Private Insurance

In understanding the reimbursement issues associated with the AcrySof® ReSTOR® IOL, there are a few challenges related to privately insured patients that you should consider. For example, non-Medicare patients shouldn't be expected to pay for the extra cost and additional services involved in cataract surgery without first understanding which services are covered, and which are not.

Make sure your patients are fully educated on the procedure, and be sure to obtain written authorization from their third-party payers to bill the patient for non-covered services. Your administration personnel should make the same distinction when managing charges and payments, using appropriate CPT and HCPCS codes to identify and distinguish covered items and services from noncovered items and services.

Also, some patients with cataracts may not meet their health plan's coverage criteria, but still desire the AcrySof® ReSTOR® IOL for their corrective procedure. These cases are subject to unique rules and regulations.

The following link contains valuable information regarding private coverage:

• "Coding for Cataract Surgery."
  A Supplement to Ophthalmology Management. June 2005.