Strabismus, commonly known as crossed eyes, is a condition where the eyes do not align properly. While it can be treated with vision therapy or eyeglasses in some cases, surgery may be necessary to align the eyes properly.

If your child needs strabismus surgery, it’s important to understand how your health insurance coverage works for this procedure.

What Is Strabismus Surgery?

Strabismus surgery is a procedure that is designed to treat misaligned eyes. During the surgery, the eye muscles are adjusted to straighten the eyes so that they align correctly. This helps improve vision and overall eye health.

Strabismus surgery may be recommended for children or adults depending on the severity of the misalignment.

How Does Health Insurance Cover Strabismus Surgery?

Health insurance coverage for strabismus surgery varies depending on the insurance plan, the severity of the condition, and the individual’s age.

In some cases, insurance companies may consider strabismus surgery to be a cosmetic procedure and may not cover it. However, in most cases, insurance companies will cover at least a portion of the cost of the procedure.

Prior Authorization

If your child needs strabismus surgery, you may need to obtain prior authorization from your insurance company. Prior authorization is the process of getting approval from your insurer before the procedure is performed.

The insurance company will review the medical records and other documentation provided by your doctor to determine if the surgery is medically necessary.

Co-Payments and Deductibles

If your insurance plan covers strabismus surgery, you will likely be responsible for co-payments and deductibles. A co-payment is a fixed amount you pay out of pocket each time your child receives medical care.

A deductible is the amount you must pay out of pocket before your insurance plan begins to cover the cost of medical care. The amount of your co-payment and deductible will depend on your specific insurance plan.

Out-of-Network Providers

If your child needs strabismus surgery and your doctor is not in your insurance plan’s network, you may be responsible for a greater portion of the cost of the procedure.

Out-of-network providers may charge more for their services than in-network providers, and your insurance plan may cover a smaller percentage of the cost of the procedure.

Appealing a Denied Claim

If your insurance company denies your claim for strabismus surgery, you have the option to appeal the decision. To appeal, you will need to provide additional documentation to your insurance company showing that the surgery is medically necessary.

You may also need to obtain a second opinion from another doctor.

Medicaid Coverage

Medicaid is a government-funded program that provides health coverage for low-income families. Medicaid may cover strabismus surgery, but coverage varies by state.

Some states have stricter eligibility requirements than others, and some may not cover the procedure at all. Contact your local Medicaid office to find out more about your coverage options.

Conclusion

Strabismus surgery is an important procedure that can help improve vision and overall eye health. If your child needs this surgery, it’s important to understand how your health insurance coverage works for this procedure.

Contact your insurance company to find out more about your coverage options and any requirements for prior authorization or appeals.