Hi there Sushila
Yes, as Anne rightly says, it's possible to get your PMI (Private Medical Insurance/Insurer) to cover crosslinking -- it's not completely unheard of. However, neither is it straightforward. This is because it currently sits in the uncomfortable half-way-house between fully approved as a treatment for Keratoconus and still in its trial phase. To cut a long story short (and to oversimplify a quite complex situation) it's in the late stages of trials, is becoming effectively a defacto option for many ophthalmologists but as yet because the trials haven't published their final conclusions, it can't be said to have an unequivocal approval. It is that last point which gives the PMIs some wriggle-room to refuse a claim. But it is the other points preceding it which gives one the potential to insist a claim is accepted by a PMI.
As this subject may be relevant to others, I'll repeat my "hints and tips" on how to increase your chances of being able to make a successful claim for crosslinking from a PMI.
1) You must have a PMI policy which offers medical treatment. Check your policy document -- a "cash plan" type of policy might well pay a benefit in the event of you having the crosslinking, but it certainly won't cover the cost of the procedure itself. Check your policy document to see what type of policy you have.
2) Make sure that you have some documentation confirming your diagnosis and the need to see a specialist eye professional (usually an ophthalmologist for crosslinking). This can come from either the eye clinic you attend to manage your Keratoconus or your GP in Primary Care. On no account should you contact a consultant directly or do anything which could be seen as a self-referral.
3) Again, check your policy document for the PMI's requirements as to which consultants you should use in respect of the cover offered. In some cases -- knowing the general trend for the PMI industry I'd have to say now the vast majority of providers will require this -- you should only get a referral to a consultant ophthalmologist from the PMI's "panel" i.e. pre-approved specialists. Some policies let you see who you like, but if that's not how your policy is worded, then do not
violate this criteria as it will make things trickier. I could write a shed-load about how I dislike the creeping tendency to make this clause a standard term of the PMI's products but for the sake of brevity and trying to stay relevant to the point, I won't
4) At this stage, I should say that subject to 1) ~ 3) above being followed, then your PMI policy should definitely cover the cost of your consultation. So at least you can probably save a bit of time vis-a-vis the waiting list on the NHS. Now, though, the fun starts...
5) When you see your consultant, you must establish without any ambiguity that the following are applicable to your circumstances:
a) That your diagnosis is Keratoconus
b) That your Keratoconus is progressing
c) That the consultant's best advice is that crosslinking is indicated for you
d) That the crosslinking would be performed with curative intent
e) That the ophthalmologist considers that crosslinking is the customary and expected
treatment based on current practice.
The precise wording in the italics above is so important -- confirmation from the consultant is critical to being able to get any claim accepted -- I'd recommend that you write it down and ask her/him to confirm that would be their judgement. If they are happy to confirm all this in writing e.g. send you a letter stating the above then so much the better.
6) If this plays out as I've described, then submit your claim for crosslinking to the PMI.
7) There's only two possible outcomes -- they either accept the claim or they don't. If they don't then do by all means post here and I'll do my best to help. No guarantees, but as others have said in this thread, the NHS situation is, a-hem, trying to be polite, somewhat patchy.
Sorry, have covered a lot of ground there so do please say if you're not sure of anything I've written.