Why Do Cataract Surgery Costs Vary So Much by Clinic? Understanding Non-Covered Cataract Procedures

"Doctor, I noticed that cataract surgery prices vary from clinic to clinic. Isn't it all the same procedure?"

Hello! I am Dr. Min-Kyung Kim, an ophthalmologist at BGN Eye Clinic Jamsil.

This was the very first question asked by a patient in their 70s and their son who visited my office yesterday. According to the Ministry of Health and Welfare, the cost of the exact same multifocal lens can vary by up to 27 times between clinics. Today, I will clear up your questions about non-covered cataract procedures and surgery costs from an ophthalmologist's perspective.

Why Does the Same Lens Have Such Different Prices?

First, let's briefly discuss what a cataract is. Many patients come in without knowing exactly what the surgery entails; they just know they are "getting surgery because their vision is blurry."

Simply put, a cataract occurs when the eye's natural lens becomes cloudy with age, much like a fogged-up window. Cataract surgery involves removing this cloudy lens and replacing it with a new artificial one.

Regarding surgery costs, I recently saw a shocking article in a financial journal. It stated that cataract surgery cost 290,000 KRW at one clinic in Seoul and 6,800,000 KRW at another, a staggering 23-fold difference. At first, I wondered how this could make sense. However, this massive price gap exists primarily because multifocal lenses are classified as non-covered (out-of-pocket) items.

"Is Cataract Surgery Covered by Insurance?" Why Caregivers Are Paying Closer Attention

Because most cataract patients are elderly, they often visit with their children. The most frequently asked question is, "Is cataract surgery covered by insurance?" Interestingly, the children are usually much more knowledgeable about private health insurance and required documentation than the patients themselves.

Last month, a patient came in with her son. She simply said, "Just give me the cheap one," but her son meticulously checked, saying, "Mother, you have private insurance." Many children are well-versed in how to process corporate insurance claims and thoughtfully ask about paperwork and procedures on behalf of their parents.

What to Watch Out for Even if You Have Private Insurance

Of course, having private health insurance does not guarantee 100% coverage. Recently, insurance companies have become stricter, and claims can be denied for various reasons.

For example, a recent patient told me, "I chose the multifocal lens because I have private insurance, but the insurance company is only covering a fraction of the cost!" If the procedure is classified as outpatient treatment, you might only receive a small outpatient allowance. You could pay millions of won for the surgery but only receive a few hundred thousand won in reimbursement.

To address this, the government has updated regulations so that surgeries performed on the elderly or at general hospitals are approved without additional proof. However, since policies still vary by insurance company, it is highly recommended to check with your provider before surgery.

Monofocal vs. Multifocal: Is There Really a Big Difference?

I get this question all the time! Honestly, there is no single correct answer. It entirely depends on your individual eye condition and lifestyle.

• Monofocal Lenses (Covered): These are covered by National Health Insurance, significantly reducing the patient's financial burden. However, you will still need to wear reading glasses or regular glasses for close-up tasks after surgery.
• Multifocal Lenses (Non-Covered): As a representative non-covered item, prices vary by clinic. However, most patients can live without glasses after surgery, and presbyopia is corrected simultaneously.

One patient who received a multifocal lens excitedly told me, "I can finally enjoy reading books to my grandson again." She used to stress over finding her reading glasses, but now her daily life is comfortable. On the other hand, a patient who opted for a monofocal lens said, "I have no problem watching TV, and I only need reading glasses for the newspaper, so I am completely satisfied."

The Constant Release of New Lenses Complicates Matters

Even among medical professionals, we often say, "Another new intraocular lens just came out." The technology for cataract lenses is advancing incredibly fast.

With every new lens release, costs change, and pricing standards vary across clinics. Therefore, rather than simply looking at a price tag, it is crucial to consult thoroughly with your medical team to understand the characteristics of the lens best suited for your eyes and confirm the exact cost.

Checking Your Private Insurance: Start Here

The most common question during consultations is regarding "private insurance coverage." I always advise patients to call their insurance company prior to surgery.

Essential Insurance Checklist

• "Is multifocal lens cataract surgery covered?"
• "What are the criteria for outpatient vs. inpatient coverage?"

Since terms and conditions vary by provider, verifying your specific policy beforehand is the safest and most accurate approach.

If you do not have private insurance, the cost of multifocal lenses can be burdensome. In such cases, I assure patients that a monofocal lens is still an excellent choice.

Do Not Rush; Make a Careful Decision

Lately, some people rush into surgery, saying, "I need to do it quickly before insurance standards become even stricter." However, cataract surgery is an important, once-in-a-lifetime procedure. You should never rush your decision based solely on insurance processing.

In fact, medical professionals may have slightly different opinions on the optimal timing for surgery. Do not make a hasty decision just because the financial burden seems low. Take the time to fully consider your eye condition and daily lifestyle patterns.

If you are considering cataract surgery, carefully check your private insurance first and get a comprehensive eye exam and consultation. Don't just look at the price tag; pay attention to how thoroughly the medical staff recommends a lens tailored to your lifestyle.

We will always prioritize our patients' eye health and provide honest medical care.

Please feel free to reach out if you have any questions.

This has been Dr. Min-Kyung Kim from BGN Eye Clinic Jamsil.