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It's true that the criteria for receiving insurance reimbursement for cataract surgery have become stricter.

However, if you carefully adhere to these strict criteria and provide thorough documentation,

even if payment is initially denied, you may be able to receive full reimbursement later when insurance regulations are relaxed.

(Note: This applies only to those who subscribed to insurance before 2015.)

In this article, I will explain the criteria for receiving insurance reimbursement for cataract surgery and how to respond to them.

If you prefer watching a video, please refer to the well-organized content in the YouTube link below!

I am Kim Sun-young, a board-certified ophthalmologist with 17 years of experience and the head director of Gangnam Healing Eye Clinic ^_^

I have performed over 20,000 cataract surgeries,

and I even personally performed cataract surgery on my own parents... haha.

Recently, I have been receiving offers from various broadcasting programs such as KBS's Make Me Man and A Morning to Try,

Thanks to that, patients sometimes call me 'the doctor that public broadcasting seeks out'... haha (I'm really grateful).

Many people are worried about whether they will be able to receive insurance reimbursement for cataract surgery.

First of all, please note that those who subscribed to insurance after 2015 are not eligible.

Therefore, only those who subscribed before 2015 can receive it,

and you must also meet the following two conditions.

The above is a press release provided by the Korea Life Insurance Association and the General Insurance Association and a notice of precautions for real loss insurance subscribers related to cataract surgery announced by Kyobo Life Insurance.

The most important content in the data is the part in the red box.

To put it simply:

1) 6-Hour Hospitalization

You must prove that you were hospitalized for at least 6 hours.

Sometimes, ophthalmology clinics create and submit '6-hour hospitalization' documents even though the patient was not hospitalized,

This is often caught and can lead to denial of insurance reimbursement for cataract surgery.

The reason is that only 'hospital rooms licensed by the public health center', not 'general recovery rooms', are recognized as hospital rooms.

In fact, some ophthalmology clinics disguise unlicensed recovery rooms, and are sometimes caught.

The above photo is of the hospital room at my ophthalmology clinic.

We strictly adhere to the 6-hour hospitalization procedure here.

(So far, there have been no problems.)

2) Slit-Lamp Microscope Examination Report

This is an examination report used to check the progression of cataracts.

Slit-lamp microscope examination looks like this, and the above photo is of a patient with secondary cataracts.

Insurance reimbursement is rarely denied due to this.

The reason is that if the criteria are not met, I do not recommend surgery at all.

In fact, many ophthalmology clinics

lure patients with sweet words like 'You can get insurance reimbursement for cataract surgery' and perform surgery, and then later abandon them.

In this case, insurance companies often give the following answer.

"With this level of cataract progression... it is not serious, so we cannot provide insurance reimbursement for cataract surgery."

So, I send patients with non-severe cataracts back home for the time being,

and if they want surgery now or intend to receive reimbursement later,

I proceed with surgery after sufficient consultation.

In this case,

I personally help with everything from preparing insurance documents to submitting them.

Originally, it is illegal for a doctor to provide such assistance without an insurance license,

but I obtained an insurance agent license myself with the hope that my patients would receive reimbursement by any means,

and I also provided insurance-related education to my staff.

In a way,

these two things are

essential and basic.

I hope that you do not go to an ophthalmology clinic that does not even follow these basics

and end up losing millions of won later ㅠㅠ

If you are reading this article and want to receive a simple consultation from me,

rather than contacting me immediately,

please read at least 2-3 more blog posts.

Just as a clap makes a sound when both hands meet, not just one hand,

if you trust me more and visit,

I will do my best to provide thorough consultation ^^

Below is an article I wrote myself,

please be sure to read it before making a reservation ^_^

<Why go all the way to Gangnam for cataract surgery?>

<Reservation & Directions>

This post was written directly in compliance with Article 56, Paragraph 1 of the Medical Law for the purpose of providing medical information

Source :https://blog.naver.com/wpsjtltmals7/224011477314

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