Preparing

Ask your doctor’s billing staff to outline all associated costs and payment dates for you.

Scleral lens fitting cost structures vary from provider to provider.

Examples:

• Global fee: A single fee covering all care and lens costs. A good follow-up question for this common fee structure is whether there are any limits - for example, what if you end up needing more re-fits than expected before your final lenses? Will they charge more? Note: Charging more may be perfectly appropriate in the circumstances but no one likes surprises, so find out what might trigger extra fees ahead of time.

• Time and materials: Some practices may charge a fee per visit along with the cost of any lenses manufactured during the fitting process. This allows them to ensure they can recoup the cost if the fitting process is protracted, which is very important. (Many scleral lens fitters may lose money on challenging patients.) A good follow-up question is to ask about the range of possibilities for number of visits. Bear in mind that while the provider may be able to predict how easy or difficult you are to fit from a technical standpoint, you may require more adjustments than they expect before you are happy with the lenses from a comfort standpoint.

Don’t be cheap. Trying to do scleral lenses on the cheap is not a good idea. You are likely to get what you pay for.

Expect to be actively involved in the insurance process, unless you are specifically told otherwise.

Some scleral lens practices are “cash pay only”.

Some scleral lens practices take Medicare but no other insurance.

Insurance coverage for sclerals may be available through your major medical plan, or through your vision plan if you have one.

Medical coverage, where available, is intended for situations where sclerals are considered medically necessary. Proving the necessity to the insurer’s satisfaction may take considerable effort as well as active support from your referring doctor and/or your lens provider. These efforts are often well worth it if they provide you with access an expert scleral provider.

Vision plans are naturally more skimpy because they will see sclerals as simply an alternative vision correction means. This may limit your access to the best providers for your needs.

Find out ahead of time about the procedures and turnaround times for replacement lenses in case of emergency.

You can also ask about the factors that affect scleral lens life, and whether you can bring your sclerals in to have them examined for any excessive “wear and tear”.

Sometimes patients are encouraged to replace their sclerals annually because a lens coating has worn off but the lens itself may be in perfectly good condition, so you may want to clarify what is prompting the need for replacement.

You may have heard or read about a “warranty period”. A scleral lens laboratories may provide warranty coverage to the provider if no final lenses are dispensed to the patient within a set period after the first set (typically 90 days). Some providers pass this warranty benefit on to the patient in order to reduce the financial impact if things don’t work out.

It is important to understand that this “warranty” is not a “money-back guarantee” type concept for sclerals.

Scleral lens fitting is a medical process and outcomes cannot be guaranteed. By far the largest cost involved is your provider’s time, which you should not expect to be refunded any more than other doctors’ fees are refunded.

However, if you have prepaid the full cost, things don’t work out and you decide to move on to another provider, a lens warranty benefit (if available) might become important financially to help mitigate the cost of starting from scratch with a new provider.

So, if a warranty is available, make sure you know the terms. This may have implications for your appointment schedule, to ensure the clock is not run out before your lens fit has been optimized.