When are contact lenses considered medically necessary?

Clinically speaking, contact lenses are considered medically necessary when conventional glasses or contact lenses are inadequate to correct vision or the contact lens is being used to therapeutically manage an ocular condition. However, vision and medical insurance carriers often have very specific criteria of what diagnoses qualify as “medically necessary” and will authorize coverage for.

Are specialty contact lenses expensive?

Specialty contact lenses are a greater investment than conventional contacts in 2 ways: 1) contact lens fitting or professional services and 2) the cost of the contact lens materials. Fitting these lenses properly and efficiently requires highly specialized training and knowledge by the doctor as well as sophisticated diagnostic equipment, laboratory materials, tools and education. Many specialty contacts are custom designed to fit each individual eye which makes it different than off-the-shelf contact lenses which are made in predetermined parameters. Rigid gas permeable contact lenses, for example, can last up to 1-2 years depending on how well the lens(es) are cared for, the wear and tear caused by the interaction with your particular tear chemistry and ocular surface as well as whether your vision correction remains stable.

Will my insurance cover the cost of my fitting fee and/or contacts?

Depending on the plan, coverage may be obtained through your vision or medical insurance. Our clinic will be happy to look into your individual benefits for specialty contact lens fittings and/or materials before proceeding and provide approximate quotes on out-of-pocket costs. A specialty contact lens consultation is strongly suggested so Dr. Chung can fully assess your eye condition and vision needs in order to provide you with an informed lens recommendation and accurate cost determination.

Do I need a referral?

Not necessarily! Dr. Chung welcomes new patients and in fact, recommends every patient interested in a medically necessary contact lens fitting to first undergo a comprehensive eye exam with dilation if they have not had one in the last year. This provides critical information about your current eye health for Dr. Chung to determine your best corrected visual potential and prognosis for success in contact lenses. Dr. Chung welcomes all referrals from practitioners who believe their patients could benefit - she has extensive experience co-managing patients across all disciplines from ophthalmology to rheumatology as well as fellow optometrists.