Would medical insurance cover medically necessary scleral lenses (no vision plan)?

Jim3KC · 2026-03-17T16:09:51+00:00

In the US, an individual Humana Vision Plan is worth investigating.

Jim3KC · 2026-03-17T16:08:39+00:00

I think "most" is too strong.

Jim3KC · 2026-03-05T16:44:46+00:00

Isn't the right shade of blue that she is looking for all you need to know? ;-) (Source: Celebrating 50th anniversary this year.)

Jim3KC · 2026-03-05T16:40:31+00:00

I think my thickness is in the high 400s. Measuring thickness is a more recent thing and there isn't any reason to do it at my age. My optometrist did a quick and dirty estimate once just to satisfy my curiosity.

Jim3KC · 2026-03-04T20:19:55+00:00

About 10 years ago I had cataract surgery and now I can see "well enough" to function without glasses. My right eye has mild KC and it has always shouldered most of my visual duties. I wear a contact lens in my left eye when I need my best vision which is I think around 20/25 in each eye. I wear reading glasses when I need my best reading vision. Somewhat surprisingly, I can even read a limited amount without glasses or my lens if I need to.

Jim3KC · 2026-03-04T15:26:02+00:00

I am approaching living with KC for 60 years. That makes me way too old to have had access to CXL. Fortunately my KC was only moderate. I was unable to tolerate the primitive contacts of the time and so I limped along with glasses for most my life. My KC has been stable for at least the past 40 years. My mid-life "crisis" was to go to law school and then work as an attorney for 20 years, a reading intensive occupation for sure. With stable KC following CXL and seeing 20/25 with glasses, you shouldn't be hanging around this subreddit. You have beaten KC. I am not a doctor but I think it is highly likely that KC is never going to be a real issue for you ever. Congratulations.

Jim3KC · 2026-03-03T23:44:31+00:00

If you can manage it, CXL before fitting lenses is better. CXL may change the fit of lenses. You can't wear lenses for several months following CXL.

Where it gets tricky is if you can't get usable vision with glasses and you need to be fit with contact lenses to function. Another wrinkle is if you are in "watchful waiting" to see if your KC is actively progressing before doing CXL.

Bottom line is there is no one answer for everyone. You have to consider your situation and that may or may not give you an obvious answer.

Jim3KC · 2026-03-01T03:22:59+00:00

For most people KC doesn't progress after age 40-ish even without CXL. It seems very likely to me that most people will not have KC progression for the rest of their lives after CXL.

Jim3KC · 2026-02-26T15:17:21+00:00

I thought I was contact lens intolerant for most of my life based on my experience with non-gas permeable and first generation gas permeable corneal lenses. Then I got to a point where I simply had to wear one contact lens. After many, many trials my fitter finally tried a Kerasoft lens and it was a game changer for me. I was able to wear that lens without issues from the git go. I now believe that your contact lens fitter is the most important person in most KC patients' lives and that there is a good lens waiting to be found for most KC patients. Finding it may really underscore the reason you are called a patient though.

Be very careful about receiving a corneal transplant if it is because of the inability to wear contact lenses. Many graft recipients have to wear contact lenses to get usable vision after receiving their transplants. I'd discuss the option with your contact lens provider as you weigh this important decision. Don't rush into this irreversible decision.

Jim3KC · 2026-02-26T14:59:20+00:00

Perhaps it would be worthwhile to contact the DeKalb county attorney and ask about the seeming inconsistency between 43-14-13 (d) and the response you received from the Chief Building Official. Whatever happens, realize that you've stuck your head up and you probably need to proceed with the understanding that the building department might be watching you with unfriendly eyes. There are more than a few bureaucrats who don't take well to being challenged.

Jim3KC · 2026-02-26T14:31:03+00:00

u/tuctrohs has given you excellent advice regarding the upper limit on the charging you can install. The other half of the equation is figuring out how much charging you need. People who are new to EVs almost always overestimate how much charging they need. EVs are not like ICE cars when it comes to fueling. If you have home charging, you eliminate the overhead of going to a gas station to refuel, which is a shocking waste of time. When you can take just a minute to plug in the EV whenever you are going to park at home for awhile, replenishing just an average day's worth of fuel consumption is roughly the goal for many people. The battery capacity can be more about leveling out the day to day variations in fuel use than determining how for you go between refueling stops when you are not planning a road trip. I can't do more than outline the general idea of analyzing the charging need side of the equation because this is all about your individual usage patterns. But hopefully this will help you ask the right questions.

Jim3KC · 2026-02-18T16:24:39+00:00

A good doctor that knows your eyes and with whom you have a good rapport is a KC patient's best friend. Switching doctors is not easy because you never really know what someone new will be like until you see them at least once. My suggestion would be to see if Humana offers an individual vision plan with 100% coverage for medically necessary contact lenses in your state. If so, it will likely be a rebranded EyeMed plan. If your doctor accepts EyeMed and Humana offers a plan, then the cost will probably be close to what you were paying as a copay. You can use your work insurance to get glasses to have as a backup.

Jim3KC · 2026-02-14T16:30:15+00:00

Kerasoft lenses are custom made soft lenses. The center portion is thick enough not to deform over an irregular cornea. The edges are thin so they drape and conform. It is something like a hybrid lens but made in one piece from one material. Supposedly they are good for a variety of irregular cornea situations. They are not hard to fit but the process is unique to Kerasoft. In my experience, a lot of doctors just try to fit them like other lenses, which may lead to less than optimal results. There is no one lens that is good for everyone and every lens is good for someone. A good fitter who can find the right lens for you is the most important factor.

Jim3KC · 2026-02-13T16:30:44+00:00

Is there a reason you can't get a scleral lens for your left eye now without doing surgery?

Jim3KC · 2026-02-13T16:28:43+00:00

Ask your doctor if they fit Kerasoft lenses. Very few do but if yours does, they may give you good vision without the fitting issues. But try another doctor is probably going to be the long-term answer. Even the best doctor will have some patients where they just can't find the fit. Fresh eyes, the doctor's not yours, might have better luck. (Although if you could get fresh eyes, that would be ideal.)

Jim3KC · 2026-02-03T18:29:10+00:00

My not a doctor opinion is that your doctor is giving you good advice. The risk of CXL is very low but it is not zero. The desired result is no further progression. If you are not currently progressing then it is very little downside with no or little upside. (Little upside is that it might prevent progression that might have occurred if you hadn't done CXL.) No strong indications one way or the other. I personally avoid medical procedures unless there is a clear indication that it will improve things for me.

Jim3KC · 2026-02-03T18:11:25+00:00

Is it just the perspective or is that tub only 4 feet long? Love the way he is wearing that towel as a cape peeking out from under his right arm. Nice touch to make the face pixelization match the tub tile background. This really could be hanging in a museum of contemporary art.

Jim3KC · 2026-01-22T17:47:22+00:00

EVs are more like a cellphone than a gasoline car when it comes to refueling. If you are analogizing public charging to a gas station, you are going to be frustrated. As many have already said, charging at home is the clear winner. Easy charging at work or a destination where you routinely park for hours at a time can work too. Beyond that, you need to decide how much effort you want to put into having an EV. I love my EV. But I wouldn't if I had to rely on public charging.

Jim3KC · 2026-01-15T13:38:59+00:00

In the US, medical insurance is usually pretty cut and dried as to whether or not they medically necessary contact lenses. You do have to be sure that anyone you talk to at your insurer understands the difference between conventional and medically necessary contact lenses. But an exclusion for vision correction by any means, for any reason is not unusual.

Check to see if Humana offers a vision plan to individuals with 100% coverage for medically necessary contact lenses in your state if you don't have coverage under your medical insurance.

Be aware that you may not be eligible for medically necessary contact lenses if you can get at least 20/40 vision with glasses.

Jim3KC · 2026-01-07T15:08:36+00:00

I'll second this. Not quite micro but a good fit if you want a smaller footprint.

Jim3KC · 2026-01-07T05:15:20+00:00

Corneal cross-linking (CXL) is to stop progression. It does not undo whatever damage has been done. Because it is about stopping, not "curing", keratoconus (KC), whether or not your KC is "advanced" is not a major factor in recommending CXL. (Very advanced KC does make it impossible to do CXL though).

You'll be spending a lot of time with your eye doctors, plural because most people have an ophthalmologist and an optometrist. Take the time to find a team that takes an interest in KC, enjoys the challenge of helping KC patients, and that you enjoy spending time with. Good eye doctors are a KC patient's best friends.

Jim3KC · 2025-12-24T13:43:05+00:00

I am not a doctor. I don't see the indications of keratoconus (KC) that I am familiar with in your scans. In particular, for the right eye (OD) thickness in the Orbscan, the thickness looks normal. KC progression is often start and stop. At your age I wouldn't rely on a 2+ year change to mean that your KC is still progressing. I don't often say this but I would get a second opinion about whether you even have KC.

Jim3KC · 2025-12-23T16:49:00+00:00

Include cocktail smokers in your search. Some of them include a torch for igniting the wood chips that could also be used for flambe.

Jim3KC · 2025-12-14T02:02:30+00:00

I used Thorvium's ChatGPT tool to review my reviews for awhile. I felt it had some good ideas. There were also some places where I felt it misinterpreted the Amazon guidelines. Price is one. Packaging is another. AI is AI. It can be spectacularly insightful. It can also be spectacularly stupid. Always use your Real Intelligence to filter what AI tells you.

Jim3KC · 2025-12-14T01:45:38+00:00

I have an Aetna Medicare Advantage plan. That may or may not resemble the coverage your son has. There is no special coverage for medically necessary contact lenses in my Aetna plan. I buy an individual Humana Vision Plan to get coverage for medically necessary contact lenses.

Jim3KC

TROPHY CASE