Mitch Ibach, OD – To Pay or Not to Pay
“The tremendous efforts by clinicians, payers and our industry partners have strengthened our coverage and ability to provide this breakthrough treatment to the patients who really need it.” – Dr. Mitch Ibach, OD, Vance Thompson Vision
Over the last several years, more and more insurance carriers have established positive coverage policies for iLink™ FDA-approved corneal cross-linking. Today, more than 95% of commercially insured patients have access to this procedure to slow or halt the progression of keratoconus. Major insurance carriers, such as Aetna and Cigna, have positive coverage policies for iLink FDA-approved cross-linking, demonstrating their belief that this procedure is medically necessary for the treatment of progressive keratoconus. However, not everyone that is part of the 95% will have full insurance coverage for iLink FDA-approved cross-linking.
In a recent Mastering Keratoconus blog post on Primary Care Optometry News, Dr. Mitch Ibach, a residency-trained optometrist at Vance Thompson Vision in Sioux Falls, South Dakota, discusses insurance coverage for iLink FDA-approved cross-linking and outlines reasons why specific cross-linking procedures may not be fully covered.
Generally, insurance carriers look to FDA-approval inclusion and exclusion criteria when determining coverage. Dr. Ibach shares three explanations as to why insurance may not cover a cross-linking procedure.
- Patients with central corneal scars or corneal pathology that could delay healing, were excluded from approval trial and may require additional documentation to receive insurance coverage.
- Defined progression according to the clinical trial criteria, is often required for insurance coverage. Insurance companies may mandate documentation of specific criteria demonstrating progression of keratoconus.
- Non-FDA-approved procedures are not covered by insurance. Only iLink FDA-approved epithelium-off cross-linking with Photrexa® Viscous, Photrexa® and the KXL® System is eligible for insurance coverage.
Not everyone living with keratoconus has access to insurance. For patients who have no insurance, or patients with state low-income or disability health insurance benefits, such as Medicaid, there are programs available where participating practices are able to offer the iLink procedure at a reduced fee or sometimes at no cost.
Insurance coverage and treatment costs factor into any medical decision, but if left untreated, progressive keratoconus can lead to significant vision loss and the need for a corneal transplant. iLink FDA-approved cross-linking is effective in slowing or halting keratoconus, and early intervention ultimately helps preserve vision. To learn more about insurance coverage for iLink FDA-approved corneal cross-linking, read Dr. Ibach’s blog today.
Suggestions offered by the physician are based on their experiences using the KXL® System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgment. The company does not recommend or endorse any particular course of treatment or medical choice.
Dr. Mitch Ibach is a paid consultant of Glaukos.