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CostHelper > Health & Personal Care  > Opthamology & Optometry > Macular Hole Treatment

Macular Hole Treatment Cost


How Much Does Macular Hole Treatment Cost?

 
average costWith Health Insurance: Hospital Copay + 10%-50% Coinsurancehigh costWithout Health Insurance: $1,500-$5,000+
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A macular hole[1] is a break in a part of the retina, called the macula, that's responsible for central vision. It's created when the vitreous, a gel-like substance in the eye, shrinks and tugs at the retina in the process. Though the condition often comes with old age, it can also be caused by eye disorders, such as retinal detachment; eye disease, such as diabetic retinopathy; or eye injuries. Some macular holes will heal on their own and require no treatment; others may require surgery to improve vision.

Typical costs:

  • Patients experiencing symptoms[2] such as a slight distortion or blurriness in vision typically start out with a visit to an eye doctor. The national average charge for a comprehensive eye exam is $114 for those without insurance. For patients with vision insurance coverage, the typical copay is $5-$35.
  • If medical attention is needed, an eye doctor will typically recommend a vitrectomy[3] , a procedure in which eye fluid is removed so that the retina can be repaired. Vitrectomies typically cost about $5,000 per eye, including fees for the doctor, hospital and anesthesiologist. For instance, at VitreoRetinal Surgery[4] in Minneapolis, patients would typically pay $1,500-$3,000 for the procedure, depending on the extent of the problem and any other complications that may be present, in addition to fees for the hospital and anesthesiologist, and $50-$350 for an initial consultation.
  • For insured patients, out-of-pocket costs typically consist of a specialist copay, possibly a hospital copay of $100 or more, and coinsurance of 10%-50% for the procedure, which could reach the yearly out-of-pocket maximum. According to the Kaiser Family Foundation, the average hospital copay for outpatient surgery is $132 and for inpatient surgery is $232. The average coinsurance rate is 17%-18%.
What should be included:
  • In addition to taking a complete medical history, an eye doctor may perform tests[5] to see how much of the retina is affected, such as a refraction test[6] or using a lighted instrument called an ophthalmoscope to examine the eye.
  • If needed, a vitrectomy typically takes two to three hours. At the end of the procedure, a silicone oil or a gas will be injected into the eye to replace the vitreous, and following surgery, patients will need to lie face-down for a few days or sometimes more, to enable the gas or oil to seal the hole.
Additional costs:
  • According to the National Institutes of Health, if a macular hole exists in one eye, there is a 10%-15% chance that a macular hole will develop in the other eye as well.
  • Following a vitrectomy, patients often buy or rent health aids to help them remain in a face down position during their recovery period. Products include specially designed pillows[7] , body cushions[8] and chairs[9] and range in price from $20-$300, depending on the size and type of product. Some health insurers, like Cigna[10] will cover rental of the products.
Shopping for macular hole treatment:
  • Patients considering vitrectomy should note the risks[11] , such as infection, an increase in the rate of cataract development, and the development of retinal detachment.
  • The American Academy of Ophthalmology provides a database of ophthalmologists[12] patients can search.
  • The Mayo Clinic offers a list of tips[13] to help patients prepare for a visit to the ophthalmologist.
Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
 
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What People Are Paying - Recent Comments
Macular Hole
Amount: $15,000.00
Posted by: ?????? in Grants Pass, OR.Posted: October 20th, 2014 01:10PM
Treatment: VitrectomyInsurance: none
We paid the optometrist $350 for initial visit.Diagnosis: macular hole.
We paid the retina specialist $550. for initial visit. Confirmed macular hole.
Vitrectomy surgery:
Dr. Charged $2,500. Hospital charged $13,000. Haven't heard from the anesthesiologist yet. Looks like it will be more than $15,000. before they are through billing us.
Was this post helpful to you?   yes     no Report prohibited or spam
hole macular eye
Amount: $0.00
Posted by: antonella in mountain top, PA.Posted: March 7th, 2013 04:03AM
Treatment: noInsurance: no
Ophthalmologist: italy
my mom just discover this problem, the doctor said the she is going rapidaly blind, the problem is the she leave in italy but i am american citizen! is nothing i can do to help.? please let me know
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External Resources:
  1.  www.nei.nih.gov/health/macularhole/macularhole.asp#1
  2.  www.nei.nih.gov/health/macularhole/macularhole.asp#d
  3.  www.webmd.com/eye-health/vitrectomy
  4.  www.retinaphysicians.com/
  5.  www.mayoclinic.org/retinal-diseases/diagnosis.html
  6.  www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004297/
  7.  www.sears.com/shc/s/p_10153_12605_SPM1538132601P?sid=IDx20101019x00001a&ci_src=14110944...
  8.  www.vitrectomy.com/?m=sale
  9.  www.kellycomfort.com/ourproductsseated.html
  10.  www.cigna.com/assets/docs/health-care-professionals/coverage_positions/not-found.html
  11.  www.nei.nih.gov/health/macularhole/macularhole.asp#8
  12.  www.aao.org/find_eyemd.cfm
  13.  www.mayoclinic.com/health/retinal-detachment/DS00254/DSECTION=preparing-for-your-appoin...
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