Medical Necessity For Cataract Surgery Form (Page 3 of 3) in pdf

Medical Necessity For Cataract Surgery Form Page 3

Vista Eye Specialists

Binoy R. Jani, M.D.

Basic Monofocal Lens

With single-vision lens implants, there is a very high likelihood

that you will need glasses for near-vision activities after surgery,

even if you do not wear near-vision glasses before surgery.

These activities include reading, applying makeup, shaving,

sewing, reading your watch, dialing a cell phone, and baiting

fishhooks. Medicare and most private insurance carriers will pay

80% of your cataract surgery and the monofocal lens. This is

considered basic coverage.

Presbyopia Correcting Lens (Multifocal Lens)

Advanced technology implants are designed to provide a full range of vision—near

and far. Medicare and private insurance provide basic coverage and allow you to

pay for the upgrade, if you choose to do so. Based on FDA clinical data, 80% of

patients never need glasses again for any activities. Those who do need glasses

need them only for very specific tasks. The goal is to significantly decrease your

dependence on glasses. There is an additional cost for this technology. If it is

determined that you are a candidate for the presbyopia correcting lens, we can

discuss payment plans that make this option affordable for our patients.

Astigmatism Correcting Lens (Toric Lens)

The Astigmatic correcting lens is specifically designed to treat those who have

astigmatism. In years past, cataract surgery removed the cataract, but a patient

with astigmatism still required glasses for near and distance vision. The design of

the Toric lens makes it possible to reduce or eliminate astigmatism. There is an

additional cost for this upgrade. Again, we strive to make the Toric lens

affordable for our patients by offering payment plans.

□ Yes, I would like to hear more about freedom from glasses

after cataract surgery.

□ No, I want just my basic coverage.

Name ___________________

Date____________

Medical Necessity For Cataract Surgery Form Page 3