by: AllMed Healthcare Management
Eye wear may be a fashion accessory, but when you depend on it for seeing the world, it?s a lot more. Today, many people are turning to refractive laser eye surgery, such as Lasik surgery, to improve their vision. However, this high-cost surgery is normally not paid for by insurance because it fails to meet the conservative therapy test and is classified as cosmetic. This trend is shifting.
We are seeing an increasing number of circumstances where refractive eye surgery is determined to be medically necessary and, therefore, payable by the insurance provider. For example, if conservative therapy treatments fail or if a patient is intolerant of contact lenses and cannot wear glasses because they might pose a risk in their job (e.g. police or firefighters), refractive eye surgery may be the most medically viable treatment option.
Conservative Therapy Options:
Examples of conservative therapy treatments include the following:
Photorefractive keratectomy (PRK) ? a refractive laser surgical procedure that is often done (and covered) for a patient that suffers from recurrent corneal erosion (e.g. diabetics). With PRK, a laser is used to remove corneal tissue to correct vision problems.
Patching, epithelial debridement (mechanical removal of faulty tissue), and bandaged contact lens placement ? treatments that often don?t work.
Stromal puncturing ? a procedure involving the physician puncturing the anterior corneal stroma ? can also be used but can fail or result in permanent vision loss. In such cases, PRK is the best alternative for removing the damaged cells (or membranes) and possibly correcting the vision problems.
Physicians can help patients who are in medical need of laser eye surgery make a stronger case by initiating the following:
Document a full medical history of the patient?s eye complaints
Show proof that the patient has not responded to conservative treatments and that the purpose of the surgery is for medical reasons other than simply improved eyesight
Still, even when the physician does this, each decision is taken on a case-by-case basis and is subject to the extenuating circumstances clearly noted in the patient?s medical record.
For more information about medical necessity reviews on cases like this, visit our website or call us at 1-800-400-9916.
About The Author
AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com, http://www.allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.
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The Basics Of Cosmetic Surgery
The Basics Of Cosmetic Surgery
by: Sintilia Miecevole
It is not uncommon for a person to have something they would like to change about their body. Some people have abnormally large noses. Some women would like to see their bust size larger or reduced. Many people would like to decrease the fatty deposits in their tummies, hips and thighs! This is where cosmetic surgery can come in. When you have cosmetic surgery done, you are having a healthy, normal part of your body reshaped and changed for aesthetic reasons. These parts of the body don?t have to be changed. Cosmetic surgery should not be confused with reconstructive surgery. Cosmetic surgery is used strictly to enhance and improve the appearance of a given part of the body.
There have been many medical advances in cosmetic surgery over the last several years. Most cosmetic procedures can now be done as outpatient surgery. This can mean very little discomfort and very little time off from...
The Basics Of Cosmetic Surgery
Cosmetic dentistry > The Basics Of Cosmetic Surgery
Rhinoplasty Before And After - Surgery And Recovery - Part II
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by: Wendy Butler
Now that you have made the decision to undergo rhinoplasty and have prepared for your surgery, the next step is the rhinoplasty surgery itself and the after affects.
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You will either be under local or general anesthesia. Local anesthesia is when you are lightly sedated and your nose and the surrounding area is numb. You know what is going on but cannot feel what is happening to your nose. General anesthesia is when you sleep through the surgery and do not know what is happening.
Rhinoplasty surgery normally takes one to two hours unless it is a complex rhinoplasty. The rhinoplasty itself consists of...
Rhinoplasty Before And After - Surgery And Recovery - Part II
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Collagen Injections on the Forefront of Cosmetic Plastic Surgery
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by: Harry John
Cosmetic plastic surgery boosts your confidence the way you look. And increase in self-confidence in the look can encourage you to focus your energy on other areas like family and career. There may me certain flaws in your body and face that makeup, diet and exercise can’t help mask. There you should look into the ultimate in makeover, i.e., cosmetic plastic surgery.
The advancement of corrective body and facial surgeries has made the cosmetic procedures easy, affordable and less invasive. This has led many to go for pure cosmetic procedures where aesthetic value comes first.
But, cosmetic procedures are not totally different from reconstructive procedures. Cosmetic surgery also considers your general health conditions and particular physical traits. That’s why you should not plunge into a procedure just for look alteration.
Of many cosmetic...
Collagen Injections on the Forefront of Cosmetic Plastic Surgery
Cosmetic dentistry > Collagen Injections on the Forefront of Cosmetic Plastic Surgery
Rhinoplasty Before And After - Surgery And Recovery - Part II
Rhinoplasty Before And After - Surgery And Recovery - Part II
by: Wendy Butler
Now that you have made the decision to undergo rhinoplasty and have prepared for your surgery, the next step is the rhinoplasty surgery itself and the after affects.
Rhinoplasty can be performed in the surgeon's office-based facility, an outpatient surgery center, or a hospital. Usually the surgery is performed on an outpatient basis but if it is a complicated rhinoplasty then you may be required to stay in the hospital.
You will either be under local or general anesthesia. Local anesthesia is when you are lightly sedated and your nose and the surrounding area is numb. You know what is going on but cannot feel what is happening to your nose. General anesthesia is when you sleep through the surgery and do not know what is happening.
Rhinoplasty surgery normally takes one to two hours unless it is a complex rhinoplasty. The rhinoplasty itself consists of...
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by: Tom Ace
Plasma TV has become an important part of television technology. Over the past few years, there have been several major advances in the industry, including the plasma TV. As with any major technology advances, the plasma TV is quickly becoming more affordable - good news for the consumer.
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Cosmetic dentistry Laser Eye Surgery ? Will Insurance Pay? Determining the Medical Necessity of ?Cosmetic? Treatments televisions Plasma TV The Price Goes Down
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Recycle Your Inkjet Cartridge And Help The Environment
by: Neil craig
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Cosmetic dentistry Recycle Your Inkjet Cartridge And Help The Environment ink cartridges
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by: Troy Francis
Do you need to borrow money? Home equity lines may be one source of credit. Home equity credit lines may provide you with large amounts of cash at a low interest rate and they may provide you with certain tax advantages with other loans.
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Batteries - From Laptops to Motorcycles
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by: Eric Comforth
What would you do without them? Seriously, if every single battery of every single type were suddenly zapped out of every single thing that it operated, what would any of us do?
Laptop computers, without a doubt, are the lifeblood of many a businessperson today. Portable, convenient, they allow us to work on the run and do more business. Laptop batteries are essential to keep this resource working,...
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Cosmetic dentistry > Batteries - From Laptops to Motorcycles
Cosmetic dentistry
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