Why Scleral Lenses are "Medically Necessary"
Under NY Medicaid
Standard vision insurance covers basic eyeglasses or cosmetic contact lenses up to a modest annual allowance. However, when a patient has a distorted or irregular cornea, standard lenses cannot bend light correctly into the eye.
New York Medicaid classifies specialty scleral lenses as a medically necessary prosthetic device when standard corrective lenses fail to bring your vision to a functional baseline.
Qualifying Corneal Conditions
If you have been diagnosed with any of the following conditions, you may qualify for Medicaid-covered scleral lenses at our practice:
Keratoconus: A progressive condition where the cornea thins and bulges into a cone-like shape.
Pellucid Marginal Degeneration (PMD): Clear, non-inflammatory corneal thinning causing irregular astigmatism.
Post-Surgical Corneal Irregularities: Distortion following corneal transplants, RK (radial keratotomy), or complicated LASIK.
Corneal Trauma and Scarring: Irregularities caused by prior eye injuries, infections, or ulcers.
Severe Dry Eye & Ocular Surface Disease: Conditions like Stevens-Johnson Syndrome where the eye requires continuous hydration.
How Scleral Lenses Restore Your Sight
Unlike traditional contact lenses that rest directly on the delicate, sensitive tissue of the cornea, scleral lenses are large-diameter, rigid gaspermeable lenses designed to vault completely over the cornea. The space between your irregular cornea and the back of the scleral lens is filled with a sterile, non-preserved saline solution. This fluid reservoir neutralizes all surface irregularities of your cornea, acting as a new, perfectly smooth front surface for your eye.
Insurances We Accept for Medically Necessary Scleral Lenses
One of the biggest hurdles NYC patients face is finding an eye doctor equipped with advanced 3D diagnostic technology who also accepts Medicaid plans. At Green Eye Care, we manage the administrative paperwork to secure prior authorization approvals across a wide variety of managed care plans
Healthfirst: One of the largest Medicaid HMOs in New York. We routinely secure prior authorizations for medically necessary scleral fittings.
Fidelis Care: We navigate the medical necessity requirements between Fidelis Care and its vision partners (like Davis Vision).
Superior Vision / Anthem HealthPlus BCBS: We have a strong track record of securing approvals for patients under Anthem HealthPlus Medicaid plans.
Major Vision Plans: We also accept VSP, EyeMed, and Spectera for medical exceptions and specialty lens coverage.
Our 4-Step Prior Authorization &
Custom Fitting Process
Many retail optical shops turn Medicaid patients away because the paperwork is time-consuming. At Green Eye Care, we have built our administrative workflow specifically to handle this red tape so you don't have to.
Diagnostic Exam & Corneal Topography: We map your eye to provide the clinical proof your insurance requires.
Prior Authorization Submission: Our team submits the medical necessity claims directly to your provider and manages all communications.
Custom Lens Fabrication: Once approved, your lenses are ordered to the exact micron-level measurements of your eye.
Precision Fitting & Patient Training: We ensure maximum comfort and teach you how to insert, remove, and care for your lenses.
Serving Patients From All 5 NYC Boroughs
Because few optical practices across New York City offer medically necessary scleral lens fittings under Medicaid, our office welcomes patients traveling from across the entire metropolitan area including Manhattan, The Bronx, Brooklyn, Queens, and Staten Island.
Frequently Asked Questions
Does NY Medicaid cover the full cost of scleral lenses?
What if my scleral lens claim was previously denied?
How long does the insurance approval process take?
Does NY Medicaid cover scleral lenses for Keratoconus in NYC?
Why were my scleral lenses denied by Medicaid at another optical shop?
Do patients from outside East Harlem visit Green Eye Care for scleral lenses?
Take the First Step
Toward Clear Sight
Don't let blurry vision prevent you from receiving the care you need. Read our original guide on how to get scleral lenses covered by Medicaid in NYC or review our full list of accepted insurance plans.
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