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

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