What You Will Find In This Packet

READING

Welcome letter

Aaron J. Affleck, M.D and Cataract Surgery

Seeing clearer with Cataract Surgery

Lens Options

Differences Matter!

Vision Preference with Cataract Surgery

Out of Pocket Costs

Your appointment with Dr. Affleck and Affleck, MD Eye Care

Aaron J. Affleck, MD, 2900 Valencia Drive, Idaho Falls, ID 83404 Phone 208-523-6868, Fax 208-523-7272, LOVEhealthyEYES.com

About Dr. Affleck

What are the symptoms of a cataract?

How is a cataract detected?

How do cataract procedures work?

Who get cataracts?

What happens if cataracts are not treated?

Testimonials

Getting to know Aaron J. Affleck, MD.

Aaron J. Affleck, MD, is an experienced, board certified surgeon of the eye in Idaho Falls, and Rexburg area. Over his years in practice he has performed thousands of cataract procedures. Dr. Affleck completed his ophthalmology residency training as Chief Resident at Kresge Eye Institute / Wayne State University1 in Detroit, Michigan. Nationwide and globally this institute is known for being in the forefront of medical eye care and training.

Dr. Affleck received his medical degree from The Chicago Medical School3, which also has a national reputation in progressive medical and healthcare education.

Aaron J. Affleck, MD most frequently performs the phacoemulsification cataract surgery procedure which requires no stitches or patching.

He uses advanced testing technology and at his modern practice he offers premium implant lenses that correct astigmatism and lenses that give the same benefits as bifocal and trifocal contacts and glasses.

What are the symptoms of a cataract?

The most common symptoms of a cataract are:

Cloudy or blurry vision

Colors seem faded or have a yellow tint

Glare (Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.)

Poor night vision

Frequent prescription changes in your eyeglasses or contact lenses

Need very bright light to read or do close-up work

Double vision or multiple images in one eye. (This symptom may clear as the cataract gets worse.)

A cataract needs to be removed when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. These symptoms also can be a sign of other eye problems. A dilated exam with Dr. Affleck may help to explain these symptoms.

Aaron J. Affleck, MD and CATARACT SURGERY

How is a cataract detected? A cataract is detected through a comprehensive eye exam. An eye chart measures how well you see at various distances. Drops are placed in your eyes to widen, or dilate, the pupils. Dr. Affleck then uses a magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. How do cataract procedures work? A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Dr. Affleck then inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. This procedure is one of the latest techniques and most common in cataract surgery today. It is called phacoemulsification, also known as “small Incision cataract surgery.” After the natural lens has been removed, it is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, acrylic or silicone lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens. Who get cataracts? Most everyone at middle age eventually develop age related cataracts. However, they are mild and do not affect the vision. With time, the cataracts worsen and after the age of 60 is when most people’s life styles and vision are affected by their cataracts.

What happens if cataracts are not treated? Your eye can not be damaged by cataracts. However, in most cases cataract do get worse and so will your vision.

Testimonial "Having suffered with cataracts for several years, I was happy when my Optometrist said it was time to remove them. When I asked about who could do the procedure he suggested Dr. Affleck. I contacted his office and set a date. Dr. Affleck explained the procedure and said I would be impressed with the results. This proved to be an understatement. The people were so nice. I experienced no pain at all and I was seeing great in just a few hours. It’s been a little over a month since I’ve had my eyes done. I am amazed at what I can see and how clear everything is. I’ve worn glasses since I was eight. I am now 63 and can see perfectly without them. Dr. Affleck and his team are the people to go to for the best results."— Kent

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1 http://www.kresgeeye.org/ 2 http://www.kresgeeye.org/?id=142&sid=1 3 Now known as Rosalind Franklin University of Medicine and Science http://www.rosalindfranklin.edu/dnn/chicagomedicalschool/home/cms.aspx

Aaron J. Affleck, MD, 2900 Valenica Drive, Idaho Falls, ID 83404 Phone 208-523-6868, Fax 208-523-7272, LOVEhealthyEYES.com

Important Things You

Should Know When You Are Considering

Cataract Surgery!

What is a Cataract? Cataracts are age-related changes in the lens of the eye. The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that

reaches the retina. The clouding may become severe enough to cause blurred vision. Most

age-related cataracts develop from these protein changes. When a cataract is small, the cloudiness

affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to “grow” slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get worse. Seeing may become more difficult. Your vision may get duller or blurrier. The clear lens slowly changes to a yellowish or brownish color, adding a tint to the vision. As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting may affect the sharpness of the image transmitted to the retina. If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks. Cataract left untreated long enough normally will result in loss of vision. Is Cataract Surgery Effective? Cataract surgery is one of the most commonly performed surgeries in the United States. It is an extremely safe and effective procedure. In the United States alone there are more than a million cataract surgeries per year. Unless there are other medical conditions that have an impact on vision, in about 90 percent of the cases people have better vision. With the cataract procedure Dr. Affleck performs there is no stitching and no patching after surgery. Through these advancements, the cataract procedure healing time is significantly less than in years past so you can get back to your normal activities quickly. Most people only take 2 to 8 weeks before their eye have healed and are stable.

Seeing better with CATARACT SURGERY

How will my vision improve from cataract surgery? There are several different options for the types of lenses replacing the cloudy lens that is removed. You can have a lens that only corrects distance vision, a lens that corrects distance vision and astigmatism, or even a lens that will correct your distance vision and your near vision reducing and possibly eliminating the need for reading glasses. Thinking of your lifestyle and your vision needs will help you determine which lens is right for you.

What do I need to do to prepare for Cataract Surgery? A few weeks before your surgery, you will have an exam with Dr. Affleck and he will order certain tests that will measure the curve of your cornea and the size and shape of your eye. He uses state of the art tests to determine which lens implant is right for you. You will choose the type of lens up to one week before your surgery day and pay any out of pocket costs for lens upgrades. You should also contact your insurance company for any questions about your coverage. A few days before surgery you will start on medication eye drops to help decrease your healing time and decrease your chance of infection. Dr. Affleck also recommends hydration therapy at least one week before surgery.

What happens during Cataract Surgery? The cataract surgery usually takes less than an hour. You will be given drops for your eye and some medication/sedation to relax you during the procedure. You will need someone to drive you home from surgery. During surgery, the natural lens, which has become cloudy and harder over time, is removed and replaced with an intraocular lens (IOL). The IOL allows light to pass through to the retina clearly, improving your vision. You won’t be able to see or feel your new lens!

What will I feel like after surgery? Your eyes may feel dry and itchy after surgery. You will be given eye drops to help reduce the dryness and itchiness. Your eyes may be sensitive to light and you will be given dark glasses to bring with you to help with your light sensitivity. Dr. Affleck will have you using eye drops for a few weeks after surgery to help with healing. You will see Dr. Affleck the day after surgery so he can evaluate your recovery and answer any questions you may have. Some patients choose to follow up with their Optometrist and others continue to see Dr. Affleck through the post-operative period. You will be able to resume normal activities as soon as you feel like it, however, you shouldn’t bend at the waist or lift heavy objects for a week.

Information in this brochure is general and is not intended as medical advice; please be sure to talk with Dr. Affleck for more specific information about the treatment and your own situation.

Other resources: http://www.cataractsurgery.com/

http://www.nei.nih.gov/health/cataract/cataract_facts.asp

http://www.geteyesmart.org/eyesmart/diseases/cataracts.cfm

http://www.aboutcataractsurgery.com/

www.acroysofrestor.com

www.allaboutvision.com

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Aaron J. Affleck, MD, 2900 Valencia Drive, Idaho Falls, ID 83404 Phone 208-523-6868, Fax 208-523-7272, www.LOVEhealthyEYES.com

At your cataract surgery consultation, different intraocular lens, or IOL options will be discussed with you. For your convenience, we have provided more information to help you choose. The lens selection must be made 1 week before surgery and additional costs are added for the upgraded lenses.

Monofocal Lens Monofocal lenses only correct vision at one visual range, typically at a distance. Implanting a standard monofocal IOL during surgery would be considered the standard of care and medically necessary. This is because your eye's natural lens is removed as part of the procedure, and you need an artificial lens as a replacement to restore your sight. You likely would have very good distance vision with this type of IOL, but you would need to wear reading glasses for near vision. There is the possibility of needing glasses for perfect distance vision. There are no additional costs associated with the monofocal lens and insurance companies cover the lens as part of the surgical procedure. You will be responsible for any deductibles and co-pays associated with the procedure.

Monovision If you have been successful with monovision in your contacts or glasses, you might consider having an IOL in one eye that provides near vision and an IOL in the other eye that provides distance vision. Usually people can adjust to this, but if you can't, your vision may be blurred at both near and far. Another problem is that depth perception may decrease because there is less binocular vision — meaning, your eyes aren't working together as they once did. There are no additional costs associated with monovision. Again, this only recommended when it has been tried prior to surgery, and has been successful.

Astigmatism Correcting Lens (Toric® IOL) The Astigmatism Correcting Lens is ideal if you have visually significant corneal astigmatism. Corneal astigmatism occurs when the cornea is not perfectly spherical and is instead slightly oval in shape. The AcrySof Toric IOL has built in astigmatic correction which is used to counterbalance and correct the corneal astigmatism. This provides exceptional single focus vision (or you see clearly at one distant point) making it an excellent choice for the best distance vision after surgery without the need for glasses in most cases. Reading glasses, however, will still be required in order to see up close. The Astigmatism Correcting IOL also provides an excellent choice for patients who enjoy monovision and have astigmatism. It is a way to reduce the dependence on glasses. The single focus vision provided by these IOL’s is superior to that from the traditional monofocal IOL’s. Along with the extra lens, an additional surgical procedure may be performed. Limbal Relaxing Incisions (LRI’s) are small relaxing incisions in the limbus, which allows the cornea to become more rounded when it heals. Astigmatism Correcting IOL additional fees per eye. Physician Fee: $300 Surgical Facility: $350 (These fees may vary) These fees are for the extra testing necessary before surgery, the added cost of the Premium IOL, and the extra corneal surgical step needed in most cases at the time of surgery.

Multifocal IOL (ReSTOR® IOL) Multifocal Lenses will provide you with good vision at distance and at near. With multifocal lenses, you won't need glasses for most activities, and, if there are times when you do need them, your glasses require a much milder prescription than with monofocal lenses. Instead of a flat surface, the multifocal implant lens has a multi-tiered surface rising in concentric rings from the edge to the center. This proven design both transmits and gathers light evenly over a full

Learning More about

IOL Options

range of distances. In the multifocal implant lens, the thin outer edge focuses images from distant sources, the thicker center focuses near images, and the steps between focus on ranges between the two extremes. The Multifocal (IOL) offers most patients the benefit of life without heavy reliance on glasses. In a clinical study, 80 percent of patients who received the Multifocal IOL in both eyes reported that they didn't need glasses after the surgery. Only about 10 percent of patients with monofocal IOL report the same result. Most patients who do need glasses will benefit from a milder prescription, resulting in glasses that are noticeably lighter. Chances are they will need their glasses much less often than users of monofocal IOLs.

Along with the extra lens, an additional surgical procedure may be performed, the Limbal Relaxing Incisions (LRI’s). These are typically performed if there is significant corneal astigmatism.

Multifocal IOL additional fees per eye. Physician Fee: $800 Surgical Facility: $800 (These fees may vary) These fees are for the extra testing necessary before surgery, the added cost of the Premium IOL, and the extra corneal surgical step needed in most cases at the time of surgery. Although rare, some patients may require a slight refractive adjustment to your vision after the cataract surgery with LASIK vision correction. There cannot be any residual near-sightedness, far-sightedness, or astigmatism after the cataract surgery for the Premium IOL’s to work optimally. Although some physicians charge a discounted fee if LASIK is needed, Dr. Affleck will provide the LASIK vision correction at no additional cost if needed.

Insurance Coverage and Financing Fortunately, most people needing cataract surgery are covered at least in part by some kind of health insurance company such as Medicare or a commercial insurance for those aspects of the procedure that are considered medically necessary. The cost of cataract surgery depends on many variables, such as the type of procedure you have and the intraocular lens (IOL) implanted in your eye. While Medicare and many insurance providers cover the traditional monofocal lens, they consider the implantation of high-tech, "premium" lens as medically unnecessary. Therefore, any extra costs directly associated with this more expensive type of lens and the additional surgical procedures must be paid for out-of-pocket.

Insurance Providers argue that premium lenses are not medically necessary because 1) Reading glasses are much less expensive than premium IOLs and easily can provide you with functional vision. 2) Many people must pay for and wear eyeglasses that correct common refractive errors such as nearsightedness and farsightedness. Regular health insurance typically doesn't cover you for these kinds of vision problems. 3) When people undergo refractive surgery such as LASIK to correct common vision errors, they also must pay full costs that typically aren't covered by insurance. Again, this is because surgical vision correction of this nature is considered cosmetic or medically unnecessary because you have the option of wearing much less expensive eyeglasses.

So, while the costs of a basic cataract procedure and standard IOL would be covered by an insurance provider and you will be responsible for any deductible or co-payment of the portion of the procedure covered by insurance. You would need to pay out-of-pocket for any extra expense associated with a premium (Toric or Multifocal) lens that may help perfect your vision.

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Aaron J. Affleck, MD, 2900 Valencia Drive, Idaho Falls, ID 83404Phone 208-523-6868, Fax 208-523-7272, LOVEhealthyEYES.com

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You’ll find so many differences that make Affleck, MD Eye Care and Dr. Affleck the right place for YOUR eye care that you’ll wonder why you considered anywhere else.

Doctor/Patient relationship Many of our patients have been amazed to learn that Dr. Affleck personally sees you for your pre-operative appointment. Dr. Affleck believes outstanding eye care starts by spending appropriate individual time with patients. He does your exam, educates you about your condition, and discusses your options. Together you and Dr. Affleck create your individual treatment plan.

At Affleck, MD Eye Care you will find an optimized schedule that allows time for Dr. Affleck to personally provide his skills to all areas of patients care. Dr. Affleck personally executes any needed measurements for your procedure, not relying on someone else’s calculations. You are guaranteed that your best health interests are met because Dr. Affleck administers all the treatments whether it is a surgical procedure or simple in office care.

Dr. Affleck and you will see "eye to eye" and develop a relationship with respect. You will not find an “assembly line” environment or only briefly meet the doctor before surgery.

Dr. Affleck continues his remarkable patient care with you by participating in all your follow-up care scheduled at Affleck, M.D. Eye Care. You will visit with Dr. Affleck at every appointment, ensuring answers to all your questions from your surgeon! Dr. Affleck understands that every experience is individual and appreciates following his patients and ensuring their best possible outcome! Experience and Training With over two decades of experience and thousands of successful surgeries Dr. Affleck has seen many changes in techniques, lasers, and treatable prescriptions. This gives him the experience to personalize your procedure based on past experience. Sight is precious and this area of medicine has ever-changing medical technology and techniques.

Seeing Eye To Eye with Aaron J. Affleck, M.D. The Differences Matter…

Dr. Affleck is proactive in staying up-to–date in his knowledge and skills in this constantly evolving field. He blends advance medicine, cost and benefits to bring to you remarkable and satisfying results. Surgical Outcomes Dr. Affleck’s complication rates in all his surgeries and treatments are lower than the national average. He has a passion for what he does and for the patients he treats which make him an indispensable surgeon. As you ask around to your family, neighbors and friends you will learn you have put your trust in the right hands.

"I would certainly recommend Dr. Affleck to anyone because I know that he will take the time to look at your problem, talk to you, make sure you understand what he can do, and what your result most likely will be. I found out that everything I expected was above and beyond my expectation." Doug “Dr. Affleck was awesome, I had all trust in him for the surgery, he was wonderful, I had complete peace about him doing the surgery on my boy.” Tiffany "Oh I would recommend him in a heartbeat, he does a good job, he's gentle, he's explains everything to you, his bed side manner is great. He cares.” Elaine

Staff and More! Our staff love patients! We have a team of 5 employees with over 30 years of experience in the medical field. The staff is trained on the latest equipment, EMR, and ophthalmic techniques enabling us to provide you the best possible patient care!

You will find Dr. Affleck and his team’s first priority is the safety and quality of your eye care. You deserve the best possible care and we are committed to delivering high standards to you by being patient focused, gaining continuing education and working closely with your network of caregivers

Ultimately your surgeon's skill and experience will be the most important factors affecting your outcome!

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Aaron J. Affleck, MD, 2900 Valencia Drive, Idaho Falls, ID 83404Phone 208-523-6868, Fax 208-523-7272, LOVEhealthyEYES.com

Cataract Surgical Documents

Aaron J. Affleck, MD 2900 Valencia Drive. Idaho Falls, ID 83404

LOVEhealthyEYES.com Phone: 208-523-6868 After hrs 208-557-7567

Due to these complexities of insurance plans Affleck, M.D. Eye Care, Aaron J. Affleck, M.D. and staff members cannot make warranties of any fees or charges in advance of health-related services. What we can provide are basic CPT codes for your visit, treatment or surgery. What is a CPT code? A CPT code is an acronym for Current Procedural Terminology. The purpose of the coding system is to provide uniform language that accurately describes medical, surgical, and diagnostic services. Why do CPT codes help? They determine the amount of reimbursement Dr. Affleck will receive from your insurance company. The amount Dr. Affleck receives for a specific code can vary depending on the insurance company. The codes also determine how much you may need to pay out-of-pocket through co-payments, coinsurance and etc. How to use CPT codes? In the table on the next page is a list of codes that may be used to describe the visit, treatment or surgery. Call your insurance company and ask for an approximately cost analysis of the CPT Codes in your plan and you will better understand your out-of-pocket costs.

Remember to ask about the following also: Is Dr. Affleck in-network provider? What are the allowable charges? What are my annual deductible, coinsurance, and/or copayments? Are their exclusions, or limitation? Are referrals and pre-authorizations required? Is there anything else in my plan that will effect payment of services or my out-of-pocket costs? You may also have a secondary or supplemental insurance which you should also call for estimated costs and coverage. Kindly understand, you are an individual, with distinctive needs of health-related services. Therefore, we cannot be responsible for providing the exact CPT or all the CPT codes which will be used for your future visit, treatment or surgery in question. It can only give you a starting point. If the future visit, treatment or surgery in question will be performed in another location other than Affleck, M.D. Eye Care, with anesthesia please contact the facility for their charging information. Here is the work sheet for the exam, evaluation, tests and measurement to determine if you need cataracts, and if so what kind of lens will Dr. Affleck recommend.

DIRECTORY FOR SURGICAL FACILITIES

Facility Phone Number Contact Name

The Mountain View Hospital Annex: Ambulatory Surgical Center 208-557-2871 Billing/Patient Accounts

Mountain View Hospital 208-557-2871 Billing/Patient Accounts

Eastern Idaho Regional Medical Center (EIRMC) 208-529-6090 Billing Department

Cataract Surgical Documents

APPROXIMATELY COST ANALYSIS WORKSHEET Disclaimer: Medicare’s allowables are subject to change and vary with your insurance agreement. More CPT services may be added or not performed. This is not guaranteed pricing.

SURGERY

CPT Code is in bold Other insurance

Your ?% out of pocket

Medicare allowable Your 20% out of pocket

1. Dr. Affleck surgical fee

Removal of cataract: 66984

+$ + $694.69 + $138.94

2. MVH Surgical Facility fee

Removal of cataract 66984

+$ + $1,644.18 + $328.84

3. Anesthesia Removal of cataract: 66984

+ $ $124.80 to $249.60 +

+ $24.93 to $50.00

Subtotal from 1-3: $492.71 to

$517.70

PREMIUM IOL FEEs

*Not available to all, you must be a candidate and fees are normally not paid by insurances. CPT Code is in bold Other insurance Medicare allowable

4. (optional) Surgical facility premium IOL fee

(optional) * ReSTOR IOL: V2788

or Toric IOL: V2788

$?paid by insurance (optional & full amount due in advance)* + $900 or $350

$0.00 paid by Medicare optional & full amount due in advance)* + $у00 or $350

5. (optional) Dr. Affleck’s surgical fee for premium IOL

(optional) * ReSTOR IOL: V2788

or Toric IOL: V2788

$? paid by insurance (optional & full amount due in advance)* + $800 or $300

$0.00 paid by Medicare (optional & full amount due in

advance)* + $800 or $300

Subtotal from 4-5:

Add annual deductible, coinsurance, balance billing, copayments and/or etc.

TOTAL from 1-5:

DR. AFFLECK’S EXAM & CONSULT

Other insurances Allowable

Your ?% out of pocket

Medicare Allowable

Your 20% out of pocket

Evaluation & Management: CPT Code for a new patient 92004

+ $ + $ + $140.73 +$28.15

OR Evaluation & Management: CPT Code for an established patient 92004

Or + $

Or + $

Or + $116.98

Or +$23.40

Tests / measurements: CPT Code: 92136

+ $ + $ + $79.85 +$16.00

Refraction: CPT Code: 92015 + $ + $ + $0.00 +$0.00

Subtotal + $67.55

Add annual deductible, coinsurance, balance billing, copayments and/or etc.

Total:

Vision Preference

Questionnaire

Zone 1

Zone 2

Zone 3

The Treatment Best Suited To

Your Visual Needs.

What is your vision preference?

If undergoing cataract surgery, this questionnaire will help us provide the treatment best suited to your visual needs. It is important to understand many patients still need to wear glasses for some activities after surgery, but due to recent technological advances, we are now able to offer the possibility for you to be potentially free from glasses. If you have questions, please let us know and we will be happy to assist you.

Taking a minute to fill out the following will help you and Dr. Affleck better understand your lifestyle.

Would you like glasses-free distance vision? � I’d rather not wear glasses for distance vision. � I wouldn’t mind wearing glasses for distance vision.

Would you like to see up close without glasses? � I’d rather not wear glasses for near vision. �I don’t mind wearing reading glasses.

Zone 1 Zone 2 Zone 3

Reading Sewing

Applying Make-up Working Crossword

Puzzles

Shaving Emailing Cooking

Reading Labels on Shelf

Watching TV

Driving Watching Movies

Golfing

Which “Zone of Vision” is most important to you? PLEASE CHOOSE ONLY ONE.

� Zone 1 � Zone 2 � Zone 3

If you had to wear glasses after surgery for one zone, which would it be?

� Zone 1 � Zone 2 � Zone 3

How important is it to be free from glasses for your daily activities?

� Very important � Moderately important � Not important

Place an “X” on the following scale to describe your personality as best you can:

Easygoing Perfectionist

Vision Preference with CATARACT SURGERY

Aaron J. Affleck, MD, 2900 Valencia Drive, Idaho Falls, ID 83404 Phone 208-523-6868, Fax 208-523-7272, www.LOVEhealthyEYES.com