a degenerative eye condition characterized by corneal tissue weakening and loss of natural curve. As a result, light rays are not properly focused on the retina, resulting in vision impairment. Without the necessity for corneal transplant surgery, Intacs inserts are put beneath the surface of the cornea, preserving its structure and increasing vision.

Cost of Intacs for Keratoconus

Keratoconus can be treated with both Intacs and corneal transplant surgery. Intacs usually costs roughly $2,000 per eye, which is less than a corneal transplant. In addition, Intacs implants are significantly less intrusive. In order to establish the cost of Intacs for your keratoconus therapy, an ophthalmologist will thoroughly discuss your eye care with you.

Is keratoconus considered a medical condition?

  • Keratoconus is an eye condition that affects the cornea’s structure, causing vision loss.
  • Keratoconus affects about one in every 2,000 people, usually starting in puberty and progressing into the mid-30s.
  • Early stages of the condition can be treated with glasses, but as the disease progresses into late childhood and early adulthood, corneal transplantation may be required to restore vision.
  • Corneal collagen cross-linking is a technique that can either stop or reduce the progression of keratoconus.
  • In the United States, keratoconus is the most common reason for corneal transplantation.

Is corneal cross-linking expensive?

The cost of treating keratoconus is determined on the severity of the problem and the type(s) of treatment required.

Because there is no cure, keratoconus therapy can last for decades, increasing the total cost of the disease.

Contact lens fitting for keratoconus is a considerably more sophisticated and personalized process than fitting regular contacts on a healthy eye. In order to diagnose, monitor, and manage keratoconus, clinicians who specialize in the illness must invest in specialized technology such as automated corneal topography machines.

Treatment of keratoconus with contact lenses can cost anywhere from $2,000 to $4,000 per eye, depending on the examination, measurements, fitting, and materials used. However, depending on the severity of the disease and the type of contact lenses recommended, this range can be wide or narrow.

According to industry sources, the cost of corneal cross-linking for keratoconus in the United States normally varies from $2,500 to $4,000 per eye.

Intacs and other keratoconus corneal insert or corneal implant surgery can cost anything from $1,500 to $2,500 per eye.

According to the Agency for Healthcare Research and Quality, a corneal transplant for severe keratoconus in the United States costs around $13,000 for an outpatient treatment and nearly $28,000 for an in-hospital procedure for people without health insurance (U.S. Dept. of Health & Human Services).

In most circumstances, health insurance will cover the cost of eye tests and keratoconus surgery conducted in the United States. Depending on the type of policy you have, the cost of keratoconus contact lenses may or may not be reimbursed by insurance. For further information, contact your insurance provider.

Can keratoconus be cured naturally?

Keratoconus Reversal However, regardless of the source of your Keratoconus, there is no way to reverse it naturally or medically with diet, exercise, medicines, or other therapy.

Is keratoconus a pre existing condition?

Our estimate had a very high level of uncertainty attached to it. Both our significant standard deviation and the sensitivity of our estimate to the necessity for a PK demonstrated this. This variance in yearly costs makes it difficult for keratoconus patients to budget for treatment and increases the necessity for keratoconus health insurance coverage. Medical insurance is obtained specifically to handle such uncertainty, and it is an essential advantage for those with keratoconus. Most major medical insurers cover the cost of PK and surgery follow-up, as well as the cost of normal care in many circumstances. However, because keratoconus is a long-term chronic condition, patients with it must deal with limitations imposed by pre-existing conditions. People with keratoconus must deal with yet another burden related to their illness, one that may be alleviated by the recent passing of the Patient Protection and Affordable Care Act, which limits exclusions based on pre-existing disorders. 24

The annual risk of a PK and the discount rate were discovered to have the largest influence on cost. The annual risk of PK in our model was calculated using data from the CLEK Study and the Australian Graft Registry. The average incidence of PK among CLEK participants was around 2%. 15 Not surprisingly, we discovered that increasing this to 10% dramatically raised the lifetime cost of care, while lowering it to 1% significantly decreased it, however neither of these extremes appears to represent the “real” population incidence of PK among persons with keratoconus. Similarly, we discovered that the onset of clinically significant disease at the age of 18 significantly raised lifetime expenditures, owing to the model’s and study population’s higher risk of early PK. Although early identification of keratoconus is prevalent, it was discovered that severe treatment was postponed until later in life among CLEK patients. 15 While changes in the discount rate had an impact on overall expenses, this was due to lawmakers’ decisions rather than clinicians’ or investigators’. Most authorities in the United States recommend a 3% rate, and the sensitivity to this rate reflects the value put on future health advantages. 20 The cost of keratoconus will not be considered as more essential than diseases with a more proximal impact if policymakers opt to place a lesser value on future health than is commonly observed now. If the contrary is true, keratoconus will become more important in terms of public health.

One of the model’s most important flaws is the anticipated age of a patient’s diagnosis of clinically severe keratoconus. The age of onset was considered to be 40.2 years, which was the average age of the recruited patients in the CLEK Study. Given that the first symptoms of keratoconus can appear as early as puberty, this may appear to be an unusually old age of onset; however, the patients we attempted to model were those with clinically significant disease, not those with only the first symptoms that are easily treated with rigid contact lenses. We decided to utilize the average age of the patients in the CLEK Study since they would have a considerably higher chance of early PK than a cohort with a lot younger age of onset. Of course, an earlier onset of the disease incurs a large financial burden for the patient, approximately doubling the expected lifetime cost.

The lack of additional literature to determine our model’s external validity is the second drawback. We base our assumptions in the model on parameters collected from the literature, physician consultations, and our own estimates; however, it remains to be seen whether this economic model accurately reflects the disease’s natural history. In the meanwhile, it is left to the reader to assess the model’s and estimations’ face validity. Similarly, potential treatments for advanced disease such as Intacs corneal implants, Descemet stripping endothelial keratoplasty, and collagen cross linking were not considered in our model. We didn’t include these choices because there isn’t enough information about the cost, effectiveness, and long-term effects of these procedures right now. As more information becomes available in the literature, we will be able to use our model to estimate the economic impact of these developments. Finally, we estimated graft survival using Australian data. Unfortunately, there are no comparable studies in the United States. Surprisingly, in a recent small-scale trial in Iowa, the survival rates of corneal grafts for keratoconus were lower. 22 We used a more conservative approach to cost estimation and relied on the strongest possible evidence by taking the approach we did.

With a mean lifetime cost of $25 168, it’s clear that the cost of keratoconus care is a significant burden for both patients and their insurers. When we consider the influence of keratoconus on VRQoL, we can see that, despite its minor impact on quality of life, this chronic condition is a significant burden for those who suffer from it. Future research should focus on minimizing the double burdens that people with the condition bear, in addition to the clinical and biological interest this disease holds for researchers.

What is the recovery time for a cornea transplant?

After surgery, you should be able to return to work or your normal routine in 1 to 2 weeks. However, your vision will remain fuzzy. Heavy lifting should be avoided for 4 weeks or until your doctor says it’s acceptable.

Are Intacs worth it?

You’ll most likely relax for a bit before returning home (have someone else drive you). The first day following surgery, most people have clearer eyesight, but you may require a couple of days of rest to assist recovery. Because the ring segments are beneath the cornea’s nerve endings, you won’t feel them. Other people can’t see them until they stare into your eyes very carefully.

The degree of keratoconus in each person will determine the outcome of these implants. Milder forms of keratoconus may not require any extra vision correction lenses. For better vision, people with moderate keratoconus may need glasses or soft contact lenses.

When it comes to modifying the curvature of the cornea and flattening the cone formed by keratoconus, Intacs can be quite helpful. However, the Intacs operation will not be able to stop the progression of keratoconus, which is caused by the weakening of the collagen (structural protein) in the corneal tissue.

Corneal cross-linking (CXL) is a treatment that strengthens corneal collagen fibers and stabilizes the cornea by combining a topical vitamin B (riboflavin) solution with controlled UV radiation exposure. For the greatest treatment outcome in progressive keratoconus, CXL is sometimes combined with Intacs implants.