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Costs Involved with Cataract Surgery

Posted , 6 users are following.

momof327
momof327

My 81 year old dad was told he needed cataract surgery for both eyes. He is covered by medicare and his secondary. My question is that he is being charged out-of-pocket to do measurements of the eye. They want $150 per eye. Is this a customary charge? I  would have thought the measurements were included in the surgical costs.

Thanks for the help. This is new territory for us.

 

0 likes, 13 replies

13 Replies

  • eugene68271
    eugene68271 momof327

    Posted

    Gosh, I don't know about that. I haven't yet seen my charges, although I'm not on Medicare and am covered by private insurance. My 87-year-old dad had cataract surgery two years ago, is on Medicare/Medicaid, and I don't recall he had any out-of-pocket charges. But then that was before a lot of changes re the Affordable Care Act. I guess I'm not a definitive expert on this question. Wish I was more help.
  • Songbill
    Songbill momof327

    Posted

    I had my catract surgery done on both eyes last Fall. I am 70 and had it ALL paid for by Medicare and my seceondary insurer. There was certainly no "out-of-pocket" charges for the opthmalogist to do the pre-op measuresments several weeks berfore each surgery.  Under the Medicare rules of "accepting assignment", the doctor can't charge extra. IMHO, your situation doesn't sound right to me.

    Suggestion: Contact Medicare and get "a second opinion" (no pun intended) and/or call one or more other opthmalogists in your area and ask if they have such an added "out-of-pocket" charge for pre-op measuring of Medicare patients.

  • momof327
    momof327

    Posted

    Thank you for the replies! I was thinking the same thing as even if they did HAVE to charge, $150 sounds too pricey. My dad is on a fixed income so I'll definitely be looking further into the situation. I'm going to try and get some answers from Medicare.  ;(' Not happt about any of this.
  • Guest
    Guest momof327

    Posted

    For surgeries or procedures, it's difficult to know the exact costs in advance because no one knows exactly what services you'll need.  Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
  • fde
    fde momof327

    Posted

    Sadly , the vision field is expensive and they know that in the end for good vision , you will likely pay whatever they ask and Obama care does nothing to control the soaring costs of medical care . They may charge whatever they want
    • momof327
      momof327 fde

      Posted

      Yoy sadly seem right. I called Medicare and they said even if the Dr. participates in Medicare, if it's something they don't cover *ie, measurements) then too bad, so sad. I just don't understand how the surgery can be approved yet not the measurements as you HAVE to get the measurements in order to get the surgey they cover. Just doesn't make sense to me.
    • Songbill
      Songbill momof327

      Posted

      This still doesn't sound right to me, at all. Maybe the communications need to be more clear. Are they talking about the pre-op measurement that MUST be done in order to actually do the catarcat surgery on the eye? The one where the doctor or nurse has you look into a machine for less than a half-minute and makes a note of some measurements that are used during the surgery a few days or weeks later? Maybe the doctor is talking about some kind of other "optional" measurements unrelated to the surgery. I'd pursue this a lot more before giving up. Also, don't assume the first Medicare rep you talked to understood the specifics and gave you a correct answer. I'd call another opthmalogist and see what they say about Medicare covering all the costs of the operation. Ask them about the pre-op measurement. Good luck!
    • momof327
      momof327 Songbill

      Posted

      Yes, that's exactly what I'm speaking of. The pre-op measurements. Thank you but it looks like they "got him" convinced it's something not covered. I'm trying to look out for him but unfortunately things are moving along much too quickly. Still not happy as I feel something is just not right about it all.
  • LeeAs
    LeeAs momof327

    Posted

    I had both eyes done this past February.  I paid $1500 per eye for a premium lens, and $300 per eye for ORB which was explained was a way for the doc to measure the eye in real time during surgery.  It was optional and Medicare paid for the surgery completely.  Had I not opted for the ORB, I would have not been charged extra for measurements.  You may with to pursue this with medicare....  Some docs, and I have no idea if yours is included, seem to be trying to beat the contracted rates they have with medicare and pvt insurers with mandatory add ons which are not included in the contracted rated. 
    • momof327
      momof327 LeeAs

      Posted

      Sounds like this doctor is doing exactly that. Getting "around" the contracted rates with something that seems to me pretty absurd when you need the pre-op measurements in order to get the surgery. Just MHO
    • Songbill
      Songbill momof327

      Posted

      Good point.  Why not try this: Tell the opthamologist your Dad doesn't have the money to pay for the $150 per eye pre-op measurements, so he's decided to have the surgery done without having or paying for the measurements. You'd be bluffing, of course, but see what he says. If he agrees to do surgery without the essential pre-op measurements, I think that'd be malpractice....IMHO. You may want to talk to a lawyer at that point....and get a new opthamologist.
  • LeeAs
    LeeAs momof327

    Posted

    This happened to me years ago...an additional charge for "misc."..when I called and inquired as to the specifics, I was told, gloves, gauze, etc.  I complained to the insurance company that it appeared the provider was trying to do an end run around the agreed upon rate and the inurance company was totally indifferent, as was Medicare in this case.  When I complained to the provider that nobody else I contacted charged in excess of the contracted rate, I received a letter from the provider informing my I was no longer welcome at that practice.  Bottom line:  not all providers are ethical and honest and unless they are forced to do the right thing, they will not.
    • momof327
      momof327 LeeAs

      Posted

      That indeed seems to be the case here so he's just going to "bite the bullet" and proceed since he feels he's already invested. 
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