Let's talk about Cataract surgery choices and outcomes.

Laser because it is a more gentle surgery with a faster recovery rate.

Most people have conventional cataract surgery and have no problems during the surgery or during recovery. For anyone considering laser cataract surgery, read this article before you make a decision (copy and paste title and do a search for it) and also do a search for "laser cataract surgery complications" to find more info on it before having it done:

Femto Laser Cataract: Avoiding Complications (Like every new surgery, this one is associated with unique potential problems. Here’s how to keep things going smoothly.)

Light energy from the laser causes disruption of tissue borders with minimal damage to nearby tissue. The old lens is removed, and then, the new lens is inserted. Recovery time is very similar to traditional cataract surgery, and most patients experience clearer vision and can resume normal activities fairly rapidly.

Which method is best for you?

Talk to your eye doctor to learn more about these two procedures that will dramatically improve your vision. Both methods have proven success rates, so make a list of questions for your doctor and get them answered so you can make an informed choice.

If you're talking to me directly in this response, I already had my surgery with no fancy extras. I personally believe most of these things are profit-driven and therefore unnecessary.

I chose the monofocal implant lens because I heard too many patients complain about the progressive lens implant. I also asked for monovision results. My dominant R eye now has good distance vision. On Thursday my nondominant left eye will receive an implant for near vision. After I chose that option the surgeon said that is what he has, monofocal monovision implants.

I chose the monofocal implant and asked for monovision results.

Did you have this done in USA?

I had Symfony lenses implanted both eyes July 10 and Aug 21 respectively.

We retired to Venice, FL USA and that is where I am having my cat surgery done.

I have been a successful monosion contact lens wearer for years. I have three different power lenses to choose from. Since my right eye implant last thursday, I have been experimenting with different power eyeglass lenses over my left eye. So my right eye is corrected for distance. Full monovision for me is +2.50 over my left and that was too much. +1.75 and +1.50 were too much and +1.00 was not enough but +1.25 was just right. So yesterday I told the doctor how well the +1.25 was working. So this morning I will get the left monofocal implant giving me intermediate vision in my left nondominant eye to work with my distant dominant right eye. These are big decisions and you are smart to think it over until you and your doctor feel comfortable with your choice.

Also, I had regular cataract surgery, no laser or anything like that and no ORA during the cataract surgery to check the calculations (used for people who had refractive surgery like LASIK, PRK, Relex Smile, etc. prior to cataract surgery, but I didn't have ORA and my results turned out fine).

I'm sure the procedure you chose was the right one for you. We are all different and it's between you and your doctor to decide which proceedure is best for you. Just answering questions that others ask me about my choice. We are here to learn and discuss. It's not a competition.

No it's not a competition, but there is some incorrect information floating around online that you won't be able to see at intermediate distances without glasses after getting monofocal lenses set for distance, so I'm just telling my story on here (again) for other people out there who are worried about getting monofocal lenses set for distance like I was.

And yes we are here to learn, but with some people who have an agenda (for what reason I have no idea) to push premium lens like the Symfony and giving incorrect information about monofocal IOLs, we are not learning at all, are we? We're just spreading unnecessary fear like I had before my surgeries. And some people are so afraid of monofocals from stories told on here and other cataract forums that they wouldn't even consider mini-monovision (and I decided not to get it either due to the fact I don't want to have to wear glasses for distance at all if I can avoid it and with mini-monovision you may need to wear glasses for driving at night).

LOL apparently you haven't done much research about cataract surgery on online forums, good for you!

Since you don't seem to know, I'll fill you in. The story that has gone around this forum and another online cataract discussion forum as fact (mainly due to one particular person who used to post a lot on the topic) is you won't be able to see anything without glasses from 6 feet in if you get monofocal IOLs set for distance unless you're in a tiny minority of people (around 1% or less). This is totally false information and since you started this topic to discuss our experiences, I thought I would take the time to go over it again to help other people avoid the anguish I went through worrying about how my cataract surgery would turn out.

I meant to say how my cataract surgery with monofocals set for distance would turn out. I really don't have any other reason to be on here except for that.

Yes. I will probably need readers for very tiny print. The number one reason for having cataract surgery is to allow more light to reach your retina. We are fortunate to have the added benefit of some visual acuity improvement. There was a time when cataract surgery meant removal of the crystalline lens but no implant. After surgery the patient was fitted with very thick eyeglasses lenses that gave limited tunnel vision. I'm not trying to scare anyone. I'm sorry you were so frightened before your surgery. My husband was afraid but I kept telling him how quick and painless it was. He was totally relaxed when he had the second eye done.

Unfortunately, that has not been my experience.  I had cataract surgery in February and March of this year, having monofocal toric lenses inserted into both eyes for distance.

I now have great driving vision and distance vision, but cannot read without glasses at all.  I even have to wear glasses to use the computer, which I never had to before.

It is unfortunate and I need to be sure that I have at least one pair of reading glasses with me at all times or I am stuffed - cannot see at all to read without them.

I'm not sure but it might be because you have toric monofocal lenses. I have regular monofocal lenses and can see fine without glasses except for tiny print.

Okay, that's interesting.  My surgeon was good and discussed my options with me.  I asked him about multifocal lenses and he said that he did not feel the technology was advanced enough yet, so he suggested monofocal lenses and it was just what I wanted the correction for.  I decided upon distance, as I do a lot of driving and night driving and he just said to me that I had astigmatism, so he was going to use toric lenses and that was it.

My distance is beautifully corrected and I now have better than 20/20 distance vision, but when I look at my mobile I have to put glasses on and I can't see that - it is a real nuisance, whereas my mother had cataract surgery about 20 years ago now and she had standard monofocal lens implants put in and her reading vision is a hell of a lot better than mine is now and I used to be able to read perfectly without glasses.  I wore glasses for distance and then took them off for reading and other near tasks.

Toric IOLs can be problematic whether they're monofocal toric lenses or premium toric lenses, plus they cost extra. To avoid any potential problems with toric IOLs (or any other treatments to correct astigmatism either during or after cataract surgery like limbal relaxing incisions or PRK or LASIK), the best bet is to just wear glasses or contact lenses to correct the astigmatism after cataract surgery.

And of course when I said "the best bet is to just wear glasses or contact lenses to correct the astigmatism after cataract surgery" I meant after cataract surgery with regular monofocal IOLs.

This is interesting because my Mom just had laser cataract surgery with the femto laser. In researching I discovered after the fact that a doctor cannot charge a medicare patient just for the use of the laser to break up the cataract but the doctor can charge if the patient is getting a specialty lens or has an astigmatism. My Mom did not get a specialty lens but the doctor said she had a small astigmatism that he will fix at the same time. She never even knew she had an astigmatism. The point is that I did not know she could not be charged just for the use of the laser. I really feel she probably did not even have a problem that had to be fixed wth the laser but the doctor knew he had to say this so he could get paid thousands extra. I really feel taken advantage of.

Are you saying your mom paid extra for the femto laser used for her cataract surgery itself, but also was charged another extra charge for the laser to do limbal relaxing incisions to correct astigmatism? I think some doctors charge extra for limbal relaxing incisions and some don't (and I mean limbal relaxing incisions done without laser).

All I can tell you is that she was charged 1400- per eye for the femto. I noticed on a form it said femto and LRI. I did not know what LRI even was until afterwards. I just feel since he said it was a very small astigmatism it probably was not even necessary to correct it with the femto but he had to say that to get paid for using the femto. I am learning all of this now. I had no idea that if a doctor felt the femto was necessary(which he said was going so far as to say he insisted upon it for a good outcome) he could not charge just for the method of breaking up the cataract. 

Also, femto laser used for cataract surgery is different than LASIK (just wanted to clear that up). And limbal relaxing incisions done for astigmatism are done during cataract surgery, while LASIK or PRK are done after cataract surgery.

I know..I understand that. I just was wondering if that LRI during the surgery was necessary for a better outcome. 

What exactly do you mean by this: "I just feel since he said it was a very small astigmatism it probably was not even necessary to correct it with the femto but he had to say that to get paid for using the femto." Who are you referring to when you say he had to say that to get paid? Paid by who?

LRI can be done without laser. Medicare doesn't pay for any femto laser for any reason that I'm aware of during cataract surgery.

From what I understand a Doctor cannot charge a medicare patient just for using the Femto as a means to break up the cataract. I know medicare does not pay for the Femto for any reason but if a doctor feels the laser is necessary the cost is not supposed to be passed on to the patient UNLESS during the surgery a patient is having a specialty lens or having an astigmatism fixed. My feeling is that the doctor in order to get paid by my Morher for using the Femto had to say he was fixing an astigmatism but my feeling is did she really need the astigmatism fixed or was this the only way he could charge extra. 

Here are 2 articles to read (the only way I know what I know is by searching on google and I personally wouldn't let them do LRI on me):

Correcting Astigmatism During Cataract Surgery

Cataract Surgery on Astigmatic Patients

There's another forum online where a cataract surgeon answers questions. I wouldn't trust too much what people say online, except for maybe if a doctor is answering and even then not everything said by cataract surgeons is accurate (and I try to double check everything I read before deciding if I think it's accurate or not).

Since she was paying out of pocket for the femto laser, it doesn't matter what he said the reason was he was using it since Medicare doesn't care because they're not covering it.

When we went initially he just mentioned that there was an astigmatism and that he would correct it at the same time. I did not know what this meant but he is a very well trusted doctor and I just felt he was doing the best thing. It is all over now. Whats done is done. I just feel she should not have had all that extra expense. Why would you not have LRI done?

From what I read if a Doctor is just using the Femto to break up the cataract because the Doctor feels this is the best method he cannot pass the cost onto the patient. 

Because I don't want anyone cutting on my eyes for no reason other than to avoid wearing glasses (if it even ends up working).

Not true. Where did you read that?

And what I meant by that is even if it ends up working since sometimes it doesn't.

I still don't understand what you mean by in order to get paid by your mother he had to tell Medicare the femto was necessary. Medicare couldn't care less what your mother wants to pay for that's not included in standard cataract surgery. If he wanted to be nice, he just would not have charged her for it at all.

Or are you saying he tricked your mother into paying for the femto laser by making it sound like it was necessary? That sounds more like what happened.

I meant to say he tricked her into paying for it by telling Medicare it was necessary and that made her (and you) think it was necessary.

I do not feel "tricked". There are articles on the website eyecare. org that talk about the use of Femto on Medicare patients and that the cost of this method cannot be passed onto the patient. I do not think they told Medicare anything. The article is very interesting. If you take a look at it you will understand more why I am upset about having to pay when essentially he never should have charged me. 

OK I finally realized what you mean. Medicare didn't used to allow patients to even pay extra out of pocket themselves for premium lenses during cataract surgery (dumb as that is). I don't know exactly when that was changed, but it also applies to femto laser used during cataract surgery. So I guess your doctor had to submit the information to Medicare even though it's a treatment they don't pay for. For anyone interested, google "Laser-Assisted Cataract Surgery and CMS Rulings 05-01 and 1536-R" for more info.

 

I do not know yet what paperwork the Doctor is submitting. I just realized/learned that if he did not mention the word astimatism he legally would be wrong to have charged her for the use of the Femto. It just bothers me because I feel he probably knows he is not allowed to charge for just using the Femto unless there is a specialty lens used or an astigmatism fixed. It is just an honesty issue. 

OK

Apparently Medicare started allowing people to pay extra for things like premium lenses on May 3, 2005, and now people are "allowed" (gee thanks!) to pay thousands of dollars extra for totally unnecessary femto laser cataract surgery also (see "Laser-Assisted Cataract Surgery and CMS Rulings 05-01 and 1536-R".

And when I say it's unnecessary, of course this is my opinion. You are entitled to your opinion and I'm entitled to mine (and I am not going to try to convince you otherwise).

If you find where it says Medicare will pay for femto laser cataract surgery (I'll also try to find it), please send me the links by private message. Also, it's possible you're thinking of YAG laser after cataract surgery...Medicare definitely pays for that, but doesn't pay for any other laser procedure involving cataracts that I can think of.

YAG laser treats posterior capsule opacification (PCO) after cataract surgery. It's a different type of laser than femto laser and since it's a necessary procedure it's paid for by Medicare.

Another article to read - it says femto laser is only paid for by Medicare if it's used during a cornea transplant, not cataract surgery:

"Femto Reimbursement: How to navigate the possible pitfalls of charging for the use of the new femtosecond cataract lasers"

Written by Riva Lee Asbell, Ft. Lauderdale, Fla.

Published 5 April 2012

If this part of the above article is what you're referring to (mainly the second paragraph pasted below), then you should contact Medicare to ask them why you had to pay (other than that I don't know what to tell you):

• Medically necessary cataract surgery, regardless of the lens implanted, that also involves femtosecond astigmatic keratotomy for refractive indications. This represents the intersection of the medically necessary cataract without astigmatism (where the use of the femtosecond laser is not reimbursable) and elective refractive indications (for which the surgeon and the facility can charge the patient extra for the use of the laser). As the ASCRS/AAO statement reads, “Medicare patients may be charged a fee for performing astigmatic keratotomy, assuming they were informed about, and consented to, the non-covered charges in advance. Because astigmatic keratotomy for refractive indications is a non-covered service, a higher fee can be charged for performing it using the femtosecond laser, instead of with a metal or diamond blade."

and

"Since the laser and its use and maintenance are significant investments, performing laser AK on everyone with any amount of astigmatism might emerge as a way to recoup the investment in the technology. However, though CMS hasn’t ruled specifically on the amount of astigmatism correction that would be acceptable, it would have to be a reasonable amount of cylinder that has been documented preoperatively. As a possible guideline, various Medicare contractors and carriers have minimum amounts of astigmatism for which they will pay, falling under the heading of “correction of surgically induced astigmatism or astigmatism caused by trauma.” The minimums may differ, so it may pay to check with your local contractor/carrier to get a feel for what might be a legitimate amount."

I also found this article "Guidelines for Billing Medicare Beneficiaries When Using the Femtosecond Laser" that says on page 2 (if you think he wasn't supposed to charge, then call Medicare to complain):

Medically-Necessary Cataract Surgery Plus Astigmatic Keratotomy Performed for Refractive Indications

Medicare will cover medically-necessary cataract surgery, but not concurrent correction of astigmatism performed for refractive indications. Medicare patients may be charged a fee for performing astigmatic keratotomy, assuming that they were informed about, and consented to, the non-covered charges in advance. Because astigmatic keratotomy for refractive indications is a non-covered service, a higher fee can be charged for performing it using the FS laser, instead of with a metal or diamond blade. As with premium IOLs, however, the patient should not be charged an additional amount to concurrently perform the cataract surgical steps with the laser. While most astigmatism treatment is not covered, Medicare does cover the treatment of large degrees of astigmatism that were the result of previous ocular surgery. Local coverage determinations may apply. In this situation, neither the surgeon nor the facility may obtain additional reimbursement from either Medicare or the patient over and above the Medicare allowable amount."

 

So it seems that Medicare will cover charges for using the femto laser under the circumstances below and if this applies to your mother, I think you should question her doctor and also contact Medicare about the charge:

"While most astigmatism treatment is not covered, Medicare does cover the treatment of large degrees of astigmatism that were the result of previous ocular surgery."

At this time my Mother does not want to do or say anything to disrupt her relationship with the Doctor.I on the other hand will definately look into it further. I did sign a form stating I want all charges sent to Medicare for review so I will wait and see when I get the Medicare statement. What is even more upsetting is that 2 days before the first surgery I get a call from his office saying I must pay him before the surgery. I was so upset because we were never told payment was due before the surgery. Normally the bills are sent in and then you would pay what was not paid for. They either wanted me to go get a bank check or give them my credit card. I was beyond mad/upset. I asked if I could just bring a check the day after the surgery. I was put on hold and was told the Doctor said no and if I do not pay  today they would have to cancel the surgery which I did not want to do since my Mom had already started the drops. I was put on hold again and was then told the doctor said he would just do it then without the Femto but it would be very risky. I wanted to cancel and go to another Doctor but my Mom just did not want to so I paid up front. I knew up front that Femto was not covered but I did not know he could not charge me for it unless he was using a premium lens or fixing an astigmatism. He just made a passing statement while examing my Mom that there was a small astigmatism and he would just fix it at the same time. I would not have even said ok to the astimatism part if I knew that was why he was allowed to charge me for the Femto. It just all seems very dishonest to me. It is so hard to find honest, reliable, good people today as I sat here since 11am with a plumbing problem and the guy never called and never showed up. Nothing is easy.....

And about the limbal relaxing incisions...I even had totally successful LASIK done 15 years ago (in my early 40s), but I now know so many people with serious complications from all kinds of refractive eye surgery (LASIK, refractive lens exchange/clear lens exchange, implantable contact lenses, PRK, Relex Smile, radial keratotomy, LASEK, etc.) that I would never again allow a doctor to do anything elective to my eyes just for the purpose of avoiding glasses and actually wish I never had the LASIK done (and supposedly LASIK can cause early cataracts or at least contribute to them, that's why I found so many people with all kinds of complications - I had no idea of the extent of it - when I was looking up info on cataract surgery done after LASIK). Most doctors (including my own cataract surgeon) would would deny LASIK contributes to early cataracts though.

Jillie I think if you read back through the responses prior to your mom’s cataract surgery a number of people mentioned your mom should find a surgeon that would do the surgery under the health care insurance and not have any or minimal charges.  The regular surgery (not laser) is every bit as good.  I did not have laser surgery and my surgery went well.  If you google which is better there are so few reasons why one would pay out of pocket thousands of dollars when regular surgery works just as well.

Sounds like the doctor was very greedy to me. I would report and complain to Medicare - they need to know what doctors are doing and it just isn’t right.  I think in another post you mentioned your mom was in her eighties?   There is no reason she should have been charged for cataract surgery.

Ugh, plumbers can be as hard to deal with as doctors! From what I read, your mother's astigmatism would have to have been caused by prior surgery for Medicare to pay for the femto laser for her cataract surgery. It sounds like he wanted you to pay in advance because he knew Medicare wouldn't cover it (that's what I meant by "tricked" - those lasers cost around $500,000 so they need to get money to pay them off). Plus as you saw in the 60 Minutes piece, like I said before, probably most of those people had very advanced cataracts and they do regular cataract surgery on them with no problems, no laser involved.

That’s because lasik has become a very profitable business.

We did not even know what LRI meant. He just made it sound like just a routine part if the procedure. I did not know it was elective. 

I took her to 2 very well respected doctors and they both pretty much insisted on Femto for a good outcome. They both said she had very advanced cataracts. The surgeon who did the procedure has said numerous times over the past few weeks how happy he was that we did the Femto because her cararacts were so difficult. He even said it was the most difficult cataract case he had in 33 years. I wanted to go for a third consult but my Mom is frail and just wanted it done. I feel the traditional way would have been fine but when your told it is very risky and the outcome is questionable what are you supposed to do? I was not going to risk anything bad happening to my Mother.

Yes..I know the laser machines are expensive. I agree with you. Many people have advanced cataracts and do not go the laser way. I tried to read both sides and really felt the traditional way would be fine. My regular eye doctor who I spoke to knows the surgeon my Mom used and I went to him on his advise. He said he is not about the money and would only recommend Femto if he felt it would be the best thing to do.

My Mom will be 82 on November 1st. I agree with you and in time I will look into it. I can tell you that Medicare does not care. My Mom was in the hospital in May and there are charges on the statements for doctors she never even saw. They billed Medicare and they paid the doctors. Reasons like this is why everyones insurance is through the roof. No honesty.

It is unfortunate you had no one else there to help you research this more and support you.  

Lasik and all the other refractive surgeries I listed. In my opinion, doctors also look at premium cataract lenses as money makers, although I know everyone on here thinks they're a great thing and were only created to help people (another area where my opinion differs from most people's opinions who post).

Correction: the astigmatism would have to be caused by prior surgery OR trauma for Medicare to pay for femto laser for LRI and the actual cataract surgery.

Did he let you read a copy of the informed consent? It should have been on there for your mother to initial, plus I'm pretty sure the extra charge would have also been listed there.

I am all alone. It is just the two of us. I did do some research and constantly was going up and back between the Femto and traditional. I always leaned toward the traditional way but when you are told traditional by 2 highly recommended doctors is not a good choice what are yoy supposed to do? My Mom was not wiiling to go for any more eye exams and consults. I am mostly upset about the doctor charging so much for the Femto which is not allowed by Medicare rules but since he "threw" in saying he will fix her astigmatism he could now charge her. I did not even know what "fixing" the astigmatism entailed. He just made it sound like it was just a simple part of the procedure. If I had known before I would have asked more questions about her astigmatism. I wonder what he would have said if I said not to fix the astigmatism. He would not have been allowed then to charge her. What is  also unbelievable the 1st doctor never mentioned an astigmatism but was charging her for a premium lens. I knew nothing of premium lenses when we went to the first dr but in my research thought a premium lens was not necessary for my Mom. 

If you felt you were given good info Jillie, then you did the right thing. The main problem is that it wasn't clearly explained to you that you would have to pay extra.

She wasn't charged for the actual cataract surgery, Sue, she was just charged extra for the femto laser and the LRI.

Anyway, is she feeling better now? I know you said she had a bad experience with her 2nd surgery.

The extra charge was listed. He said the Femto is not covered by Medicare. But I just feel what he failed to say is Femto is not covered and I cannot charge you for it but I can charge you for it because you have an astigmatism I am going to  fix. If I said no..do not fix the astigmatism what then would have happened? He cannot legally by medicare rules charge you just for the use of the Femto without another procedure. I find this all disturbing and exhausting. 

Yes he absolutely can charge for femto without another procedure. Did you read the articles I posted?

That is the most important thing. She said she is starting to feel better so for that I am grateful. She was really upset after the second eye was done. She has some swelling of the cornea which he said gets better 100% of the time. She should feel better over the next week or so. Thank you for asking. 

Cataract surgery done with femto laser is a premium addition to regular cataract surgery and no insurance companies pay for it and neither does Medicare. It's paid for totally out of pocket like premium IOLs are.

That's good Jillie...

If you google femto and medicare the 1st article talks about Femto reimbursement and it states the medicare patient cannot be billed extra strictly for the use of the Femto

Did she have a premium package? It says "However—and here is where a fine distinction comes into play—the surgeon can’t specifically charge extra for the use of the femtosecond laser in this “premium package.”

If a doctor opts to do Femto on a standard procedure with a regular lens it is not covered but the cost of using the laser should not be charged to the Medicare patient. 

No premium package. No special lens. 

What that means is if she was getting a premium lens and also was having laser cataract surgery, they have to bill her for a bundled "package" which includes everything and the amount for the laser has to be included in the package and can't be billed separately. I did find another article that lists some medical reasons someone would not have to pay extra for femto laser used during cataract surgery, but I don't think your mother's situation applies.

Here's the article that discusses under what circumstances femto laser used during cataract surgery will be paid for by Medicare "Who’s Getting Femto Laser Cataract Surgery?"

So in some cases it's deemed necessary by Medicare to use femto laser during cataract surgery, but not in routine cataract surgery.

And if it was paid for by insurance companies, even though I think it's unnecessary, I probably would have had it myself!

Anyway, read that article and see if your mother's situation warranted not having to pay for the femto laser and if it did, ask your doctor why he didn't document that for Medicare (I would think if Medicare would pay for the laser, her doctor would have explained that in the paperwork he submitted to Medicare).

You said: "No premium package. No special lens."

And that means the femto laser still had to be paid for out of pocket (only it wouldn't be bundled in a premium lens package, since there was no premium lens used), unless she had one of the things mentioned in the article I posted in which case I'm pretty sure her doctor would have documented that for Medicare so that she didn't have to pay for the femto laser out of pocket.

The doctor was "allowed" to charge for the femto because he said she had astigmatism that he would fix at the same time . If he was just doing femto with a regular lens he is not supposed to charge for the use of the laser which I did not know until after the fact. I never would have agreed to pay all the extra money for a little astigmatism that never bothered her before.

It only should not be charged to the Medicare patient if they have one of the exceptions where Medicare will cover the cost of the laser and I'm pretty sure your doctor would have told Medicare if your mother had one of those exceptions.

You said: "The doctor was "allowed" to charge for the femto because he said she had astigmatism that he would fix at the same time . If he was just doing femto with a regular lens he is not supposed to charge for the use of the laser which I did not know until after the fact. I never would have agreed to pay all the extra money for a little astigmatism that never bothered her before."

OK jillie, I hope you can get it straightened out. I don't agree with you, but try filing a complaint with Medicare (google for their phone number).

• Medically necessary cataract extraction with implantation of a conventional intraocular lens. This is the most common cataract patient scenario and, unfortunately, neither the surgeon nor the surgical facility can bill the patient or Medicare extra for the use of the femtosecond laser in this situation. This is based on the definition of a global surgery procedure. The global surgery concept for a surgical procedure includes the incision, the procedure itself and the closure, no matter how those steps are accomplished. So, whether you use a femtosecond laser or a diamond knife, Medicare pays you the same fee.

I thought in initial thread you mentioned doctor wanted to use laser due to thickness of cataractand would be gentler in breaking it up.  Did doctor change reason to for using laser to correcting astigmatism?

I do not understand what you do not agree with me about?

Yes he wanted to use the laser due to the thick dense cataract. He just said it was less risky and she would have a better outcome so we agreed to pay extra not really thinking anything of it when he mentioned there was a little astigmatism he would fix at the same time. Just trusted he was doing the right thing. Did not know until after the surgery that the doctor if not for saying he was fixing an astigmatism should not have charged for using the femto as the method for breaking up the cataract.

I read this article again (see below) and what I think it means is even if Medicare pays for the basic cataract surgery and it's done partly with laser (not all parts of cataract surgery are done with the laser), any charges for the laser that are not covered by Medicare can be charged to the patient. You should call Medicare and ask them or google the CMS rulings to read more about it.

Laser-Assisted Cataract Surgery and CMS Rulings 05-01 and 1536-R

 

I did read where it said if the doctor also does a refractive procedure then Medicare won't pay anything toward the laser, but I don't think LRI are considered a refractive procedure. I didn't know any of this so thanks for going over it so many times until I finally realized what you meant lol (and everywhere online it says Medicare and insurance won't pay for femto laser used in routine cataract surgery, so there's another example how things you read online aren't necessarily true). I did also read that there are parts of the surgery that Medicare won't pay for if laser is used, but I have to find that article again and will post it here.

That is right. Medicare and insurance do not pay and the doctor is not allowed to bill Medicare  nor the patient strictly for the removal of a cataract with a standard lens.If in fact LRI is not a refractive procedure than he should not have charged me just for the use of the Femto. This is exhausting but by the time this is over I will become an expert on this subject.

You need to file a grievance with Medicare. I'll private message you the link.

I was under the impression Medicare would not pay anything at all toward laser cataract surgery, that's what I said I didn't agree with about.

I don't think Medicare considers LRI for minor astigmatism to be a refractive procedure. Maybe your doctor was entitled to bill you for something related to the surgery even if you think he wasn't. I think you should speak to his billing department and then if not satisfied, file a grievance with Medicare (I sent you the link).

I think you meant to say Medicare does pay? I'm not sure if private insurance will pay for laser cataract surgery though or part of it, if not all of it. Medicare pays for standard cataract surgery without laser, that much I do know.

Here's the link

cms . gov / Medicare / Appeals-and-Grievances / MMCAG / Grievances . html

The billing department consists of one woman who I do not care for. My mother does not want me to do anything right now. She wants to still be able to go to him until she is all healed. I just want to know that what I paid for I actually was responsible for that's all. I will wait until all the statements from Medicare comes(which usually takes months) and then I will investigate further. 

OK jillie, let us know how it turns out (I'm very curious now).

I'll also let you know if I find that article again that specified what doctors could charge patients for after laser cataract surgery covered by Medicare.

So for anyone reading this who has Medicare in the US, Medicare will pay for laser cataract surgery if you are getting standard monofocal IOLs and no refractive procedures done at the same time (including premium IOLs or I guess limbal relaxing incisions although I'm not sure if that's accurate, but from what jillie has said, it seems to be).

I actually just re-read "Guidelines for Billing Medicare Beneficiaries When Using the Femtosecond Laser" and it seems that US doctors are also not supposed to charge Medicare patients extra for laser cataract surgery even when someone gets a premium IOL unless they also get limbal relaxing incisions. So jillie is right and apparently her mother's doctor probably only did the LRI in order to charge her mother extra for the laser used for her cataract surgery (I think Medicare pays a standard amount no matter which method is used - conventional cataract surgery or laser cataract surgery - and then there's a surcharge for the use of the laser, so I think that's what jillie's mother was billed for, the surcharge, not the entire surgery because I think the amount she was billed sounds too low for the entire surgery amount). Anyway, all websites I have read from various doctor's practices, etc. always say laser cataract surgery costs extra out of pocket even for Medicare patients, which is apparently incorrect.

This article "Who’s Getting Femto Laser Cataract Surgery?" says "“The bottom line,” he says, “is that we can charge for the diagnostics; we can use the femtosecond laser as part of a premium channel package; we can charge for astigmatic surgery that uses the laser; we can charge for the premium IOL that is implanted with the help of the laser; but we can’t charge for the laser itself.”

Wow - I guess you're right jillie and I also think they're not supposed to charge extra for the laser if it's part of a premium IOL package even though this article says they can.

And from the same article "“We cannot get reimbursed for using the laser, per se,” he notes. “So if you’re using femtosecond laser for cataract, the patient is probably getting a premium lens of some kind—toric, multifocal or accommodating. Most surgeons don’t use femtosecond laser for a standard procedure."

I wonder if private insurance companies have the same rules....

So what it boils down to is your mother's doctor did limbal relaxing incisions on an 81 year old woman who didn't really need them in order to bill her for the femto laser that was used during her cataract surgery (and for all you know, maybe he didn't even do the LRIs). Disgusting and another indication of the greed in this industry that I hate so much!

From that same article it says "Medically-Necessary Cataract Extraction with a Premium Refractive IOL (No astigmatic keratotomy)":

"Neither the surgeon nor the facility should use the differential charge allowed for implantation of a premium refractive IOL to recover all or a portion of the costs of using the FS laser for cataract surgical steps. As set forth above, Medicare Part B covers the cataract surgery and the implantation of a conventional lens without regard to the technology used.

Imaging performed as part of the FS laser surgery, which is necessary to implant premium refractive IOLs, is considered a non-covered service as long as these services are not used routinely when implanting conventional IOLs. A separate charge for the imaging is allowed with that consideration. However, as set forth above, Medicare Part B covers the cataract surgery without regard to the technology used. The Medicare beneficiary receiving a premium refractive IOL may be charged for non-covered services (such as imaging), but not for using the FS laser to perform covered steps of cataract surgery, such as the phaco incision, capsulotomy, and lens fragmentation."

It also says the following (but of course it's not enforced and these are guidelines from the American Academy of Opthalmology):

"Advertising: Promotional claims must be consistent with the best available clinical evidence and should not be deceptive or misleading to patients. Caution should be exercised with advertising or public media statements that describe why patients must pay additional out-of-pocket fees. Balance billing Medicare beneficiaries to use the FS laser for covered steps of cataract surgery is prohibited. Extra charges to the beneficiary can only be billed when a premium refractive IOL is used, and when the same imaging services are not used by the surgeon when implanting conventional IOLs. Statements that imply otherwise should be avoided. CMS has provided an example of what it considers a misleading representation: “While traditional cataract surgery is fully covered by most private medical insurance and Medicare, bladeless cataract surgery requires patients to pay out-of-pocket for the portion of the procedure that insurance does not cover”.

"Transparency: Patient-shared pricing should be discussed openly with the patient. Increased charges should be explained and documented."

 

If you read the comments at the bottom of this page, the doctor whose page it is also does limbal relaxing incisions for astigmatism correction along with laser cataract surgery in order to directly bill Medicare patients for the upcharge of using the femto laser, so apparently it's a common (and despicable) practice:

"The Cost of Cataract Surgery" - Dr. Gary Foster – Fort Collins & Loveland, CO

Also in the article "Femto lasers in cataract surgery" by Michelle Dalton it says:

"Although cataract surgeons will not be able to pass along any costs associated with the cataract removal to Medicare patients, they would be able to pass along any refractive procedures performed with the laser (such as limbal relaxing incisions), Dr. Nichamin said. Patient acceptance of femtosecond technology during cataract surgery is going to drive the demand, Dr. Slade predicted. “They think we’ve had lasers forever; patients instantly got the messaging with the IntraLase and LASIK, and I think they’ll follow suit with these,” he said. The femtosecond laser “will revolutionize the premium lens industry,” Dr. Nagy said, agreeing that patient demand will be the driving force for rapid surgeon acceptance. These lasers “facilitate premium implants,” Dr. Vukich said. “Patients want the best implant and want the best laser possible for those implants. You’ll need a viable financial model to justify the purchase, but it will provide an upstream benefit.”

“LASIK didn’t succeed because surgeons wanted to buy more lasers,” Dr. Slade said. “At some point, it became patient-driven, and the same dynamic will come into play with this technology.”

WOW! You really did alot of research last night. I can tell you that I am very upset because I had a feeling what he did was wrong and this all really confirms it. I was also wondering if the LRI was done(I sort of hope not). I was thinking that when she was admitted for the procedure the wrist band they put on her just said cats sx fl which I read as cataract surgery femto laser. I do not remember seeing LRI written. I do not know if that means anything. I guess I will just have to wait until he sends in the bill. He does get paid the standard Medicare fee plus he took 2800- from my Mother wrongfully. Feeling sick from all this.

I hope you report it to Medicare.  They cannot fix what they do not know.  In Canada prior to June 2012 opthamologists were don’t this and each charging different rates.  The government then changed so that cataract procedures are now done through hospitals including purchase of lenses so rates are standardized.

A surgeon has no conscience to charge an 81 year old that kind of fee for standard cataract procedure.  He took advantage and likely paperwork you signed allowed him to do it.  

I want to do something. I believe my Mother should be reimbursed the 2800- she paid him wrongfully. My Mother is very upset and does not want me to do anything now because she still needs to see him to follow up. The situation is not good. I am really upset. I did alot of research and I thought we did the right thing. It was not until after the surgery that I read she could not be charged for the Femto unless a refractive procedure took place. I had no idea what lri was until now. 

If the surgeon is unscrupulous don’t be surprised he’ll suggest other procedures that will b additional expenses.  To me he had already shown his true colours by charging for something not need for an 81 year old.  If her 2nd surgery isn’t giving her as sharp a vision hopefully you’ll have this corrected by glasses - don’t let him talk your mom into a lasik to correct.

I agree go to follow up visits but hopefully it will end there.

Does the surgeon have to know you’ve alerted Medicare?

Also as I know you are likely sole caretaker for your mom - despite what she thinks you need to protect her.  I know it sometimes creates friction between you and your mom.  My mom was a victim of a financial scam and didn’t want to fight back - maybe embarrassment was a factor but it caused some friction between us and I took over and am fighting this week off her behalf.  Seniors are in vulnerable positions and often victims of all kinds of fraud and scams.  Unfortunately my opinion is sometimes you can’t just let it go and even though f it upsets them - fight on their behalf.  This isn’t deciding on where to go for lunch and letting them choose.  She has been a victim of someone that took advantage of her fear and concern.  Just my 2 cents.

I completely understand what you are saying. Just to let you know my Mom is a very young in mind 81 year old. She is more with it than I am. We are very close and there is no friction  between us. I will not let it go. I just feel until she is healed I cannot do anything to disrupt her visits with the Doctor. She would just let it go but I cannot. What he did was wrong. 

Her second eye is feeling a little better today which I am happy about. I am sure if I contact Medicare now he would definately be contacted about it. I just wish I knew what LRI even meant. I just figured it was part of the Femto procedure name. Hopefully others will learn from all this. 

I completely understand  your not wanting to upset your mom and also make future visits with this doctor uncomfortable.  Just be super cautious and questioning if he brings up any additional procedure that will cost another fee.  And sometimes after they’ve gotten paid such people no longer want to invest much time in follow up.  I wish you both all the best.

Thank you...

There's nothing to report to Medicare, Sue. These doctors use a loophole that Medicare provides for them and Medicare knows all about it.

Even if your mom had the LRI, probably nothing bad will happen to her, so try not to worry Jillie.

From what I read online, most, if not all doctors use the LRI thing to be able to bill patients for laser cataract surgery out of pocket under Medicare's rules (and Medicare is fully aware of this - this loophole was probably provided by Medicare due to doctors' protests after Medicare decided to allow laser cataract surgery to be billed at the same rate as regular cataract surgery). This doctor didn't do anything out of the ordinary.

jillie - you are not going to win a Medicare grievance or appeal because the LRI is a loophole that Medicare sanctions to allow doctors to bill people out of pocket for laser cataract surgery. It's too bad you didn't know that ahead of time.

I disagree. I absolutely feel that this Doctor was wrong in not explaining what LRI was. When I saw Femtolri written on the forms I just thought it was part of the Femto procedure. When the doctor on examining my mom initially just said in passing there is a small astigmatism and he would just fix it at the same time I had no idea exactly what it meant and just thought it was part of removing the cataract. My Mother nor I would have ever said ok to such a procedure. I would like to know if we had said to him we did not want the astigmatism fixed and only wanted a standard lens what would he have then said/done. That is the million dollar question. Those are his only 2 options to be able to charge for the use of the Femto. It just bothers me so much that I am having trouble eating&sleeping. Why is there so much deception and dishonesty? I feel he took advantage and did the wrong thing. How do you just let it go and not do or say something. I am trying to find a Medicare advocate type person that I can explain what happened and if I should do sonething to get my Mom the money she really should not have had to pay. 

 

The only reason I feel I have a case is because the Doctor never even said LRI or what the procedure was or what was involved in doing it.

The problem is that Medicare allows doctors to charge patients for the laser part of cataract surgery if the doctor also does limbal relaxing incisions. I guess you should try filing an appeal or grievance with Medicare and tell them that you didn't have the chance to decide whether or not to have the LRI since it wasn't fully explained to you (and they might come back and say that's your fault for not asking more questions - I don't know).

Guess it is likely a different system in Canada.  Report has to go in from opthamologist prior to Medicare approving.  Typically if cataract affects your vision to 20/40 and glasses cannot correct it better than that Medicare will approve cataract surgery 

When you saw it said "LRI" on the informed consent, did you ask what that was? Did it say you had to pay extra for it? I'm on your side, really I am. I'm just trying to understand what happened and tell you my opinion on whether or not Medicare (a huge government bureaucracy) will do anything to help you. If Medicare won't help you, you can try asking the doctor for a refund or file a chargeback on your credit card and explain it to the credit card company.

I did not know to ask any questions because I did not know what lri even meant. I just thought it was just part of the name of the Femto. I did not know lri was a procedure. 

I unfortunately know too late. All I know is that was the way he was able to make my mother pay and I feel he was negligent in not divulging exactly what he was going to do. It was just wrong.

Yes it's a totally different system in Canada. Cataract surgery is paid for by Medicare here whether it's regular or laser cataract surgery, but Medicare allows a loophole where if the doctor also does limbal relaxing incisions, he or she can then bill the patient for the use of the laser in the actual surgery (not just for the LRI). The basic surgery is still paid for by Medicare (Jillie's mother got billed $1,400 extra for the laser either for both eyes or one eye, I'm not sure and I think the basic surgery would cost more than that - sounds like a lot but there is no regulation as far as how much doctors can charge for surgery in the United States).

Yes it was wrong and he's not the only doctor who does this and Medicare is aware of it and is the one who allows it to happen.

It did say Femtolri and I did not think anything of it. They just said the Femto laser was mot a covered procedure and had to be paid for. No one said you are paying extra because of the LRI. It is a little complicated because the woman in his office filled out and had my Mom sign all the papers. She signed everything and I got copies to look over at home. She was not able to see what she was signing and I have my own vision problems so I could not look it over until I got home. On the ABN form that she had my Mom sign it say Femto and the lri part was totally illegible. You would not even know what it said. That form happened to be checked off wrong by his office. They checked off the box that says I do not agree to Femto and do not have to pay. I felt the right thing to do was bring the error to their attention. I thought the box that stated I want all paperwork sent to Medicare should be checked so I had another form sent to my Mom with the correct box checked . I feel they checked the wrong box on purpose as to not send what he did into Medicare. I really do not know. On the second form it says FemtoLRIs more clearly but thought nothing of it. I just want some guidance as what is the right thing to do. I know you are on my side and just trying to help and I appreciate you. I just hate dishonesty so much and unfortunately there is too much of it.

Maybe try going on the AARP website and see if there's a discussion forum for cataract surgery and ask if anyone else had this happen to them (probably lots of people don't even pay close attention like you did). Also try writing to your congressman to complain about it (they all have websites).

 

My Mom paid 2800-. The Doctor gets reimbursed by Medicare and my Mom has a supplemental plan. Some people who do not have the suppl.plan alot of Doctors accept 80% as payment in full but he is going to get 100% plus 2800-.

Believe me Jillie, I also hate dishonesty and have seen people worldwide (in the US and outside the US) blinded or left in terrible pain for their entire lives by dishonest eye surgeons (aside from stealing their money). I'll try to find some other things you can do and post here if I find anything.

When I said probably most people don't notice, what I really meant is probably most people with Medicare don't even know that laser cataract surgery is supposed to be covered by Medicare at the same billing rate that regular cataract surgery is covered at, since doctors lie and just say Medicare doesn't pay for laser cataract surgery at all (which is not the entire story of course as we know).

I appreciate your help. Thankfully my Mother is feeling good. Her vision at the Doctor today was 20/25 which is fantastic. She just wants to forget it. She is happy she can see. She wants me to do nothing to interfere with her going to this Doctor. I will not do anything to prevent her from seeing him. I had liked him. He is very nice to my Mother. I just feel he took money from her in an underhanded sort of way.  I just want to do the right thing.

So if your mom doesn't want to make waves with this doctor, the best thing to do is forget it, but if you want to try to help other people avoid the same thing, you can try writing to your congressman, etc. (not sure what the etc. might be though, I would have to look into it and it's probably an uphill battle anyway that's totally unwinnable).

And I'm happy she's doing well (and if you still feel like you can't forget it, you can do the things I suggested already, try arguing with the doctor that you didn't understand what LRI were and didn't know your mom would be charged for the laser part of the surgery if she agreed to have them or trying arguing that to Medicare and see what they say).

I have a question maybe you or someone else can answer. Would my Moms outcome had been the same without the LRI procedure. She saw 20/25 today. Would her vision had been this good without that added procedure?

 

Hi Jillie - it depends on whether or not she did have astigmatism.  I am leaning if it was t discussed much with your mom and you - she didn’t have it or if she did it was negligible.  Most who have astigmatism- doctors discuss toric monofocal lenses with them rather than regular monofocal lenses.

Before he had done the second eye I asked the Doctor if my Mom had an astigmatism in that eye too. He said it is very small and will just fix it. It was said ver nonchalantly. That was it. She never even knew she ever had one. If she did and he fixed it I would think I should be able to see a copy of the paperwork that he sends into the insurance company which I requested be done. There has to be a record of what he did. 

They are only supposed to use toric lenses if you have moderate or worse than moderate astigmatism. LRI are for mild astigmatism, but even if the person has mild astigmatism that bothers them, they can fix that with glasses and therefore LRI are totally unnecessary.

I agree.  Toric lenses are also considered premium lenses and there are additional fees.  So if someone with astigmatism didn’t want to pay for toric lenses and got monofocal lenses it would be common sense they’d wear glasses as they knew there’d be a good chance of needing glasses with monofocal lenses.

You can also try contacting a consumer reporter like Eyewitness News (I used to live in NYC) - do a search for Eyewitness News ABC7 New York Share Your Story.

I also looked into whether or not you could sue in small claims court (I'm not sure if you could), but even if you could you said your mother doesn't want to start trouble with this doctor. I guess in that case you just have to let it go since whatever you do, the doctor isn't going to be happy about it.

You can also contact the Center for Medicare Advocacy (search for website) to ask them if there's anything you can do.

You can also file a "surprise medical bill" complaint with Consumers Union at consumersunion.org/share-your-surprise-medical-bill-story/

You can also file a "surprise medical bill" complaint with Consumers Union at consumersunion . org / share-your-surprise-medical-bill-story /

 

Here's an article you can read and also file a complaint online with Consumers Union (they take complaints from consumers and then fight to have legislation passed):

5 Doctors Most Likely to Stick You With Surprise Medical Bills - Insurance often won't cover the expenses, but there are ways to avoid paying excessive charges by Donna Rosato, January 17, 2017

 

I looked over all that you said. I do not really feel it was a surprise medical bill. We were simply told that Femto was the only way to go for a good outcome and that it is not covered by Medicare. That is all we were told. That is true. It is not covered by Medicare but what he failed to say is that he could not charge my Mom for it either if he chose to use the Femto instead of the traditional way unless she wanted a premium lens or have an lri procedure. In the exam when in passing he said there is also a small astigmatism he will just fix at the same time we had no knowledge that meant an LRI procedure. We did not even know what that meant. It was never said or explained. My Mom never would have agreed to having to pay 2800- for a small astigmatism. It was just to me a deceptive way to get paid for the use of the Femto. I really would like help with just how to move forward. I cannot do anything for a while. My Mom has to go back in a few weeks and then in 3 months. I do not think any sort of formal complaint should be filed until a letter is sent to the Doctor explaining how we feel. I think he should have a chance to respond to my grievance first. I wish it did not bother me but it does.

I think really don’t know the process in USA being Canadian.

However here is a suggestion. I am a firm believer in a softer approach first.  If as you say the doctor has been kind and good to your mother perhaps you should reach out to see if you could have a one on one discussion with him.  Rather than accusatory try to win his sympathetic side over.  Explain your finances are limited and age of your mom and you both are alone without much family around and are each other’s support.  Explain this has been traumatic and you are sole caregiver for your mom and it was only after this you’ve discovered what LRI meant and really it wasn’t necessary procedure. And if this was all the explained and implications of doing LRI you wouldn’t have opted for it.

Maybe he will refund or offer to go 50/50

if conversation is civil then your mom doesn’t need to know anything and will have her follow up appointments.  If you wait 3 months you may not have any recourse after that much time has passed. 

I agree with exactly what you said and that is my feeling to. My Mom likes him as did I. I do not want to attack simply explain my feelings. I would rather put it all in writing to him than talking to him in person. I really love everything you said and think you said it perfectly. What do you think of putting it in writing in a nice letter? 

Really think it is better in person for a few reasons.  One always hard for people to know the tone and people interpret words differently. Plus what if you never get a reply ie your letter is ignored.  You’ll end up fretting if he received it (particularly if you mail it and even if you leave it with reception ).

I know it is harder to meet in person and to keep emotion out of conversation but I think you’d know his reaction first hand.

How about this.  Write a letter and in putting it in writing you’ll have an idea of what you want to say and it will provide you a guideline for the conversation.  But keep letter home.  If the conversation goes nowhere you could mail him the letter (keep a copy for yourself) and then if you want to take it further with Medicare you have written proof of your having had a conversation and sending a letter.

It is really difficult for me because I hate confrontation of any sort and if I feel attacked by him in any way that is a problem for me. I can get very nasty and I want to prevent that from happening. I am extremely mentally fragile really on the edge of just surviving. I only push on everyday for my Mother because she needs me. I have no one, I am totally alone dealing not only with caring for my mother but having many health problems of my own that are neglected. It is just a difficult situation for me. I will wait a little while and think about what to do. The whole thing is just making me sicker. Thank you for your help and suggestions. I appreciate it. Maybe you want to come over and be my advocate(lol). I wish I had someone to talk on my behalf. In my emotional state it is hard for me to deal with alone.

Ahh feel for you - really do.   

perhaps the best course of action is to let it go.  12 years ago I went through a 2 year court battle with a house  we purchased.  It leaked every rainfall and spring melt was horrible.  Basement was newly renovated so had no idea that it would flood like that.  We lost over $80k paying to have it repaired landscaping and deck and walkway redone and paying half that amount to a lawyer.  In hindsight should have paid to fix it and minimized our losses but I was determined to bring this person to justice.  I soon learned there is no justice in a courtroom and have since called it the legal system.  It took me a while to let it go and not be bitter and there have been some amazing things come out of that time.

I say all that to let you know it’s ok to give yourself permission to walk away.  Your mom needs you and there are so many more worthwhile things for you to spend your energy with.

Just my 2 cents worth Jillie.    Don’t let this rob you of peace and joy of these years with your mom.  Once you open a legal battle it will rob you more than just money.

I just wanted to let you know my Mom is not doing well anymore. She is unable to see out of her right eye. She said everything is blurry and double. It is odd because her right eye was so perfect immediately after surgery and was so clear until a few days ago. Her left eye was blurry for days after surgery but ok now. I have been so upset over this whole situation to begin with but now that she cannot see I am pretty much on the verge of a nervous breakdown over all this. I called the doctor and I am taking her tomorrow. Did you ever hear of this happening? 

Yes this is likely PCO or what people term a secondary cataract.

Posterior capsule opacification (PCO) is a fairly common complication of cataract surgery. Sometimes you can develop a thickening of the back (posterior) of the lens capsule which holds your artificial lens in place.

This thickening of the capsule causes your vision to become cloudy. If this happens you may need to have laser treatment to make vision clear again. Once you have had the laser treatment for PCO it doesn’t normally cause any long term problem with your sight.  It sometimes takes a few years to happen and some people can develop it soon after cataract surgery.  I was told took 2 to 6 years but leRned on these forums can develop much sooner for some people.  It can be cleared up with a simple laser treatment.

I just read a little about this. It seems that there is a big problem with this happening after the Femto laser. I am so upset because I was so against the laser but doctor not only pushed the laser but insisted upon using it for a good outcome. If this happened without using the laser I would be hearing "I told you so" meaning you should have used the laser. Nothing I do is ever good. 

Don’t be down on yourself.  Sounds like you have me this surgeon was sly and upsd a few unnecessary services.  I was told to expect PCO within 2 to 5 years.  I had traditional surgery.  Symfony lenses are also square edge IOLs which are supposed to slow the process although justvreading a few posts in last few days of people needing the YAG for PCO weeks after their surgeries do now not sure whether my surgeon’s estimate of 2 to 5 years is right or whether I could experience it sooner.

One thing you should know about the YAG (laser treatment for PCO) is that once it’s done it’s difficult to have s lens exchange.  Sounds like before the blurring your mother had good vision so likelihood of her wanting or needing an exchange is low.

Hopefully that treatment is covered under insurance/healthcare?