LASIK and healthcare in Canada thread

I just wanted to clear up some confusion regarding LASIK on the Canadian Healthcare thread. LASIK is NOT covered by insurance and to the best of my knowledge is not a covered service in any single payer healthcare system. It’s considered elective/cosmetic. In Canada, LASIK centers are exempt from that non-compete against the government medical system law they have since it’s considered a completely cosmetic/elective procedure.

In the US there are a lot of “middle men” who make arrangements with major insurers to offer discounted LASIK for their members. This way the insurance company can say they offer a LASIK benefit to their members and the LASIK doctors who sign on for this get good exposure amongst those insurance company members. The “middle men” and insurance company then take their cut from the procedure. They only take a cut and in fact do not financially reimburse the surgeon in any way. The only “reimbursement” the surgeon gets from the insurance company is increased exposure. As a LASIK surgeon myself, it’s really quite annoying to see how many people come out of the woodwork to get a slice of your pie.

That being said, LASIK is the favorite part of my practice b/c not only is it great surgery, but I get paid immediately and directly from the patient or financing company. I really hope insurance never decides to cover it and IMO they have no reason to.

It is true that the “latest and greatest” technologies in LAISK are located outside the US. This is b/c the FDA has very stringent guidelines and getting FDA approval is a very costly process. This can be viewed as both a positive and negative. In the US when you have LASIK done you have a fair amount of assurance that the equipment being used has gone through some very rigorous studies to show it to be “safe and effective.” If you go outside the US, what’s labeled as the “latest and greatest” may not turn out to be the “latest and greatest” a couple of years from now. It may turn out to be the “latest and greatest,” but you’re rolling the dice a lot more than you do in the US. South America is infamous for having been the testing ground for the different types of refractive surgery technologies that have come down the pike over the last 20+ years. Some of the technologies, like LASIK, have been quite good while some of the others – well not so much.

Thank you for that background. The cost of Lasik has gone down in eastern North Carolina due to competition, something that doen't happen when a third party payor is involved.

Clemson Fan said:

... In the US when you have LASIK done you have a fair amount of assurance that the equipment being used has gone through some very rigorous studies to show it to be “safe and effective.”...

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I wish all the best to the OP in his practice, but I think a clarification is needed here about what FDA approval means.

Once a drug is approved by the FDA, a physician is free to prescribe it as he or she sees fit. That means that a doctor can prescribe a drug "off label." What that means is that the doctor can prescribe a drug for a condition or a disease that it was never tested for. This can be both good or bad. There have been many cases where the use of a medication has been successfully extended by a doctor experimenting with it beyond what it was originally tested for. (Sometimes these extensions involve a very minimal use beyond what they were tested for, sometimes they go pretty far afield.) In other cases, matters have not gone as well.

Much of the above applies to LASIK surgury. As Clemson Fan has pointed out, the FDA conducted a set of very rigorous tests on the original equipment. Since its approval, practitioners have been trying to improve their own personal success rates by using the equipment in ways that it was not specifically (using the machine "off label"). That need not be bad. Success rates have gone up. In addition, the use of LASIK surgury to create monovision was originally off label. The FDA later approved this specific procedure.

None of this means, however, that the very procedure being used by a particular practitioner has been fully vetted by the FDA.

Please do not read too much into this post. I am simply trying to provide information relevant to what it means to have something have received FDA approval.

Roger is completely correct with what he’s saying. Actually, all of my LASIK cases are “off label” since I do them bilaterally and it’s only approved as a one eye at a time procedure. Pt’s actually have to fill out a separate consent consenting to bilateral surgery.

The one caveat is that high tech equipment is a little different than medications. A lot of this stuff is software driven and I’ve seen quite a few lasers where there are portions of the software that we’re locked out of here in the US b/c it’s not FDA approved. My malpractice insurance carrier also makes it clear that they will not cover us if we stray too far away from FDA approval refractive ranges for refractive surgery. We can ask for special permission from the malpractice insurance carrier if we feel it’s in the best interest of the patient and the patient wants to go forward with the surgery knowing it’s beyond FDA approval. I rarely do this and almost always stay within the FDA approved refractive ranges.

There are also a lot of different lasers and other high tech refractive equipment that’s just not available in the US b/c it’s not FDA approved. Some of that is good because some of the newest “latest and greatest” equipment turns out to be junk, but in the US you’re just not going to be exposed to the absolute newest laser on the market. The lasers used in the US have been vetted pretty thoroughly.

Please do not reopen a thread in which a moderator has already closed.