In New Zealand the average cost of cataract surgery with a standard IOL is in the range of $4150 to $4650. The amount that your insurance company will pay for the procedure, and the cost that is paid directly by you varies depending upon the type of intraocular lens (IOL) that you require and the hospital you choose.
In New Zealand, most private insurance companies will cover the cost of standard cataract surgery. The amount that your insurance company will pay for the procedure, and the portion of the cost that is paid directly by you (“out-of-pocket” costs) varies depending upon the type of intraocular lens (IOL) that you require, the hospital you choose to have your surgery at, and other factors.
If you don’t have private insurance, then you are responsible for the entire cost of the cataract surgery. Pricing will depend upon market conditions and the fee schedule of the health professionals involved and hospital where you choose to have your surgery. In New Zealand the average cost of cataract surgery with a standard IOL is in the range of $4150 to $4650. (This does not include the initial appointment fee and fees for any scans required).
What are the costs involved in having cataract surgery?
In a straight forward procedure, insurance coverage is very simple in terms of payment to the eye surgeon and hospital. The fee for a standard procedure is normally a fixed amount that has previously been agreed between the insurance company and health provider.
Other costs that you may need to pay will be dependent upon the excess on your policy or related costs that aren’t directly associated with the cataract procedure itself. These costs can include:
i) a comprehensive eye examination including precise measurements of your eye’s biometry (length of an eye and front curvature of an eye)
ii) charges related to anaesthesia. This can be done by an anaesthetist or by the eye surgeon.
iii) standard prescription eyeglasses, if needed, to enhance astigmatism or near vision after you’ve had surgery
iv) any follow-up procedures or medical care due to complications arising from the surgery, which are outside the standard period of cover for your postoperative care. Although this is very rare, < 0.1%.
If you don’t have private insurance then you will need to cover the full amount for eye surgeon, anaesthetic, intraocular lens and hospital fees.
Why are there different costs to the Intraocular Lens used?
With cataract surgery your eye’s natural lens is removed as part of the procedure and an artificial lens is put in as a replacement to restore your sight. Implanting a standard monofocal IOL during cataract surgery is considered the standard level of care and what is medically necessary. This would provide you with very good distance vision but you may still need reading glasses for near vision. If you had astigmatism prior to cataract surgery, you would still require prescription eyeglasses to correct the astigmatism after surgery.
Many people who have cataract surgery also request to be free of glasses after the procedure. This is now possible due to advances in both intraocular lens and surgical technology. However, most insurance companies view this as a premium product or procedure and therefore do not pay the added cost of this technology. If you wish to have the latest, high-tech advances in cataract surgery to reduce the need for glasses post surgery, you will have to pay the “out-of-pocket” cost of both the product and the service. This is similar for people who choose to have refractive surgery such as Laser Eye Surgery (LASIK) to correct common vision errors and be free from the hassle of glasses. Because LASIK is considered cosmetic or medically unnecessary, this procedure is not covered by insurance companies and the person would need to pay the full costs.
To recap, while the costs of standard cataract surgery using a standard IOL are usually covered by private medical insurance, any upgrades in lens or surgical techniques will need to be met by you. Options that are available include:
i) Presbyopia correcting IOLs (aspheric monofocal IOL with blended vision/monovision) - these lenses expand your range of vision, reducing vision loss caused by presbyopia allowing you to read and see close up without the need for reading glasses
ii) Aspheric Toric IOLs - these lenses correct astigmatism, allowing a person who had astigmatism prior to cataract surgery to see clearly for driving, computer use, or reading without the need for glasses
iii) Limbal relaxing incision - or corneal relaxing incision is an additional surgical procedure that can be performed during the cataract surgery to correct astigmatism
iv) Laser Eye Surgery - we can now offer LASIK after cataract surgery to correct any residual refraction error. LASIK can provide you with a much more accurate refractive result than cataract surgery alone.
Questions to ask your insurance provider
We advise you to talk to your insurance provider to have a clear understanding of exactly how much and what they will cover and how much you will need to pay out-of-pocket.
Some questions that you may wish to ask include:
i) is there a co-payment? Am I required to pay a certain amount e.g. 20% of all related costs even though I have health insurance cover?
ii) does my policy have a deductible amount and how much is the deductible?
iii) does my plan pay for a pair of eyeglasses post cataract surgery?
iv) is my eye surgeon affiliated with my insurance company? An eye surgeon who is a “preferred provider” or “affiliated” with an insurance company has agreed standard fees for conventional cataract surgery. If your eye surgeon is not affiliated, check whether your insurance company needs to approve him or her before covering the procedure.
v) Is the hospital where you are planning to have your surgery a “preferred provider”? It may not be, even if your surgeon is. It is important that the surgical centre that your eye surgeon will use is also approved by your health insurer.
vi) does my insurance company require approval to validate that my cataract procedure is medically necessary?
At Bowen Eye Clinic, Dr Reece Hall is an affiliated surgical provider with Southern Cross Healthcare and works with all other health insurance companies in New Zealand, including Sovereign, Unimed, NIB, Partners Life, Accuro, and ACC.
Dr Hall has been doing cataract surgery for over 13 years and operates at Bowen Hospital and Southern Cross Hospital in Wellington and Crest Hospital in Palmerston North. All three hospitals are affiliated providers for Southern Cross. He will do both your pre-operative assessment, surgery and all of your post operative care. If you choose to have your surgery at Crest Hospital, Dr Hall can also see you for your pre-assessment and post operative care in Palmerston North.
Call 0800 69 20 20 to book an assessment.