What Are Medically Necessary Contact Lenses?

Medically necessary contact lenses are non-elective contact lenses prescribed when certain medical conditions hinder vision correction through regular eyeglasses and so contact lenses are the accepted standard of treatment. With some medical conditions, patients are unable to achieve a specified level of visual acuity or performance through regular eyeglasses. This results in the need for “medically necessary contact lenses.”

Such medical conditions include:

  • Aphakia – the removal or absence of the natural lens of the eye(s) due to surgery, injury, or abnormality.
  • Anisometropia – a refractive condition where the eyes have unequal focus or optical power.
  • Keratoconus – an eye disease that causes structural damage to the eye’s cornea, changing from the normal, round shape to a bulging, cone shape.
  • Corneal Ectasia – a result of the weakening of the inner layers of the cornea. Due to this weakened cornea, the shape of the cornea changes significantly in addition to protruding forward and lending a distorted version. In some sporadic cases, it can also be attributed to a complication of a Lasik procedure.

Types of Medically Necessary Contact Lenses

Medically necessary contact lenses can be:

  • Soft Lenses – disposable or extended wear.
  • Hard Lenses – small diameter rigid gas permeable, commonly called RGPs.
  • Hybrid Lenses – rigid gas permeable with a soft lens skirt.
  • Scleral Lenses – large diameter rigid gas permeable that covers part of the sclera (white area) surrounding the iris.

What Is a Contact Lens Fitting?

Each contact lens fitting includes:

  • Initial consultation and measurements.
  • Assessment of the cornea, conjunctiva and eyelids to judge impact of contact lenses on ocular health.
  • Confirmation of the appropriate prescription to achieve the best visual outcome.
  • Thorough evaluation of centration, rotation, movement, and material of contact lenses.
  • 90 days of follow-up contact lens care for existing wearers.
  • Complimentary starter supply of contact lens solution.
  • Contact lens Instruction session on insertion, removal, handling, and care is required for brand new lens wearers.

Health Plan Coverage

Not all major medical health plans cover medically necessary contact lenses and/or fitting. And some only cover for specific diagnoses like Keratoconus.

Medicaid will cover medically necessary contact lenses and/or the fitting but they require prior authorization before dispensing any lenses, and they have specific guidelines to follow.

Vision Plan Coverage

We are participating providers for the following vision plans that offer coverage for medically necessary contact lenses and fitting for specific medical conditions:

  • Avesis
  • EyeMed
  • Humana Vision
  • Superior Vision
  • VSP – No vision plan from your employer? You can visit VSPdirect.com to sign up for an individual VSP plan to help with your contact lenses and eyeglasses.

Forms of Payment

In the event your medical or vision plan doesn’t cover medically necessary contact lenses, we offer a courtesy discount on the lenses and we accept the following forms of payment:

  • Cash
  • Check
  • MasterCard, Visa, or Discover
  • and Care Credit – Visit CareCredit.com to apply for a Medical Credit Card.

Patient Responsibility

The cost for fitting of medically necessary contact lenses is considered separate from your eye exam that is covered by your medical or routine vision plan. While we will do our very best to verify your benefit coverage, it is not the responsibility of Solinsky EyeCare to know your particular medical or routine vision plan’s coverage, restrictions and/or to guarantee payment in regard to medically necessary contact lens fitting and/or contact lenses.

How To Achieve Medically Necessary Contact Lens Success

The success of wearing contact lenses requires more than just the initial fitting. Contact lenses are a medical device that can only be dispensed by prescription. Therefore, they must be regarded with the same caution that would be used for a prescription drug. It is for this very reason that the FDA mandates that contact lenses be reevaluated on an annual basis by the prescribing physician.

It is the policy of our office that each year one of our doctors needs to evaluate your lenses to ensure that they are fitting properly, prior to renewing a prescription. A poor fitting lens can affect the health of your eyes by promoting infection, decreasing the amount of oxygen getting to the cornea, and/or setting the stage for other permanent complications. The health of your eyes is very important to us, and we aim to keep them in prime condition.

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