Keratoconus and Health Insurance

BY KARLA ZADNIK, O.D., Ph.D.
NOV. 1997

Keratoconus patients are often frustrated by the financial burden of their eye care. According to baseline data from the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study, 65 percent of the 1,209 enrolled patients wear rigid gas permeable contact lenses on both eyes.

Keratoconus is one of the few ocular diagnoses for which contact lenses are a covered benefit in the federal Medicaid program. Vision-specific health insurance companies usually know about the disease and cover it, but many general health insurers are unfamiliar with keratoconus, and most don't cover contact lenses for any reason.

FEW BENEFITS FOR THE YOUNG AND THE HEALTHY

Keratoconus patients are, by and large, young people with few general health problems. Their major health-related expenses are for contact lenses, regular lens replacement and refitting. Their major medical health insurance will cover them in the event that they need a corneal transplant but often won't pay for their keratoconus management up to that point. In short, keratoconus patients' health insurance does not benefit them in tangible ways at this point in their lives.

KERATOCONUS PATIENTS SHOULD RECEIVE ADEQUATE HEALTH INSURANCE COVERAGE OF THEIR RIGID GAS PERMEABLE CONTACT LENSES AS WELL AS THEIR SURGERIES.

A CALL TO ARMS

I urge eyecare practitioners to develop methods by which they can serve as advocates for their keratoconus patients in communicating with managed care organizations. A simple letter can educate health insurers. [To receive a copy of a sample letter via fax, call (800) 239-4684 and request document #30.]

This issue is also being addressed by the patient support and advocacy organization, the National Keratoconus Foundation (Cedars-Sinai Medical Center, Burns and Allen Research Institute, Davis Research Building D-5069, 8700 Beverly Blvd., Los Angeles, CA 90048,
e-mail: NCKF@csmc.edu).

In short, this is a call to arms to be proactive in educating health insurers: about keratoconus, about the nature of the visual disability associated with keratoconus, about the need for contact lenses, and about the realistic costs associated with fitting and refitting the complex lens designs needed in keratoconus.

DON'T WAIVE FEES, RAISE CONSCIOUSNESS

It doesn't help anyone to decrease or waive fees for keratoconus patients. Contact lens practitioners should receive appropriate compensation for their expertise and time. And patients should be able to use their health care benefits in ways that truly benefit them. We can help by making keratoconus a higher profile disease and by making the relevant people in our health care system understand keratoconus and its attendant therapies and costs. CLS

Dr. Zadnik chairs the Collaborative Longitudinal Evaluation of Keratoconus Study. She is an assistant professor at The Ohio State University College of Optometry in Columbus.