What costs are covered by health insurance for laser eye surgery (cost coverage)?

Whether laser eye surgery in Austria, Germany or Switzerland: it costs a lot of money. Many patients therefore ask themselves whether the procedure is covered by statutory or private health insurance.

Here you can find out – especially for Austria – whether and in which cases laser eye surgery costs can be covered. We also show you what is important and why the chances at the EyeLaser Vienna and Linz eye laser centers could be particularly good:

Laser eye surgery cost coverage in Austria: Basics

Laser eye treatments in Austria are generally not covered by statutory health insurance. Health insurance regulations stipulate that laser eye treatments such as Femto-LASIK 7D, SmartSight or Trans-PRK 7D are considered elective, i.e. voluntary, procedures that serve to improve quality of life. As these treatments are generally not classified as medically necessary, they fall under the category of aesthetic or comfort medical services. Therefore, patients usually have to bear the costs of these procedures themselves.

The situation is different if treatment with laser eye surgery or lens surgery is medically necessary. This is particularly the case for cataracts, keratoconus and secondary cataracts.

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When the costs of laser eye surgery are covered after all

Medical necessity

The costs of laser eye treatment are only covered by statutory health insurance in Austria in exceptional cases where there is a medical necessity. Here are the most important criteria and situations in which laser eye treatment can be classified as medically necessary:

1. intolerance to visual aids

  • Severe intolerance to glasses and contact lenses
    • If a patient has a proven severe intolerance to all types of visual aids such as glasses or contact lenses and this intolerance has a significant impact on everyday life and quality of life, this can be considered a medical reason.
    • Examples: Chronic eye inflammation, allergic reactions to contact lens materials, significant discomfort caused by pressure points from glasses.

2. professional or health requirements

  • Specific professional requirements
    • In some professions where wearing glasses or contact lenses is not possible or extremely inconvenient, there may be a medical necessity. This often applies to professions with high demands on visual performance or safety, such as pilots, firefighters or certain emergency services.
    • Examples: Safety-related professions in which wearing visual aids could jeopardize the performance of the work.

3. special medical indications

  • Eye diseases and anomalies
    • In the case of certain eye conditions that cannot be corrected by conventional visual aids, and if laser treatment is the only solution for restoring vision, there may be a medical necessity.
    • Examples: Advanced stage keratoconus where contact lenses are no longer sufficient.
  • Extremely pronounced visual defects
    • If you have a visual impairment of more than 10 dioptres and a proven intolerance to contact lenses, the costs may be covered in some cases. The same applies if there is a difference of more than 3 diopters between the two eyes.

The decision in the individual case is what counts with laser eye surgery

The decision on the assumption of costs for laser eye treatment by health insurance in Austria is always a case-by-case decision. This means that each application is examined individually and there are no general guidelines that apply equally to all patients. The health insurance company evaluates various factors and specific circumstances of each case in order to make an informed decision.

Submission of a comprehensive application

  • Patients must submit a detailed application to their health insurance company. This should include medical reports, evidence of previous treatments and their results as well as a clear description of the health and possible occupational impairments caused by visual defects.

Individual examination by the health insurance company

  • The health insurance company carefully reviews the application and evaluates the medical documents submitted. This review is carried out on an individual basis and takes into account all the specific details of the patient’s case.

Success factors

  • A successful application depends on the quality and completeness of the documents submitted. The better the medical necessity is justified and proven, the higher the chances of costs being covered.

Cost coverage for specific laser eye treatments

Cataracts

Cataracts, also known as cataracts, are an eye disease in which the lens of the eye becomes cloudy, resulting in reduced vision. Cataracts are treated by surgically removing the cloudy lens and inserting an artificial intraocular lens (IOL).

In Austria, the costs for this cataract operation are generally covered in full by the statutory health insurance companies, as it is a medically necessary procedure. This includes both the cost of the operation itself and the standard intraocular lens that is inserted.

Multifocal lenses instead of monofocal lenses: surcharge possible

However, statutory health insurance only covers the cost of standard intraocular lenses (IOLs), which are monofocal and have only one focal point. This means that these lenses generally only correct vision for a certain distance, whether for near or far vision. After the operation, most patients therefore still need glasses or contact lenses for everyday life in order to see clearly at all distances.

At EyeLaser, we alternatively recommend multifocal lenses or EDOF (Extended Depth of Focus) lenses, which have multiple focal points or offer extended depth of focus. These modern lenses can permanently correct various visual defects that already existed before the operation and often enable patients to live without glasses after the operation. However, the additional cost of these premium lenses must be borne by the patients themselves, as these costs are not covered by statutory health insurance. However, by investing in multifocal or EDOF lenses, patients can significantly improve their quality of life and reduce or eliminate the need for additional visual aids.

After cataract after cataract surgery

An after cataract, also known as a secondary cataract, can develop after cataract surgery if cells remain on the posterior lens capsule and cause opacification. This clouding can affect vision in a similar way to the original cataract. YAG laser treatment is often used to treat secondary cataracts, using precise pulses of light to open the cloudy capsule and restore vision.

The costs of YAG laser treatment to remove cataracts are fully covered by statutory health insurance in Austria. This is because cataract treatment is considered a necessary follow-up treatment for cataract surgery. Patients therefore do not have to worry about additional costs and can take advantage of the necessary treatment to restore their vision.

Crosslinking for keratoconus / PMD

Keratoconus is a progressive eye disease in which the cornea becomes deformed and thinner, resulting in distorted and blurred vision. An effective treatment for keratoconus is crosslinking, a procedure that stabilizes the cornea by strengthening its collagen fibers through a combination of riboflavin (vitamin B2) and UV light. This can slow or stop the progression of the disease and thus preserve vision.

As the procedure is recognized as medically necessary to prevent the deterioration of vision, health insurance companies usually cover the costs of this treatment. However, patients must ensure that all necessary medical evidence and reports are provided to ensure coverage.

Differences: Intervention costs covered by statutory or private health insurance

Private health insurance companies usually offer a broader and more individualized coverage of medical services, including laser eye treatments. The differences compared to statutory health insurance are as follows:

  • Extended service coverage
  • Individual policies
    • Those insured with private health insurance companies can often choose between different tariffs that include specific services such as laser eye treatment. These tariffs can be customized to meet the individual needs and health requirements of the insured person.
  • More flexible approval procedures
    • Private health insurance companies tend to have more flexible approval procedures. A medical certificate confirming the medical necessity of the treatment can often be sufficient to get the costs covered.
    • In addition, there are often fewer bureaucratic hurdles compared to statutory health insurance companies.
  • Additional services and premium offers
    • Private insurers often offer additional benefits such as extended aftercare, state-of-the-art treatment technologies and access to renowned specialists. These additional benefits can help policyholders to receive optimal care.

With EyeLaser Vienna & Linz, the best chances of cost coverage for laser eye surgery

Finally, a very important tip: If you require cost coverage in order to be able to afford the procedure, you should always (!) clarify this with your insurance company in advance.

EyeLaser offers comprehensive support and expertise to make the reimbursement process as successful as possible. Here are the most important factors that contribute to this:

1. comprehensive documentation and expert opinions

  • Detailed medical reports:
    • EyeLaser prepares detailed medical reports that clearly and precisely explain the medical necessity of laser eye treatment. These reports are crucial in convincing health insurance companies that the treatment is necessary and justified.
  • Comprehensive medical documentation:
    • EyeLaser provides all the necessary medical documents and evidence required to submit an application to the health insurance company. This includes diagnoses, treatment plans and previous therapy results.

2. expertise and experience

  • Experienced specialists:
    • The specialists at EyeLaser have extensive experience and expertise in performing laser eye treatments. Their professional reputation and in-depth knowledge increase the credibility of applications for cost coverage.
  • Proof of success:
    • EyeLaser can look back on numerous successful cases of cost coverage. This track record shows that the team knows how to submit effective and convincing claims.

3. individual advice and support

  • Personal support:
    • EyeLaser offers individual advice and supports patients personally in preparing and submitting their application. This includes explaining the entire process, answering questions and providing all the necessary information.
  • Proactive approach:
    • EyeLaser takes a proactive approach by helping patients overcome potential hurdles and ensuring that all necessary steps are completed correctly and on time.

4. knowledge of the insurance landscape

  • Understanding of health insurance requirements:
    • The EyeLaser team knows the specific requirements and criteria of the various health insurance companies in Austria. This knowledge enables them to tailor applications precisely to the expectations and specifications of the health insurance companies.
  • Network and contacts:
    • EyeLaser has a good network and contacts with decision-makers and experts in the healthcare sector, which can facilitate the application process.

5. quality and technology

  • State-of-the-art treatment methods:
    • EyeLaser uses state-of-the-art technology and treatment methods that meet the highest medical standards. This convinces the health insurance companies of the effectiveness and necessity of the proposed treatment.
  • Certifications and awards:
    • EyeLaser is often certified and has received various awards that emphasize the quality of its services and its recognition in the medical community.
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Author:

Dr. Victor Derhartunian

Nachdem er sein Handwerk von den beiden Pionieren der Laserchirurgie gelernt hat, gehört Dr. Victor Derhartunian zu den führenden Augenlaser-Chirurgen. Er leitet die Praxis in Wien und kann seine Patienten in fünf Sprachen beraten.