Is LASIK Surgery Medically Necessary? Key Insights from Liberty Laser Eye Center

Certain conditions can disqualify an individual from being a suitable candidate for LASIK surgery. Key disqualifiers include having an unstable vision prescription that has changed within the past year, being under the age of 18, or having certain autoimmune diseases like rheumatoid arthritis, which can affect healing. Other significant factors are corneal diseases such as keratoconus, having corneas that are too thin, severe dry eye syndrome, and uncontrolled diabetes. Additionally, pregnant or nursing women are typically advised to postpone the procedure due to hormonal fluctuations that can temporarily alter vision. A comprehensive pre-operative evaluation by a qualified ophthalmologist is essential to determine eligibility based on overall eye health and medical history.

Lasik eye surgery is performed to correct common refractive errors by reshaping the cornea, the eye's clear front surface. The primary medical reason is to reduce or eliminate dependence on glasses or contact lenses by improving how the eye focuses light onto the retina. It is most commonly used to treat myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. By creating a precise flap in the cornea and using an excimer laser to alter its curvature, Lasik allows light to be properly focused. It is a well-established procedure for suitable candidates with stable prescriptions. For a comparison with another laser vision correction technique, please refer to our detailed article, LASIK Vs. PRK: Which Is Right For You?.

Medically necessary LASIK is a procedure performed not for refractive error correction alone, but to treat a specific underlying eye disease or condition that cannot be adequately managed with glasses or contact lenses. This is a rare classification. Examples include performing LASIK to eliminate corneal irregularities that cause debilitating glare and monocular diplopia (double vision) after trauma, or as part of a therapeutic procedure for certain corneal pathologies. Standard LASIK for nearsightedness, farsightedness, or astigmatism is virtually always considered elective. Insurance coverage for medically necessary LASIK is highly specific and requires extensive documentation proving medical necessity. For patients with very high prescriptions, exploring advanced options is key; our detailed resource, High Myopia Solutions Beyond Standard LASIK, discusses alternatives when standard LASIK is not suitable.

Qualifying for LASIK depends on meeting several key criteria established by your eye surgeon. Generally, candidates must be at least 18 years old, have a stable eyeglass or contact lens prescription for at least one year, and have corneas that are thick and healthy enough for the procedure. Underlying health conditions like uncontrolled autoimmune diseases or severe dry eye can be disqualifying. A comprehensive pre-operative evaluation is essential to assess your unique ocular health, prescription, corneal topography, and tear film. For a deeper look at the nuanced factors that determine eligibility, including some that may surprise you, we recommend reading our detailed guide: Are You A Candidate? Surprising LASIK Eligibility Factors.

LASIK is typically considered an elective procedure, so most standard health insurance plans do not cover it. However, there are strategies to potentially get coverage or reduce your out-of-pocket cost. First, check if your employer-sponsored vision plan includes a LASIK discount program, which is more common than full insurance coverage. Some medical insurance may cover it if there is a documented medical necessity, such as severe astigmatism or an inability to wear corrective lenses due to occupational requirements. You can also use a Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for LASIK with pre-tax dollars, which provides significant savings. Always obtain a detailed pre-authorization from your insurance provider and review your plan's exclusions document thoroughly.

LASIK is typically not covered by standard health insurance plans, including those from Blue Cross Blue Shield, as it is considered an elective or cosmetic procedure. Most Blue Cross policies classify LASIK as a vision correction surgery excluded from standard medical coverage. However, some Blue Cross affiliates may offer discounts through contracted provider networks or optional vision care plans that provide reduced rates. It is crucial to review your specific policy details or contact Blue Cross member services directly to confirm any available benefits, as coverage can vary significantly by state, employer group, and individual plan. A few exceptions might exist if LASIK is deemed medically necessary to correct a condition not fixable with glasses or contacts, but this is rare.

The cost of LASIK eye surgery varies significantly based on several factors, with the national average in the United States typically ranging from $2,000 to $3,000 per eye. This price is influenced by the technology used, the surgeon's experience and reputation, and the geographic location of the practice. More advanced procedures, like bladeless or custom wavefront LASIK, often command a higher fee. It is crucial to view cost in the context of value and safety; the lowest price may not include important pre- and post-operative care or use the latest equipment. Many providers offer financing plans. A comprehensive consultation is essential to get an accurate, personalized quote and understand all included fees.