Why is nothing involving the meibomian glands covered by insurance?

[shakenbake]

Hi all,

Just out of curiosity why do I have to pay out of pocket for lipiview, lipiflow, gland expression, blephex etc?

All of these things are medical procedures with a lot of scientific evidence supporting the fact that they help MGD. Why doesn't insurance cover any of these procedures?

Will they in the future? I know lipiflow is relatively new but when I new drug is approved by the FDA insurance covers it right? And there are multiple studies regarding lipiflow.

[Hokucat]

I know, especially when MGD is one of the major causes of dry eyes. However, I've heard of some insurance companies covering or starting to cover some of these meibomian gland procedures.

I've had gland expression + probing (expression proceeded probing, all one appointment) several times, and each time it was covered by my insurance. I believe my doctors considered it a type of chalazion procedure, which had an established treatment code with my insurance. Each gland expression + probe procedure cost ~$1200, and with insurance I recall paying ~$100 out-of-pocket. However, I must admit my insurance is pretty good, so may not be the same for everyone.

And I think there were a couple people who posted in this forum that IPL and Lipiflow was covered. Pythonidler for IPL, and Hosanna for Lipiflow. Perhaps check with them if you can get what the treatment description/code those procedures were submitted to insurance under. They might just have good insurance though.

[shakenbake]

I have probably the best insurance known to mankind. Hahaha I work for a big company with great insurance. What cpt code did you use for probing? I’ll tell Dr. Cremers.

[Hokucat]

I'll have to look back at the statements for the code. It was a few years ago, so will need to find them!

[shakenbake]

hosanna13 how did you get lipiflow covered by insurance? This would be a lot easier to deal with in general if there weren't so many out of pocket expenses :/