Health insurance & laser eye surgery: information and options

// Augenlaserzentrum Franken

Laser eye surgery – costs covered by statutory health insurance

Depending on the type of refractive error diagnosed, laser correction costs Costs of several thousand euros Those affected must budget between 1,000 and 3,000 euros (per eye to be treated). Depending on the medical procedure, the procedure can also be more expensive.

For complex surgical techniques on both eyes, the patient needs a generous financial deposit. For people whose savings are insufficient, the procedure depends on the health insurance company covering the costs. But even for patients who have painstakingly built up reserves, paying the costs themselves can be painful. Accordingly, it is particularly important that the patient can forward the cost invoice to their insurer.

However, those who have statutory health insurance are often left alone to cover the costs of visual aids or laser eye surgery.

Statutory health insurance companies jump only in case of medically necessary treatment The criteria for the medical necessity of laser treatment are usually interpreted very narrowly.

In the following situations, the costs are covered by the statutory health insurance companies:

1. Wearing glasses is unreasonable for the patient (for example due to a high diopter number and the weight of the lenses). This also applies if the glasses cannot adequately compensate for the deficits.

2. The patient reacts to wearing contact lenses with intolerance. There are various visual impairments that make switching to contact lenses impossible.

3. The policyholder requires eye surgery because otherwise his vision may deteriorate (up to and including complete blindness).

From the point of view of health insurance companies, laser treatment is nothing more than a superfluous Lifestyle or cosmetic surgeryIn addition, insurance companies do not classify poor vision as an illness. Therefore, requests for reimbursement of costs are rejected in most cases. The argument that the regular costs of a visual aid are more expensive in the long run than the laser procedure does not usually lead to the desired result.

In exceptional cases (for example, with a high diopter number of 7 or more), health insurance companies agree to cover part of the costs even if there is no medical need. Sometimes it can be worthwhile to clarify the individual options in a one-on-one conversation.

// Augenlaserzentrum Franken

Laser eye surgery – willingness of private health insurers to reimburse

Private health insurance companies are also generally very reluctant to cover the costs of laser eye surgery. Nevertheless, there are some insurance companies that include so-called LASIK treatment (a common laser eye surgery method) in their range of services.

If you have your insurance policy to hand, you can check whether you can claim insurance for the laser procedure. You can also find out the details of the insurance tariff by speaking to someone in person (by email or phone). The more expensive and comprehensive the insurance model, the greater the likelihood that the insurance company will have to cover the costs. While most basic tariffs only cover very few services, many Premium tariffs the LASIK treatment in the conditions. Also in Supplementary insurance Laser eye surgery can be insured separately.

However, without a contractual claim to cover the costs, most health insurance companies will reject their customers' payment requests. Nevertheless, even with a basic tariff, it is possible that an accommodating solution (for example, partial coverage of costs) can be found after describing the situation. Objection and a certain degree of persistence on the part of the customer sometimes also have a positive effect on the audit result. This is because the blanket rejection of payment requests is part of the corporate strategy of many insurance companies!

You should give the insurance company a Quotation so that your insurance provider has a concrete idea of the costs involved.

Furthermore, the chances of having costs covered increase if you have a Proof of medical necessity For this purpose, the ophthalmologist prepares a written report to be submitted to the health insurance company.

If you have any further questions on this topic, you can also contact online.

Legal options if the insurance companies do not want to pay

Many health insurance companies reject their customers' requests for coverage with a blanket response. If you are unable to make any progress on a goodwill basis, you still have the option of taking legal action against the health insurance company's decision.

The Federal Court of Justice (and many lower courts) have repeatedly ruled that the cost of the LASIK procedure is reimbursable if it is medically necessary. It is therefore important that you can prove the medical necessity with a report from the treating ophthalmologist.

Unfortunately, even this letter of confirmation does not necessarily guarantee coverage. Some insurance companies justify their reluctance by saying that the patient can ultimately resort to cheaper visual aids (glasses or contact lenses). They also refuse to recognize poor eyesight as an illness.

However, the counterargument is that wearing a visual aid is not an equivalent solution. Ultimately, neither contact lenses nor glasses are able to cure the visual impairment. In addition, it can often be proven that the visual impairment is to be regarded as an illness due to the anatomical changes. After a detailed examination of the individual case, there are often no longer any reasons that the respective health insurance company can cite for its rejection.

If your health insurance refuses to cover the costs, the legal representation be a smart move. The specialist lawyers know the legal levers that you can use to obtain an obligation to take over.

The fact that there have been many court cases in the past has a positive effect on the general willingness of health insurance companies to talk. Many insurance companies are now also willing to out-of-court compromises a.

AXA Krankenversicherung AG, Debeka, HUK-Coburg, Signal Iduna and Versicherungskammer Bayern are just a few examples of private health insurance companies that, in our experience, react with compromise and willingness to pay.