Blue Cross Blue Shield (Empire and Excellus)

Blue Cross Blue Shield

Blue Cross Blue Shield is not a single insurance company, but an alliance of 38 local companies providing coverage in different states. The Blue Cross Blue Shield Association has been operating for 83 years, and now covers 100 million people. Although it has expanded, Blue Cross Blue Shield began as a hospital-based prepaid health care plan. Initially covering just 1300 people, it grew to cover 3 million Americans in the first 10 years.

There are two different Blue Cross Blue Shield Association members offering policies in the New York metropolitan area, Empire and Excellus. Their coverage policies are similar enough that they can both be described here because the variation between individual plans is greater than the variation of coverage between the two companies. Coverage for vision correction procedures includes:

In some cases, LASIK surgery may be covered, but only in relation to severe astigmatism following cataract surgery or scleral buckling. More information about cataract surgery and LASIK coverage are included below.

Cataract Surgery Coverage

Cataract surgery is considering a medically necessary procedure and is covered by Blue Cross Blue Shield Association plans. However, Blue Cross Blue Shield plans only cover cataract surgery using the monofocal intraocular lens. Multifocal, astigmatism-correcting, and accommodating lenses (toric,Tecnis, ReSTOR) are all considered “not medically necessary” because their only benefit is reducing dependence on corrective lenses (glasses and contacts).

LASIK Surgery Coverage

In general, elective LASIK and other refractive surgeries are considered “not medically necessary” or “experimental.” This includes phakic IOLs. However, Empire Blue Cross Blue Shield specifically states that LASIK may be covered if it is used to correct vision distortion due to cataract surgery or scleral buckling.

With Blue Cross Blue Shield-managed vision plans you can receive up to 25% off laser vision correction procedures. In addition, LASIK and other laser vision procedures can be paid for using tax-free money from an employer’s flexible spending account (FSA) or health savings account (HSA).

For answers to more specific questions, please contact Kelly Laser Center to talk to an insurance coordinator at our Manhattan or Long Island location.