Medically Necessary Contact Lenses: Understanding Insurance Coverage and Criteria

Medically Necessary Contact Lenses

Contact lenses are an essential part of vision correction for many people, providing a convenient and effective alternative to eyeglasses. In some cases, contact lenses are considered medically necessary, by VSP, EyeMed or other insurance companies. Meaning that contact lenses are required to treat or manage a specific visual condition. In this blog post, we will discuss why insurances cover contact lenses for certain patients, the criteria that needs to be met, and other important information about medical necessary contact lenses.

What are Medically Necessary Contact Lenses?

Medically necessary contact lenses are prescribed to address specific eye conditions or visual disorders. These lenses can be used to treat conditions such as very high prescription corrections, keratoconus, astigmatism, and dry eye syndrome. In some cases, they may also be used to protect the eye after surgery or to manage other vision problems.

--> Order Non-Medically Necessary Contact Lenses
with your VSP or EyeMed Insurance here! <--

Why Do Insurances Cover Contact Lenses for Certain Patients?

In some cases, contact lenses are considered medically necessary to treat or manage a specific visual condition. In these cases, insurance companies may cover the cost of the contact lenses to ensure that patients receive the treatment they need. Often such patients have a difficult or impossible ability to correct their vision with regular glasses. This coverage helps to ensure that patients have access to the vision correction they need to maintain their quality of life.

Criteria for Medically Necessary Contact Lenses

To qualify for insurance coverage for medically necessary contact lenses, patients must meet specific criteria. These criteria may vary depending on the insurance company and the specific visual medical condition being treated. Some common criteria include:

1. A documented medical condition that requires the use of contact lenses for treatment and inability to wear standard glasses to correct vision according to the Optometrist's exam.
2. A prescription from an eye care professional recommending the use of contact lenses for the specific medical condition.
3. Evidence that other forms of vision correction, such as eyeglasses, are not sufficient to treat the condition.
4. Regular follow-up visits with an eye care professional to monitor the effectiveness of the contact lenses and make any necessary adjustments.

Types of Medically Necessary Contact Lenses

There are several types of medically necessary contact lenses, including:

• Soft Contact Lenses: These lenses are made of a soft, flexible material and are often used to treat conditions such as myopia, hyperopia and astigmatism.
• Rigid Gas Permeable Contact Lenses: These lenses are made of a hard, gas-permeable material and are often used to treat conditions such as keratoconus and irregular astigmatism.
• Scleral Contact Lenses: Scleral These gas-permeable lenses are larger than traditional contact lenses and are designed to vault over the cornea, resting on the white part of the eye. They are often used to treat conditions such as keratoconus and severe dry eye syndrome.
• Hybrid Contact Lenses: These lenses combine the benefits of soft and rigid gas permeable lenses, providing the comfort of soft lenses with the visual acuity of rigid lenses. They are often used to treat conditions such as keratoconus and irregular astigmatism.

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Medically necessary contact lenses play an important role in the treatment and management of various eye conditions. In some cases, insurance companies cover the cost of these lenses to ensure that patients have access to the vision correction they need. If you think you may be a candidate for medically necessary contact lenses, talk to your eye care professional to learn more about your options.

--> Order Non-Medically Necessary Contact Lenses
​with your VSP or EyeMed Insurance here! <--