GB Ocular Prosthetics

  Do ocular prosthetics move?

The movement of the eye is not going to track 100% with your companion eye. The motility of the prosthetic eye is possible by the rectus muscles wrapped around the orbital implant working in unison with the companion eye.

 The measurement of the prosthetic eye’s motility over the orbital implant depends on various factors, such as your preoperative condition and postoperative recovery.

Does health insurance cover ocular prosthetics?

Important Notice Regarding Insurance Billing

Due to increasingly stringent regulations and overwhelming administrative burdens placed on the Durable Medical Equipment (DME) industry by insurance carriers and government programs, small specialized practices like ours can no longer absorb the enormous time, staffing, and financial resources required to file, appeal, and manage insurance claims on behalf of patients.

We no longer file insurance claims for our patients.

Instead, we provide comprehensive documentation and personalized guidance to help you file your own claims directly with your insurance company. We are happy to assist you by reviewing your coverage and answering questions to the best of our ability. However, it is ultimately your responsibility to contact your insurance provider directly to confirm that all services are covered and to verify whether prior authorization or any other specific requirements apply to your particular policy before your appointment.

We appreciate your understanding as we focus on delivering the highest quality care while navigating these challenging industry changes.

Our practice specializes in custom artificial eyes, which are billed as Durable Medical Equipment (DME). We file insurance claims only with Medicaid and certain managed-care carriers. For all other insurance plans, you are responsible for full payment at the time of service.

We will assist you as much as possible in navigating the complexities of medical insurance by answering questions, supplying necessary documentation, and explaining the claims process. In the end, however, it is your responsibility to verify your specific plan’s coverage, including whether ocular prosthetics/DME are a covered benefit, any requirements for prior authorization, referrals, deductibles, copayments, coinsurance, or out-of-network limitations. Coverage can vary widely even within the same carrier, and failure to obtain required authorizations may result in full denial of the claim. We strongly recommend that you contact your insurance carrier before your appointment to confirm benefits and obtain any necessary approvals. We will gladly provide a detailed itemized receipt (superbill) so that you may file for reimbursement directly with your carrier if your plan permits out-of-network benefits.

Our custom ocular prosthetics are backed by a 60-day warranty from the date of final delivery. This warranty covers repair or replacement due to manufacturing defects or adjustments. After 60 days, any modifications, repairs, or replacements will be billed at our standard fees. Please note that normal wear, loss, or damage caused by patient handling is not covered under the warranty.

All balances, including patient-responsibility portions after insurance processing, are due within 30 days of receipt of your explanation of benefits (EOB). We accept cash, check, credit cards, Venmo, and HSA/FSA payments.

Thank you for choosing our practice — we are committed to transparency and supporting you through every step of your care.

How long does an ocular prosthesis last?

Most people will need a replacement anywhere from 3-5 years. Socket tissue can change over time causing movement, lid drooping, and poor fitting of the prosthesis. Replacement of shells is also recommended for the same time frame. Shrinking of the eye or settling of the tissue can cause the same effects.

How often should a prosthetic eye be polished?

Cleaning the eye removes external coats of dried mucus from the surface of the prosthetic eye. Also, the removal of these deposits that would be touching the inter-palpebral zone of the socket enables the eyelids to close smoothly and help prevent adverse reactions like GPC (giant papillary conjunctivitis). This is recommended and should be done on a regular basis. Depending on the patient's environment, once every six months to a year is usually sufficient. 

How often should I remove my prosthetic eye?

When a prosthetic eye is removed and reinserted, it is certain that the micro-environment of the socket is disturbed to some extent. The main signs of the socket’s response to this procedure are conjunctival irritation and extreme mucus discharge.

Will the eye socket still have normal tear flow?

Surgery to remove your eye usually doesn’t affect the body’s ability to lubricate the socket creating natural tears. Although the ocular prosthesis is made of hard acrylic plastic which doesn’t hold lubrication easily, this sometimes causes an overproduction of tears. Tearing and mucous are significantly affected by the patient’s environment and health. Some examples of this include allergies, working in dusty environments, air conditioning or fans directly hitting the area of the socket. 

Should I lubricate my prosthetic eye?

The ocular prosthesis is made of a hard acrylic substance not able to absorb the moisture or natural tears as fast as your natural conjunctiva, causing them to evaporate on the surface. Also, if eyelid function is limited, dry eye could be a problem requiring the use of artificial lubricants. Consult with your ocularist and ophthalmologist if you have any questions or concerns.

Should I wear protective eyewear?

With the removal of an eye, you are only monocular in site so it is highly recommended that you wear a pair of glasses with shatterproof polycarbonate lenses. Even if no prescription is required in the companion eye, glasses are an exceptional means of protection.