Are Scleral Lenses Covered By Insurance?

Scleral lenses are not covered by vision or medical insurance by default. Though most insurance companies will cover the price of scleral lenses if they are medically necessary, the pricing and limits vary widely from one vision insurance company to the next.

What is the price of scleral lenses?

Scleral contacts are around three to four times more expensive than ordinary contact lenses. You should expect to pay anywhere from $500 to $4,000 for a single lens.

Because scleral contact lenses are custom-fit, they are much more expensive than ordinary contacts. To fit them, a computerized map is used to measure the cornea’s curvature.

During the fitting process, several trial lenses of various curvatures and sizes are tried.

Depending on the severity of a person’s visual problems, extra changes may be required.

Why Are Black Sclera Contacts So Expensive?

In Hollywood movies, black sclera contacts are frequently utilized as a cheap technique to generate a terrifying image.

Producing black material that also allows the wearer to see takes time.

The cost of producing black sclera contacts has reduced dramatically in recent years, making them significantly less expensive than they were previously.

Are scleral lenses medically necessary?

No, your medical insurance does not cover contact lenses that are medically required. However, we will make every effort to coordinate the advantages of your vision and medical plans.

What Conditions are Treated With Medically Necessary Contact Lenses

This varies depending on the vision plan. In the treatment of keratoconus and pellucid marginal degeneration, medically essential contacts are most commonly employed. However, medically essential contacts are frequently used to assist patients who are having difficulties following eye procedures such as LASIK and corneal transplants. Scleral contact lenses are the most often used medically essential contact lenses, however SynergEyes hybrid contact lenses are also popular.

The following is a list of the most common medically essential contacts used to treat the following conditions:1

Will VSP cover scleral lenses?

Vision insurance, unlike medical insurance, is designed to lower the cost of eyewear purchases. A major percentage of the cost of scleral lenses will be paid for certain of our patients who have vision insurance with a contact lens plan, such as EyeMed or VSP. It’s important to keep in mind that vision insurance policies vary. It’s never certain how much a speciality contact lens, such as scleral lenses, will be covered by vision insurance. Furthermore, the outcome of one patient’s experience may be very different from that of another.

This is why we advise patients to arrange an appointment at our office. We’ve seen a lot of people get a lot out of their vision insurance policies, and we’ve advised a lot of patients on how to get the most out of their coverage. Finally, we want our patients to have the best vision possible, and scleral lenses are frequently the answer.

Is keratoconus covered by medical or vision 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 often do you replace scleral lenses?

Scleral lenses are custom-made hard contact lenses with a large diameter that vaults (arches) over the cornea, the clear section of the front of the eye, and rests totally on the sclera, the white component of the eye. They range in size from 14 to 20 millimeters.

I used to wear hard contact lenses, are these the same?

Traditional hard contact lenses, also known as RGPs (rigid gas permeable), differ from scleral lenses in terms of fit and size. RGP contacts, which are significantly smaller (8-10mm in size) than scleral lenses, were popular in the 1980s and 1990s. When wearing RGPs, the RGPs rest directly on the cornea, which is extensively innervated with nerves and can cause considerable discomfort. Scleral lenses, on the other hand, do not touch the cornea and are thus far more pleasant than RGPs. It’s possible that they’ll be more comfy than soft contact lenses.

Because they are constructed of the same material as RGPs, cleaning scleral lenses is the same as cleaning RGPs. We utilize Boston Advance Cleaning Solutions or ClearCare at Eyes for Life. Scleral lenses come with additional tools to aid with insertion and removal, and the contact lens bowl is filled with preservative-free saline solution prior to insertion. During your fitting visit, you will receive a comprehensive guide to contact lens maintenance and handling.

Am I a good candidate for scleral lenses?

Scleral lenses are a type of contact lens that can be worn by practically anyone. The opening between one’s eyelids must be large enough to allow for the insertion of a 14-20mm contact lens, as a general rule.

Scleral lenses are a great alternative for people who have certain eye disorders and are advised for people who have:

Patients with a lot of astigmatism and/or vision problems with glasses or soft contact lenses are also good candidates for scleral lenses. Scleral lenses can provide greater vision than soft contact lenses or spectacles by masking any corneal abnormalities. Patients who wear soft contact lenses and discover that their vision blurs with each blink may benefit from a scleral lens, which provides more stable eyesight.

How much do scleral lenses cost?

The price of scleral lenses varies significantly depending on the manufacturer and lens type. Scleral lens fittings are more expensive than soft contact lens fittings because they require more testing, measurements, and follow-up appointments. A scleral lens fitting is a 90-day trial period that begins with a doctor placing trial lenses on your eyes and evaluating them for a satisfactory fit.

To determine your scleral lens prescription, a refraction over the contacts will be conducted. This prescription will almost certainly differ from that of your glasses or soft contact lenses. Your specific trial lenses will be ordered, and they will be produced and mailed from the manufacturer. It’s not uncommon for further adjustments to be made after the initial trial lenses have been worn to achieve the best possible outcomes.

How long do scleral lenses last?

Scleral lenses are designed to be worn every day for 10-16 hours and cleaned every night. Scleral lenses should last about 1-2 years, depending on your lens care habits and tear film dynamics (similar to that of traditional RGPs).

Why are scleral lenses so expensive?

Scleral contact lenses vault above the cornea and rest their weight on the sclera. These lenses can help with visual problems caused by uneven corneas, refractive defects, and a variety of other disorders.

Despite the fact that scleral lenses are common in advanced contact lens clinics, primary care optometrists are generally unfamiliar with them.

We put together this list of five little-known scleral lens facts to assist you better understand these lenses, how they work, and how they’re commonly used.

Scleral lenses were invented before other types of contact lenses. Despite the fact that soft contact lenses are the most common, scleral lenses have a longer history.

In 1887, two German brothers, Friedrich A. and Albert C. Müller, invented the first successful scleral lens (or, maybe more accurately, scleral shell). They perched on the sclera, vaulted over the cornea, and left a saline solution-filled chamber between the lens and the eye. These lenses were far from perfect; they were composed of blown glass, were huge, heavy, and oxygen-permeable. These defects would later be addressed, resulting in today’s scleral lenses.

Despite their size, scleral lenses are very comfortable. Because of their size and hardness, first-time scleral lens wearers frequently worry that the lenses will eye uncomfortable. Despite the fact that scleral lenses are much larger than regular soft lenses, they are just as comfortable, if not more so.

Scleral lenses are custom-made to fit the form of the individual eye they are being fitted to. They are made to gently settle on the sclera without compressing or stressing the underlying tissue.

Scleral lenses are effective even when other lenses are ineffective. When a patient can’t seem to locate a contact lens that works well or fixes their eyesight problem, scleral lenses can help.

Each scleral contact lens is created to the patient’s specifications. To maintain a constant reservoir of fluid between the lens and the cornea, the lenses must be fitted to vault over the cornea. This design keeps the eye moist throughout the duration of the lens’ use. Furthermore, the fluid layer improves vision by compensating for any imperfections in the shape of the cornea.

Scleral lenses are not prohibitively costly. One of the most common misconceptions about scleral lenses is that they are significantly more expensive than conventional soft lenses. There is more labor involved in prescribing scleral lenses since they must be fitted and adjusted to fit each unique eye, which many patients feel would result in a higher expense. Patients are frequently astonished to learn that scleral lenses are reasonably priced.

These lenses are frequently covered by insurance, and even if they aren’t, they offer enough of a benefit over ordinary lenses — in terms of both comfort and vision — that patients are willing to pay the extra money. Furthermore, if the lenses are properly cleaned and maintained, they can last much longer than any other form of lens.

Scleral lenses can aid in ocular surface healing. Scleral lenses do a lot more than just correct vision. They also protect the eye by exposing it to a fluid-filled chamber that is oxygen permeable. This system not only provides the eye with the moisture and oxygen it requires to keep healthy, but it also shields it from external threats and irritants. As a result, scleral lenses are excellent for aiding ocular surface healing, whether following a corneal transplant or recovering from a chemical or burn injury, for example.

For many patients seeking clear and comfortable vision, the advantages of scleral contact lenses make them a popular and satisfying option. Consider the benefits of scleral lenses, which are the most advanced technology available to patients today.

For more information:

Elise Kramer, OD, of Miami Contact Lens Institute, is a residency-trained ophthalmologist who specializes in ocular health and illness, ocular surface disease, and standard and specialized contact lens fitting. She has built a distinctive scleral lens practice during the last five years.

How do I get my insurance to pay for scleral lenses?

If you have medical or vision insurance, you might be eligible for a discount on scleral lenses.

Scleral lenses are reimbursed rather well by some insurance providers, like as VSP or Eyemed, and many practices accept this insurance for scleral lenses.

Scleral lens fittings are reimbursed inadequately by other insurance plans. Some of them don’t even cover the cost of the lenses! In this circumstance, expecting your doctor to equip you with scleral lenses is neither feasible nor realistic.

Having your doctor give you a certificate of medical necessity is one approach to get your insurance to support scleral lenses.

The letters we prepare for patients clarify why the patient requires scleral lenses to the insurance company. Our patients usually have keratoconus, corneal scarring, corneal transplants, RK scarring, post LASIK, and other medical eye conditions, so scleral lenses are needed to improve their eyesight. Other people have medical eye illnesses such severe dry eye, graft-vs-host disease, Sjogren’s syndrome, Stevens-Johnson syndrome, and other ocular surface disorders. Whatever the reason, we’ll prepare a letter to the insurance company stating why scleral lenses are required.

Our patient suffers from severe dry eye. Take note of the significant change in her eyes before and after the scleral lenses were applied.

You can also get a list of diagnosis codes, ICD-10 codes, CPT codes, and V codes, as well as cost for each service, from your doctor. The insurance company will be able to see what is being sought as well as the exact financial amount required.

Your insurance company might also want to talk to the doctor. In this scenario, your doctor will schedule an appointment with the insurance company to explain your medical eye condition and why scleral lenses are required.

You may be able to get a portion or the entire scleral lens fitting covered by your insurance with the help of your doctor.

What qualifies for medically necessary contact lenses?

Contact Lenses Types When there is an underlying medical eye disease or condition, such as keratoconus, corneal transplantation, corneal scarring, Sjögren’s Syndrome, ocular graft-versus-host disease (GVHD), neurotrophic keratitis, trichiasis, or Stevens-Johnson syndrome, the procedure is considered medically necessary.

How do I qualify for medically necessary contacts?

Keratoconus (a corneal disease), Aphakia (lens absence), substantial Ammetropia (a prescription larger than +/- 10.00D), and high Anisometropia (when your eyes differ in size) are some of the most prevalent eye diseases that render a patient qualified for this therapy.

Is keratoconus covered by Medicare?

Some costs associated with the diagnosis and treatment of keratoconus are likely to be covered by Medicare, but others may not. Doctors usually begin diagnosing keratoconus during routine slit lamp examinations. This service is not covered by original Medicare because it falls under the category of vision care.

If your doctor suspects you have keratoconus, they will most likely use corneal topography imaging to generate a map of your cornea. When a participating medical physician judges the test medically essential, Medicare Part B normally covers computerized corneal topography for keratoconus.

Pachymetry, a test that measures the thickness of the cornea, may be required to fully diagnose keratoconus. Some illnesses, including as glaucoma, are covered by Medicare; however, the rules do not clearly indicate that keratoconus is a covered condition. As a result, the test may not be covered by your Medicare Part B plan.