Hi to everyone that has gotten the scleral lens and those that would like to but are concerned about the cost. I copied and pasted the following from a post Dena King made on another thread about how she got her lens paid for. Dena is the one that brought this wonderful lens to our attention, Thanks again Dena!
1. Scleral lens. Mine was about $1200 which included exam I believe which was denied by insurance 2 times. Then I got very angry and filed an appeal with the commonwealth of Kentucky public protection cabinet, department of insurance, health and life division per advice from my dr.
My ophthalmologist, and lens docs both wrote letters explaining my past, and I also, wrote a letter.
I am pleased to say the state ruled in my favor stating the vision exclusion for contact lens does not apply to my case pursuant to Exposure Keratitis 370.34, Dry Eye Syndrome 375.15, secondary to Facial Paralysis 351.9, due to an acoustic neuroma 225.1,
The Kentucky dept of insurance said pursuant to KRS 304.17A-617(3)(d), HHP must cover scleral
Lens. My insurance responded to me within a week, however I had not met my $5000 deductible fully and most of it was applied to that.
I am sure all states have public insurance departments that you all can try. I sure hope this helps! Dena
My insurance co. rejected the first claim and the first appeal, seems that's customary, they reject the claims on the basis of your coverage. I gave my eye doctor a copy of Dena's post so she would know how Dena's lens got paid for. I have no idea what my doctor wrote. I also wrote a letter stating that I was close to applying for disability do to the pain from my eye and the trouble I was having working because of it. I also said that the lens didn't have a prescription in it, it was only being used to preserve my eye. I've been really busy so I'm not sure about the time frame but I think it only took a couple of weeks for the insurance company to decide in my favor.
The letter I got says: After reviewing all of the information submitted with your appeal, the Appeal Panel determined that the contact lens was medically necessary to treat a medical condition and not a vision care item excluded by your healthcare plan.
I would have gotten the lens even if the Insurance company wouldn't pay for it, it's that good, having it paid for is an extra bonus and helps pave the way for future claims if I need them.