At EYES.NYC, many of our patients have Healthfirst Medicaid insurance, and the benefit that often raises questions is “medically necessary contact lenses.” So—what exactly does that mean?
It would be lovely to have contact lenses covered by Medicaid plans, but unfortunately, it’s not the case in the majority of situations.
What are Medically Neccesary Contact Lenses?
Medically necessary contact lenses are prescribed when a patient’s vision cannot be properly corrected with eyeglasses alone. These lenses are not for convenience or cosmetic purposes; they are essential for achieving the best possible visual acuity in certain medical cases.
In our experience, these cases are relatively rare, but when needed, they can significantly improve a patient’s quality of life.
Do You Qualify? A Quick Self-Check
Wondering if you might be eligible? A few general indicators:
- Is your prescription -/+10.00 or higher?
- Have you had corneal irregularities, keratoconus, aphakia, anisometropia, or other eye conditions that make glasses ineffective?
Not sure if You Qualify? Here’s the Next Step
If you’re unsure, our optometrists can help determine your eligibility during a comprehensive eye exam. Simply schedule a visit, and your doctor will evaluate your vision needs and let you know immediately whether you may qualify for medically necessary contact lenses.
The Approval Process
Here’s how the process works at EYES.NYC:
- Schedule an Eye Exam – You’ll be seen by one of our optometrists, who will evaluate your visual needs. You may ask the doctor, and they will be able to advise you immediately whether you are a candidate for medically necessary contact lenses.
- Prior Approval Form – If medically necessary contact lenses are appropriate, the doctor will complete a prior approval request.
- Submission – Our team will handle the paperwork and submit the form to Healthfirst on your behalf.
- Insurance Decision – We wait for the insurance to review and approve the request. Please note that even with the appropriate diagnosis in place, there is no guarantee that the insurance will approve the contact lenses. Unfortunately, if contact lenses are denied, there is no way for us to overturn the insurance’s determination.
- Order & Dispense – Once approved, we will order a yearly supply of contact lenses tailored to your needs.
We are often asked to submit prior approval requests “just in case.” Please note: if there is no qualifying diagnosis, we will not be submitting a prior approval form. Healthfirst vision plans provide very clear guidelines on which patients qualify for medically necessary contact lenses.
Why Choose EYES.NYC?
✅ We accept Healthfirst and understand the ins and outs of the process.
👁️ Our doctors have extensive experience with specialty and medically necessary lens fittings.
📋 We take care of the paperwork so you don’t have to worry.
If you think you may qualify—or if you simply want to explore your contact lens options—book an exam today at EYES.NYC. We’re here to help you see your best, comfortably and affordably.
📍 Visit us at 1511 Fulton St., Brooklyn, or call us at 347-770-8100 to schedule your appointment.
