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Insurance Coverage for Corneal Collagen Crosslinking (2018)

Corneal Crosslinking Insurance Coverage in the United States January 2018

Cost of Corneal Crosslinking

There is limited evidence on the costs of corneal crosslinking, but it may be as high as $2,500 to $4,000 per eye in the United States. a cost-effectiveness study estimated the costs of the total treatment for one person as £928 in the UK National Health Service.

What is Covered: FDA-Approved Crosslinking Method

FDA has approved corneal collagen crosslinking (CXL) for progressive keratoconus in April 2016. this approval only covers the crosslinking products developed by Avedro, Inc. this FDA-approved method involves corneal epithelial debridment, hence it is known as epithelium-off or epi-off crosslinking.

Which Insurance Companies Pay for Corneal Crosslinkig in the United States?

Since FDA approval in April 2016, many insurance companies have started covering corneal collagen crosslinking (CXL) for progressive keratoconus and keratectasia. Below is an updated list of insurance companies in the United States that cover corneal collagen crosslinking (CXL) for progressive keratoconus.

Payer Name Payer Region
Aetna National
Arkansas Blue Cross Blue Shield AR
Blue Cross Blue Sheild of Mississippi MS
Blue Cross Blue Shield FEP National
Blue Cross Blue Shield of Alabama AL
Blue Cross Blue Shield of Arizona AZ
Blue Cross Blue Shield of Illinois IL
Blue Cross Blue Shield of Kansas KS
Blue Cross Blue Shield of Kansas City Kansas City, Northwestern MO, Johnson & Wyandotte Counties
Blue Cross Blue Shield of Louisiana LA
Blue Cross Blue Shield of Massachusetts MA
Blue Cross Blue Shield of Michigan MI
Blue Cross Blue Shield of Montana MT
Blue Cross Blue Shield of New Mexico NM
Blue Cross Blue Shield of Oklahoma OK
Blue Cross Blue Shield of Rhode Island RI, CT, MA
Blue Cross Blue Shield of South Carolina SC
Blue Cross Blue Shield of Tennessee TN
Blue Cross Blue Shield of Texas TX
Blue Cross of Idaho ID
Blue Shield of California CA
CareFirst Blue Cross Blue Shield MD, DC, Northern VA
Dean Health Plan WI
Harvard Pilgrim MA
Hawaii Medical Service Association HI
Highmark Blue Shield DE, PA, WV
Horizon Blue Cross of New Jersey NJ
Independence Blue Cross PA, NJ, DE, MD
John Hopkins HealthCare MD
Kaiser Permanente AZ, CA, CO, DC, GA, HI, MD, NV, TX, VA, WA
Medical Health Plans MN, WI, ND, SD
Regence Blue Cross Blue Shield ID, OR, UT, WA
Select Health ID, UT
Tricare TRICARE Policy Manual: Rare Diseases, Eye And Ocular Adnexa, Available to all Tricare beneficiaries, including dependents. also see this comment.
Tufts MA, RI
This list is subject to change. It is not intended to be a directive, nor is it a suggestion about the likelihood of coverage or reimbursement. Please confirm with your individual carriers. Source: Avedro, Inc.

Avedro's ARCH Program

The ARCH (Avedro Reimbursement Customer Hub) program is a three tiered service to help keratoconus patients with reimbursement questions, prescription assistance and the possibility of financial assistance for eligible patients.

Call the ARCH Hotline 844-528-3311 for questions about coding, billing, claims submissions or payer coverage for corneal cross-linking with Photrexa® Viscous and Photrexa® with the KXL® System.

Visit Avedro's website to learn more about insurance coverage and find cornea specialist who perform corneal crosslinking.

Learn more about corneal collagen crosslinking (CXL)


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16 comments:

  1. Please update this list to include Tricare Prime, which covered this procedure for my son in both eyes, with a referral from our primary care doctor to the corneal specialist. It was covered at 100%. He had the first eye done in June of 2017 and the second eye done in August of 2017.

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    1. Thank you. we have updated the list and referenced your Facebook comment too.

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    2. I have tricare standard and I’m stationed with my husband in TX. Every dr that I’ve seen is requiring a deposit. However tricare told me that it’s covered 100%

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  2. CAn you provide more context on the insurance coverage side of things? I saw BCBS of Illinois on your list, but was not able to find the resource on Avedros website that matched that? Also whats the best way to get this covered? One of the docs i saw said it was unlikely and that Avedro upped the price of the drug by 2x so that the CXL procedure is now in the order of $5000-$7000 per eye.

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    1. BCBS of Illinois is on Avedro's list too. if your claim was denied, you can call Avedro's ARCH program to ask for help. call 844-528-3311 or email [email protected]

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  3. I m with Highmark bcbs PA. They said they dont cover collagen crosslinking.. Do you have any idea about this. Actually we stay in Michigan and my insurance is with my husbands employer based in PA,

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  4. My son is having his second eye’s crosslinking done today in Ann Arbor, MI. (2/13/18)
    His first was done in the fall; $2,500 for one eye & Insurance covered.
    The price for this second eye now in 2018; $13,000 with insurance, $8,000 without insurance!
    We live 45 min from Windsor, ON Canada.
    Their price is still $1,200-2,500 per eye in Canada.
    Just an FYI.
    This seems like a similar situation to the Epi-pen price price discrepancy that occurred last year. This company doing the price increases is Avedro.
    How is it still the same cost in Canada???
    JG

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  5. What about texas, they told me my insurance would not cover it. I have blue cross blueshueld. It's gonna be a total of $5500 for both eyes.

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  6. Where did you have your consultation? I had one at focal point & it is $9,000 for both eyes.

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  7. I was just told by my son's doctor that our insurance had denied the claim, but when I called my insurer, they said they never received the claim. The doctor then advised me they were submitting the claims as a group, through a third party. ???? I had to implore them to submit our claim, individually, and I would work with my insurer, if need be. Now I see my insurer on this list. Wonder what all the drama is about? I'm all about keeping the insurance providers honest, but they need to be commended when they are doing the right thing, too.

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  8. I live in Minnesota and have MEDICA, they've told me repeatedly it's covered under surgical benefits but the billing dept for the cornea dr. insists it's NOT covered. I don't know what to do and really want to have this done. The dr. uses Avedro, etc

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  9. I am trying to get coverage for collagen cross linking procedure but the doctors office said insurance does not cover it. BCBS told me just to get codes but the doctors office said there are no codes . the procedure was 12,000.00. does anyone know how I can get the codes so that BCBS will consider the claim Thank you

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  10. we had Cigna Insurance when my daughter had her cross linking surgery. Doctors office said they had to pay up front for the procedure, which they did. I had previously talked with the insurance company and they said it would be covered after deductible.
    The doctors office would not submit it to the insurance. After she had several conversations with them, they finally gave her a copy of the bill and I sent it to the insurance myself. They ended up paying her back 2/3 of the cost.

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  11. Does anyoone know if this procedure is covered by Cigna Open Access

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  12. Has anyone gotten a denial from BCBSIL of Illinois, in Washington? Is there a reason why they are denying the claim? Does anyone have any tips for filing the appeal?

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  13. Avedro website says this procedure is covered by BCBS in CT, however I called my insurance and they said it is "MEDICALLY UNNECESSARY". anyone have any info on why that is?

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