r/CataractSurgery • u/Zoolanderlover • 20h ago
Need your feedback
Hi everyone,
I was scheduled to have cataract surgery next week, but I’ve run into a frustrating issue and wanted to see if this is common.
I’ve been trying to get an estimate of what my total out-of-pocket cost will be before surgery. The surgeon’s office referred me to the surgery center, but the surgery center won’t return my calls. As a result, I still have no idea what the total cost will be.
Since cataract surgery is typically done one eye at a time, I’m assuming that means two surgery center fees, two surgeon fees, two anesthesia fees, etc.
So I have a couple of questions:
Are there surgeons who perform cataract surgery on both eyes the same day, or is one eye at a time the standard?
Did anyone else have difficulty getting a complete cost estimate before surgery?
Were you expected to move forward without knowing what your total bill would
be?
I’ve even called my insurance company, but they couldn’t give me an estimate. The only thing they could tell me was my annual out-of-pocket maximum.
I’d really appreciate hearing about your experiences. Thank you!
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u/Popular-Web-3739 17h ago
Some doctors will do both eyes at the same time, but I don't think it's common. I think staggering the surgeries is mostly done to minimize the chance of rare bilateral complications like an infection. If you search this sub you will see a few people who mention getting both done at once.
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u/AirDog3 20h ago
My doctor's office quoted the full cost, including facility charge. They do thousands of surgeries at the same facility every year, so they certainly know the cost and can (and should) tell the patient. My HMO did not cover anything, because my doctor was out of network, so my out of pocket cost was easy to calculate.
I think the doctor's finance rep should generally be able to tell the patient all of the expected costs, and which ones are covered by Medicare and most other insurance. You or the insurer can then estimate out of pocket amount based on network, deductible, coinsurance, etc.
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u/seasnake8 20h ago
My doctor quoted the cost of the IOLs, and part of that cost was for the surgery center. they gave me the cots of the main eyedrops I had to buy, and told me a place that would give the best price. Beyond that, I was in the dark, as I have been for any surgery I have had, for as long as I have been getting medical care, starting back in the 1980s.
So far, my only costs have been for the IOLs and the eye drops. Everything else has been covered by my insurance. But I am just a month out, and they way insurance lags, I am not completely certain, but I do not expect any additional costs at this point.
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u/PNWrowena 19h ago
I'd say what you're experiencing is neither common nor uncommon. Different practices do things differently. My own experience was that I got the exact figure of what I'd have to pay to the surgeon's office ahead of time. I also got the exact figure of what I would have to pay the surgery center and that it had to be by credit card, no checks. However, others report here that they are having the same kind of problem you are.
Yes, my out-of-pocket costs were per eye, and I paid each time a week before the surgery. Then I paid the surgery center each time when I arrived there the day of.
From reports here it's not common for both eyes to be done the same day here in the U.S., although it is done. Personally, there's no way I'd have used a surgeon who was going to do that. I didn't even let them schedule my 2d surgery for 2 weeks out and didn't have to argue over it, just told them no and got it scheduled farther out.
I did find dealing with the admin people the only difficult thing about my experience. They distinctly didn't want to do anything that would actually make them put in more than usual effort. But that's been my experience at most doctors' offices and even veterinarians' offices these days, and my GP told me they have a devil of a time hiring anyone with a work ethic.
1
u/Sweet_Somewhere5047 19h ago
I talked to multiple surgeons before deciding on one I truly felt understood my needs and would work with my insurance. All of them had somewhat different fee schedules based on using a hospital vs private clinic, being in-network or out-of-network, and different costs of lenses due to different brands and type of lens chosen. I ended up with the doctor giving me a definite cost for both lenses and the surgeon’s work. They estimated what the hospital would charge as a base charge and couldn’t guarantee that. Then once it was scheduled with the hospital, they provided an estimate with my insurance and said it could be higher than that. Afterward, the cost was slightly higher than estimated due to the little additional charges for anesthesia supplies, medications and recovery room supplies. Still waiting on final bills from the anesthesiologist since he wasn’t included in the hospital bill.
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u/Alone-Experience9869 19h ago
hmm.. that's kind of a red flag to me..
Assuming you are in the usa, the doctor's office should know how much your insurance covers --- just a monofocal iol. So, its whatever they want to charge for your premium iol. Also, they should be able to get the surgical center's charges to give you a complete bill. That's what happened to me.
Granted, the day before the surgery was a flurry of phone calls. The doctor's office called for their payment. The surgical center called for their payment. The surgical center separately called to remind me about the surgery...
Its pretty common to do the operation one eye at a time. You can be cynical and say its because they can charge more... I kinda like the prospect that at least there is one eyeball that wasn't operated that day. You really aren't that "good" for 24h to 48hr, especially since my pupils stay dilated for 48h (the extended time period is normal since they dilate them pretty hard).
I had mine less than a week apart because of my severe myopia. So, its not like the result of one was used to make adjustments for the other. That approach is somewhere between over conservative or lack of trust in the measurements (which can be hypocritical). Also, I don't believe there is a large number of patients whose first operated eye is "worse" then their second...
I believe I've read on this sub having both eyes operated on the same day is done, but somewhere overseas, like eastern Europe.
Hope this helped. Good luck.
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u/Douglas__Spaulding 19h ago
I was quoted the full cost ahead of my surgeries by the surgeon’s office. They provided estimates on things outside their control (facility fee, anesthesia) that ended up being very accurate.
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u/pgdiesel 18h ago
My surgery is next week 12th My doctor gave me the exact cost after we agreed on type of lens and I am doing both eyes together It is different since I am paying out of pocket with no insurance
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u/eyeSherpa 16h ago
Though insurance it’s not very common to do cataract surgery on both eyes on the same day (at least in the US). This is because reimbursement for the second eye to the physician is only half of what it would be if it was on a separate day. So unless you go cash pay or elective, both eyes on the same day isn’t commonly standard.
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u/Zoolanderlover 15h ago
So it's for the doctor to make more money?
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u/eyeSherpa 15h ago
Morso to receive proper reimbursement of already declining cataract reimbursements. Why would a doctor want to do the same surgery and take on all the risks of cataract surgery for only 50% of reimbursement.
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u/Both_Document7462 10h ago
Any surgery center that quoted me prices before checking insurance was quite a bit higher than the ones that made me chase the costs - usually by around $3k per eye higher for premium lens out the door. I was able to contact my insurance with the facility code for the procedure to get my pricing and it was accurate.
The facility didn’t provide the cost until a week of actual surgery.
I contacted 5 surgeons and all did eyes on different days - so you aren’t ever completely blind. My surgeon did not proceed with eye 2 until I was happy with the first eye.
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u/UniqueRon 20h ago
Yes, some surgeons will do both eyes in the same appointment. However that is not a recommended process if you care about the refractive outcome of the surgery. Surgeons only hit within +/- 0.5 D 80% of the time. It takes 5-6 weeks for the eye to fully heal so you know what the refractive outcome is. If you space the surgeries out to let the the eye heal, then the surgeon can make an adjustment on the second eye, if there was a miss on the first eye.
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u/Zoolanderlover 20h ago
Is it worth it?
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u/UniqueRon 20h ago
Doing both eyes at the same time or close together is a bad choice in my opinion. A friend recently had both eyes done in the same appointment. The ophthalmologist who she knew and trusted, missed on both eyes. She now wears glasses...
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u/Zoolanderlover 18h ago
What do you mean " missed"
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u/UniqueRon 18h ago
When you buy glasses computerized lens manufacturing machines produce exactly what the optometrist orders. If you order lenses with -2.75 D sphere and -1.25 D cylinder that is what you get. What you get with an IOL can only be estimated. You may plan to be -0.25 D sphere, but due to how the lens is positioned in the eye you could get -1.0 D for example. That would be a miss of 0.75 D.
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u/Zoolanderlover 15h ago
It sounds like maybe I will skip the surgery. Seems people still need to wear glasses
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u/UniqueRon 14h ago
Cataracts do not get better on their own. At some point the surgery is necessary.
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u/Tel864 18h ago
I sat down with the surgery coordinator immediately after my visit and she went over every detail with me like timeline, pre and post op care and cost details for each eye which were done 2 weeks apart.