Contact lenses may be determined to be medically necessary for the treatment of specific eye conditions such as:

• Keratoconus
• High Ametropia
• Anisometropia
• Aphakia
• Aniridia
• Moderate to Severe Dry Eye Disease
• Irregular Astigmatism

Clinical documentation may be required from your doctor to support the request. Having the diagnosis of a particular eye condition does not guarantee that contact lenses would meet the criteria outlined in the clinical guidelines.

• An in-network provider will complete a prior approval form as needed.
• For out-of-network services, submit your doctor’s clinical documentation along with your claim form for review and reimbursement.