Rejected For Laser Eye Surgery: My Money-Saving Plan Foiled

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My eyes are bad, they have been for a while. So bad, it turns out, that I can’t have laser eye surgery. No LASIK, no PRK, no Custom LASIK, no acronyms at all! Anyways, this has foiled my possible money-savings plans, but I thought I’d share them anyways.

  1. Decide if I want laser eye surgery by November.
  2. Max out my Flexible Spending Account (FSA) during Open Enrollment in December. (Say, $3,000.)
  3. Get the procedure done in January.
  4. Get my $3,000 back from the FSA afterwards in January.
  5. (Travel to less-developed countries in 2008 without worrying about being blind without my glasses…) 🙁

By timing it this way, I not only get the tax benefit of paying for my procedure with pre-tax money (saving 28% or whatever your tax bracket is), but I also effectively get a 0% interest payment plan for 12 months with no credit check. This is because for all the FSA plans I have worked with, you can get the full reimbursement upfront, but you still only fund the FSA via equal amounts from your paycheck.

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  1. PoorForesight says

    Curious: Would you have gotten the LASIK or PRK if you had been approved? Do you think its worth the inconvenience, dry eyes, and possible complications?

    My consult recommended that I get PRK since I have thin corneas.. I’m still very much on the fence about the whole thing. I get paralyzed into inaction from reading all the forums on the web.

  2. don’t give up!! several docs told me I was not a good candidate for lasik due to my thin corneas and large pupils. 5 yrs ago, they came out with a new procedure called intralasik by intralase. they make the corneal flap with a laser instead of a microkeratome, which allows for greater accuracy and reduced complications. it also allows a greater latitude of cases to be treated. i had this done 5 yrs ago, and only wish i had done it sooner. i had mine done here:

  3. How bad are your eyes? I had Lasik done back when it first came out in 1999. My vision at the time was -7 for the left and -8 for the right. My prescription was pretty bad too.

  4. Get a second opinion maybe. A friend of mine with horrible vision was told the same by one vision doctor guy. She went to another, was told she could have it, had it, and now she’s more awesome at seeing stuff.

  5. I had the “custom view” done about 2.5 years ago and can’t say enough good about it. I couldn’t read the big “E” before the procedure at 12 pm on a friday on the following morning at 8:30 in the same chair I was reading 20/15.

    I guess my comments don’t help you any but I would get a second opinion and I don’t think this is something that you want the least cost provider on either!

  6. I have thin corneas as well.

    I agree to not shop by price, I shopped by asking doctors who they went to for their own surgeries. Also made sure that only that one surgeon did all the procedures (not his trainees). But once you find the person, you might as well get the best deal after that.

    I could get a second opinion, I’m sure I could find somebody who would operate on me, but really if the “best” person in my area says no, I don’t want to push past that.

  7. I’m a chicken about this, though it would be so nice to not need glasses or contacts (my vision is bad enough that my vision insurance has deemed my very expensive toric contacts “medically necessary”). I wonder if I would be rejected also. I think Poor Foresight had a good point though – you should check in with a doctor every few years to see if they’ve made any advances that would make surgery possible for you.

  8. I think I have toric contacts as well – hello astigmatism! At least they come in disposables nowadays. 😀

    Yes, perhaps one day technology will catch up. My goal was to get them done before our planned around-the-world-before-we-get-kids trip. Plus it’d be great for outdoor sports. Oh well, can’t let a little thing like being blind stop us!

  9. Jonathan, in 10 more years say hello to bi-focals.

  10. I dumped $3K into my FSA at work this year. Ended up spending about $5500 for ASA (no flap), of which $3K was on the FSA card. I did it earlier in the year after only about $500 in contributions. Its nice to get a ~$2500 loan for ~12 months with no interested thats non-taxable income.

    My doc is one of the best in the world. He’s pioneered lots of complicated eye surgeries/tools/procedures –

    I’ve been very pleased with the outcome. Good luck.

  11. That’s too bad you couldn’t get the surgery. I had it done in January of this year and I have to say that it was worth the money and stress (I was very scared).

    Not the end of the world however!


  12. Hey, Jonathan,

    Kinda unrelated, but I recently changed jobs, and I had an FSA at my former employer. It was my first year trying it out, and I’d put $100 in for the year. When I’d changed, I was in a panic to use up all of the account before my last day. Then I asked my HR about what will happen to the rest of the FSA contributions that I was supposed to put in for the rest of the year. Turns out, I didn’t have to pay them! So, I had $100 in the FSA to use but only contributed a partial-year’s worth of that. Seems like a loophole that can be exploited, especially for large expenses like surgery…

    Thought this might be handy to know. 🙂

    Ivan Tse

  13. I think it’s worth it, if you have really bad eyes and can’t deal with contacts. My wife had LASIK done in 2004, and it changed her life. She had really bad sight (-7, -8) and couldn’t use contact lenses. She went to one of the top eye doctors in town and doesn’t regret a thing. The whole thing cost us $3,800, which we financed and paid off over 12 months at 0%. Don’t forget it’s a surgery, not a haircut, so for your own good, stay away from the strip mall chains. You wouldn’t go bargain hunting for brain surgery, would you?

    Luckily my eyes aren’t too bad, only -2.25 on both, and I am comfortable with contacts. So no LASIK for me 🙂

  14. I forgot to mention, that we were able to count the cost for the LASIK surgery towards our overall tax deductible health expenses, so we saved some money there as well.

    Also, if you have Vision Insurance, they might not pay for it, but you can get a discount. In our case it was $200 off the regular price.

  15. Mike! You had it done too? So did I! Next Cheap will hop on…

    Either way Jonathan, if you’re really looking to get it done, Canada is probably an option to consider. Not kidding here, we were several years ahead of the first PRK runs in the States.

    I had mine done in January 2006 and my prescription was about as bad as possible (-9.25, 2.5 Cyl). The guy I used did PRK and LASIK, but there are lots of variations (I got LASEK) and new tech coming out that kind of changes the equation. My doc was actually talking about his new Epi-LASIK laser.

    However, don’t be too discouraged, there is still new tech coming out. I know that you’re limiting yourself to the local market, but the US is/was behind in this field. Canada has doctors with more experience (they had a head start) and likely better tech. If you’re really interested, I’d check here or just a wait a few years for the tech to migrate south.

    I used to wear contact lenses that cost $200 (each), so I’d like to hold out hope for everyone else 🙂

  16. Well I am glad to hear you at least looked into it. I am going to give it a shot in the near future.
    As someone currently in India (Bangalore) doing work for my firm let me pass on my recommendation to skip this country on your trip.
    Good luck on that and I am sure we will all be keeping an eye out for details as you begin to plan.

  17. Wow, does bad eyesight and interest in finance correlate?

    I’m around -8.5 and -9 in my eyes, not sure of the exact number.

    With all of the follow-up required of PRK and similar, I don’t know that going outside my geographic area would be prudent. Perhaps I will look around some more…

  18. I did LASIK the first month I got my job and put $3,000 away in FSA for that, and yes, it felt great not only to have a fresh pair of eyes, also making interest on that money for about 12 months.

  19. Be really careful shopping around. There is a reason you are being denied the procedure. Most likely because the doctor cannot guarantee it will give you good results. I’d visit another doctor or two but some people are not good candidates. (I think 60 Minutes did an expose on this a few years ago and the patients who were not good candidates were ones with very wide pupils. Perhaps all that has changed?)

    I have a question, if they could get your -8 to -2, would you still do it? I think being sort of blind vs totally blind would still make the procedure worth it in terms of just being able to walk around the house without glasses. I’m about a -4, but with 127 cyl (astigmatism) on my left eye. I am unlikely to get good results in my left eye, but I’m willing to do my right eye in hopes that my left eye will improve naturally. (It can happen.)

    But I could use my $5K FSA for other things, like paying down my credit cards…

  20. Jonathan, you might ask around about getting phakic intraocular lenses:

    They can correct extreme nearsightedness (it is my understanding they don’t make them for farsightedness)

    I recently had lasik and the doctor I went to also did a lot of IOLs. I asked about them since my friend is freaky about the laser, but doesn’t seem to have a problem with the idea of getting lenses implanted. If you are near the Atlanta area, give Woolfson Eye a call. They are not cheap, but I had a fantastic experience with them.

  21. Hey Jonathan;

    Going abroad for PRK (or variant) is definitely expensive as you’ll likely have to “rent a hotel” for a week. However, if you’re venturing out for some form of LASIK then you’ll only need to stay there for a couple of days.

    It really all depends on how dedicated you are to getting the procedure done. If its “not a big deal”, then you can just wait it out and try again in a few years. If you “really want it done now”, then you’ll have to look around a little harder. (but it doesn’t sound like you’re in camp #2)

  22. Glad to hear your eye doc rejected you, that’s a sign he/she is looking out for your health, not just their pocketbook. Having read what can happen when things to wrong with LASIK, I would not consider it. Dry eyes, inability to drive at night…all makes glasses sound pretty good.

    You can definately enjoy a round the world trip with glasses or contacts!

  23. I have been wondering about getting LASIK myself as my eyes are -6.5 each for contacts and -7 for glasses. I wanted to get it done before my eyes get worse because I would really like to be able to see without glasses and contacts.

    Keep the faith and maybe you will find an improvement that caters for your eyes in the near future.

  24. FocusClinic says

    I don’t know whether it goes by a slightly different name in the States but in the UK WaveLight is another option to Lasek/Lasik/PRK that might be worth considering.

  25. yes, there is a loophole. i put in $2000 in my FSA for my lasik. got it done on january 15, left the company on january 16. i basically got my lasik done for $75 as the company only had time to take it out of only one of the paychecks. the HR told me it all breaks even at the end because there are always people who don’t use it up at the end of the year and they lose it. also, i didn’t get reimbursed, i charged the lasik to my FSA master card…it got paid directly.

    i hope you can get your lasik one day, it’s the greatest feeling after wearing contacts/glasses for so long! 2 yrs later, i’m still loving it! =P

  26. Jonathan, I have enjoyed reading your blog and appreciate your efforts. Since you posted this in the frugal living section, I thought about your idea and tried to take the frugality one step further.

    Dpjax mentioned it was $5500. Another option if your flex plan is capped at $3000/year is to max it out for 2 years. The, in December of year 1 has LASIK performed on one eye. The cost should be approx half of $5500. Then, wait a few weeks for January and go back and have the second eye done. This way you could have the entire $5500 funded from a flexible spending account.

    Plus, you potentially minimize your risk with surgury on only 1 eye at a time.

    While that sounds like extra work, the tax savings are large enough to make it worth the hassle. In ADDITION the savings from Federal and State taxes, money in the flex plan is also exempt from Social Security Taxes. So a typical potential savings:

    Federal – 25%
    State – 7%
    Social Security – 7.65%
    TOTAL – 39.65%!

    At a cost of $5500, that’s putting $2,180 in your pocket! What do you think?

  27. From finance point of view, FSA is a use-it-or-lose-it account, does that mean you’ll lose your saving if you’re not getting the procedure done. What’s going to happen to your $3k in the FSA?

  28. This is a great feature of the FSAs. I’ve been a high deductible PPO guy since I started working but this year I’m planning on switching to an HMO plan with no deductible and low out of pocket costs just to get an adult tonsilectomy. The following year I plan on switching back. To pay for my share of the procedure I’m doing the exact same thing. Open a FSA and fund it to the value of my out of pocket expenses and get the procedure done in January thereby financing the procedure thoughout the entire year tax-advantaged and interest free… I’m even keeping my HSA funds growing tax-free as I will once again be jumping back to a HDPPO plan in for 2009.

  29. Jonathan, why not make your first stop on your around the world trip at Bumrungrad Hospital in Bangkok? You can’t get better medical care anywhere in the world. They have a world class eye center. LASIK is about $1500 (that’s for both eyes) last I checked. There are other good choices, too, for even nicer places to hang out during the follow-up period, like Bangkok-Phuket hospital.

  30. Like Janet, I also used the loophole, contributing $3000 and leaving the company in June. Gave myself a 50% off sale on the LASIK.

    However, I had it done 5 years ago – something no one mentioned was that pregnancy changes your eyes. Fast forward two children and my eyes are bad again.

    Anyone know if you can wear contacts after you’ve had surgery?

  31. I am the same situation as you: my eyesight is so poor that I am not eligible for Lasik. But I have been wearing contact lenses since my late teens (my eyes went bad in 2nd grade). Have been living on disposable lenses and it’s not bad at all. It’s a shame we can’t have that Lasik procedure though.

  32. Gates VP: just a small clarification. PRK was developed and first performed in the U.S. in the 80s. Yes, Canada and Europe used PRK in the early 90s, whereas PRK didn’t get FDA approval for the U.S. until 1995. Despite that, the first runs of PRK in the U.S. were several years before Canada (i.e. early 1980s).

    At this point, it is moot, since the procedure has been widely performed in Europe, Canada, US, et. al. There isn’t a better place to do PRK or LASIK in terms of the country, procedure-wise. Doctors do vary in competency, so I would definitely want someone who has a long history of the either Lasik or PRK, after all they are your eyes.

    Johnathan: did the doc tell you why you weren’t eligible for surgery? I agree with mapgirl when she wrote, “Most likely because the doctor cannot guarantee it will give you good results.” That is precisely the reason some doctors won’t do it, if it lowers their overall success rate. I’d shop around, but with the caveat that you still go to well established doctors. At the end of the day, you might not be eligible. You may check in a few years. I remember, I wasn’t a candidate for contact lenses until focus torics came out. I also wouldn’t be dissuaded by PRK. I had PRK done. The initial recovery is a pain, but if it is the only refractive option you have, I’d take it.

  33. Thanks for the clarifications Tim;

    I’ll back you on the pain factor. I had LASEK (form of PRK) done and I was out of action for a good week. I even had to wear shades at work for the first couple of days back (days 8 & 9) b/c staring at a giant light bulb (CRT) was a little tough. And I cut those days a little short 🙁

    It sucked for a while, don’t get me wrong, but all in all it was still worth it (and I paid 5k for the surgery).

    Here’s hoping we find a solution for Jonathan in a few years 🙂

  34. Your last statement says you can get full reimbursement upfront. So if I put in $200 in FSA, can I claim it back without first paying that much amount from salary?

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