What's the Catch with Lasik for $599/eye?

You already know it's too good to be true, but here's the scoop.

Discount laser centers typically use older technology that is much less expensive. They pass the savings and the 1990s vintage vision correcting technology on to you! Would you ever opt to watch a 20 year old TV for the rest of your life? I think not. There is also a tendency for discount LASIK providers to advertise a price that only applies to tiny prescriptions that almost no one qualifies for. Just like with anything, you get what you pay for with LASIK.

Here's some advice: if it seems too good to be true, it probably is. Of the millions of people who have undergone LASIK in its ten years since inception, you would be hard pressed to find one who only paid $299 per eye. For example, a certain Laser Center advertises Lasik surgery on one eye from $299. While the fine print lists an incremental rise in the price depending on the level of myopia, you must also qualify for the promotion by having good credit. This Laser Center has previously been found guilty for operating a bait and switch tactic whereby patients were lured in by the low price but were then told they didn’t qualify for it. Lasik eye surgery price promotions like these usually come to light sooner or later.

Recently a patient reported to our office that he went in to a laser center that advertised $499 per eye. After his consultation, however, when they added a fee for his level of myopia, another fee for his level of astigmatism, a fee for his credit rating, and a fee for the lifetime guarantee, his total was over $2200 per eye. His price was higher if he wanted to have post op visits included as well!

The moral of this entry, however, is not beware of false advertising, nor is it even a warning to read the fine print. Rather the moral should be that price should NOT be the main reason you choose a LASIK surgeon. Choosing a well-established trusted eye surgeon who has your best interests in mind should concern you more than the cost of the procedure. These are your eyes, after all, and LASIK surgery is surgery. Even though it is a very popular procedure that seems rather routine, there are risks that are associated with any type of surgical procedure. Before you go under the laser, do your homework: choose a reputable doctor who makes you feel comfortable and who is conservative when predicting your potential outcome. Another good rule of thumb: When in doubt, don't.

When applied to another medical procedure, this seems absurd, and it is not prudent to make a decision for something this important based only on price.
That being said, it is usually a bait and switch type of offer, please read the fine print that says STARTING at $595 or some other price. This is usually not for all prescriptions, not for state of the art technology, and may not provide everything you will need. It took me awhile to understand this strategy, but here is what I think.
Most people realize, hey, I might not get it for that price, but these people will probably still be less expensive than those higher priced centers no matter what. While this might be the impression, it simply is not true. Typically the cost for LASIK will with the same technology, the same experience quality, will cost about the same price. Therefore pick the center you like the best, and try to get the lowest cost for what you want. Chances are, you will not be saving any money at the lower advertised price center unless you have very little correction and are willing to make compromises.

Be very careful here. The discount centers mission is to get a patient in to their clinic expecting a very low fee for LASIK. Through the "sales" process, basic items are added to the fee (like paying for postop care, custom treatments, etc) that typically get the fee up near $1800-2000 per eye. I hate this practice. Even worse, if they somehow pull off doing your LASIK for $599, then you might very well be exposed to old, unmaintained, out of date lasers with behind the times hardware and software. I don't know about you, but in 2010, I want my eyes operated on with 2010(or beyond) equipment, not the dusty stuff in the corner from 2003. This happens out there, so beware!

The surgery might be $599, but the preop anesthetic drops will cost you $1500. Seriously though, in life, you get what you pay for. This holds true in eye surgery. I tell patients you wouldn't buy a bargain-bin pacemaker or parachute.
The come-on pricing you often see with LASIK is laden with asterisks and fine print. Sometimes postoperative care is not included. Often, a patient must fall within a very narrow range of prescriptions to qualify, and perhaps one in a hundred or fewer will actually qualify. Older machines are often used.
The latest wavefront technology comes at a cost--there's actually a royalty paid to the laser manufacturers every time an eye is treated, and the amount of this royalty is generally hundreds of dollars per eye. Do the math...at $599 per eye, practictioners will need to cut every corner and STILL lose money with every case they do. I guess they figure they'll make it up on volume!
The last decade is littered with news stories of discount LASIK providers who went out of business, leaving patients without any followup care, simply because this business model is absolutely unsustainable. If I were having any kind of surgery, I'd sure want my surgeon/office to be there a year, or five years downstream.