what is medically necessary contact or glasses?

[JMoondog]

I get this question about 4-5 times a year, someone will see a clause in there insurance that contacts or glasses are covered if they are medically necessary.

What is the definition of medically necessary?

I have asked a hand full of doctors, and have never recieved a really solid answer that I can give to patients. Any input would be appreciated.

Thanks in advance, and sorry if this is a previously discussed topic.

Ric

[scriptfiller]

Specs. prism for strabismus correction.

CL's. the use of HGP's for kerataconus or the use of SCL's for a "bandaid" for corneal damage.

Just a couple off the top of my head.

[JMoondog]

this is along the lines of what I was thinking, and have been told. I just just haven't worked out a snappy little answer to respond to pt's yet.

[chip anderson]

Contacts: When patient's vision can be appreciably better corrected with same than spectacles.
Keratoconnus, Corneal irregularity, cosmetic disfiguration, extreem hyperopia, aphakia, extreem myopia, etc.

Glasses: When patient is disfunctional without same. (Sometimes this means a third party will pay for one or more pair whether the patient needs them or not.)

Chip

[JMoondog]

Thanks, that will help with my pt conversations :D