For many residents in East Harlem and across the five boroughs, living with advanced corneal conditions can feel like a constant struggle for clarity. If you have been told that standard contact lenses or glasses simply won’t work for your vision, you may be a candidate for scleral lenses. At Green Eye Care, we believe everyone deserves the highest standard of ocular health, which is why we specialize in helping patients navigate the complexities of insurance to get these life-changing lenses covered.

Understanding Keratoconus and Medical Necessity

The most common reason patients seek scleral lenses for keratoconus is a condition where the cornea thins and gradually bulges into a cone-like shape. This irregularity causes blurred vision and sensitivity to light that cannot be corrected with traditional means.
 

The good news for New York Medicaid recipients is that Keratoconus is often classified as a "medically necessary" condition. Unlike cosmetic contact lenses, scleral lenses are viewed by insurance providers as a prosthetic device required to restore functional vision. If your vision cannot be corrected to a certain level with glasses due to corneal irregularity, your insurance may cover the cost of the fitting and the lenses themselves.

Our Expert Handling of Prior Authorizations

The biggest hurdle for most patients is the paperwork. Insurance companies require specific clinical data, topography maps, and a detailed Prior Authorization (PA) to approve coverage.
 

At Green Eye Care, our experienced eye doctors take the burden off your shoulders. Our administrative team are experts in the PA process. We gather all necessary diagnostic evidence during your comprehensive eye exam and submit the request directly to your provider. We know exactly what Medicaid Managed Care plans need to see to grant an approval, ensuring the process is as seamless as possible.

Your Fitting Journey in East Harlem

Located at our 117th St office in East Harlem, our fitting process is designed for precision. Scleral lenses are custom-made for your specific eye shape. Using advanced corneal topography, we map the contours of your eye to create a lens that vaults over the sensitive tissue, resting on the white part of the eye (the sclera). This creates a "liquid reservoir" that provides constant hydration and a perfectly smooth optical surface.

Insurance Plans We Accept

To ensure our community has access to this essential care, we work with a wide range of providers. We accept Healthfirst and Fidelis—two of the largest Medicaid Managed Care plans in NYC. Additionally, we accept many major vision plans that often coordinate with medical exceptions.
 

You can view our full list of accepted insurance providers here, including:

• VSP

• Superior Vision

• Davis Vision

• EyeMed

• Spectera

If you are struggling with Keratoconus, don't let the fear of cost stop you. Visit us at our 404 E 117th St location. We handle the insurance hurdles so you can focus on seeing clearly.
 

Schedule your consultation at Green Eye Care today.