What is the difference between medically necessary and cosmetic contact lenses?
• Aphakia resulting from cataract surgery on trauma; • Visual acuity problems that cannot be corrected with spectacles to 20/70 or better in the better eye with spectacle lenses; • Anisometropia of 4 diopters or more, where contact lens corrections will improve visual acuity to 20/70 or better in the poorer eye; • Keratoconus. Most standard contact lens purchases are classified as cosmetic or elective because the patient has a choice between wearing contacts or glasses. Please note that the allowances for cosmetic or elective contact lenses are different from allowance for medically necessary lenses.
“Medically necessary” contacts are a covered benefit for members that have one of four medical conditions: (1) Aphakia resulting from cataract surgery or trauma; (2) Visual acuity problems that cannot be corrected with spectacles to 20/70 or better in the better eye with spectacle lenses; (3) Anisometropia of 4 diopters or more, where contact lens correction will improve visual acuity to 20/70 or better in the poorer eye; (4) Keratoconus. Most standard contact lens purchases are classified as “cosmetic” or “elective” because the patient has a choice between wearing contacts or glasses. Please note that the allowances for cosmetic or elective contact lenses are different from allowances for medically necessary lenses. Our plans offer generous allowances for both types of contact lenses.
