How much will an insurance company pay for cataract surgery? Is it a fixed amount?
Cataract surgery is usually a "covered service" by Medicare and most
major medical insurance plans in the U.S. That does not mean, though,
that the patient will not have to pay anything out-of-pocket. A single insurance
policy will rarely cover 100% of the cost, whatever the fee of the surgeon. A
typical insurance claim will often include a deductible to be met before any
insurance payment is applied. Medicare will pay for 80% of what they decide is
the amount they want to pay. Either you or your secondary insurance will
pay the deductible (if it has not already been paid from another previous
doctor visits) and the other 20%. There is also the charge for the use of the
operating room and equipment at a hospital or Ambulatory Surgery Center (ASC).
_Written by J. Trevor Woodhams, M.D. - Chief of Surgery, Woodhams Eye Clinic