We’ve just come back from a really interesting meeting of the Ocularist Association of Australia in Melbourne.
At the meeting we discussed the development of a universal item number for an eye prosthesis. This to be used by medical insurance companies.
With the current system in Australia artificial eyes are covered by most health insurance companies as an ancillary benefit. This is similar to dental and optical claims. The issue that causes confusion and makes it hard to make a claim is the item number for artificial eyes. With Medibank private the item number for a new eye prosthesis is EP 13. HBF use the number A802 and with a number of the smaller insurance companies there is no item number at all.
Here in Western Australia the primary artificial eye is fitted during surgery and we get paid under the hospital table as the eye is implanted as part of the surgery.
The eye is initially fitted in hospital and then later we adjust it as the swelling subsides and then make up the final eye later. But is this a product or a service?
Over the years we have built up a system where a person who is going to have an eye removed meets us in advance.
We give them information about what to expect, we introduce them to a buddy system, we educate ad nurture them through the adjustment period and at the end we make the final eye.
The service we provide is aimed at reducing the trauma of eye loss. First by replacing fear of the unknown with information, social contact and eye loss stories.
Second by having the prosthesis implanted at the time of the surgery so that the patient and their family is not confronted by the sight of an empty eye socket.
There is a dramatic difference in the process of recovery for someone who is treated in this system.
Before the implanted prosthesis, the buddy system and the support material we saw people live through a major trauma that sometimes adversely effected their overall health and even the rest of their lives.
Just from our observations we see;
- People no longer hide away for the six weeks of post operative recovery.
- We see less depression and loss of confidence.
- People miss very little work time as they are not worried about their physical appearance.
- Stress on relationships is reduced because of lower levels of anxiety and depression among patients.
- People avoid the stigma of eye patches and dark glasses.
- Recovery is facilitated because people are more positive and able to resume their normal routines.
- By reducing the trauma fewer patients turn to drinking as a coping mechanism, this promotes a better outcome as drinking is not recommended during the post operative period.
Eye loss will always be a tough experience for people. However, there is no doubt in our mind that a service such as the one we describe is able to facilitate recovery.
We are also keen to see medical insurance companies adopt a universal item number so that this type of service can be accessed easy and people can get on with their lives.
