Eyelid Surgery: Q&A
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My Eyelids Are Closing Because of Droopy Upper Lids and I Was Wondering if Medicare Will Pay Surgery?
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11 Doctor Answers |
Asked by
charleybill
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Will insurance cover upper eyelid surgery?
Medicare and other insurances will cover upper eyelid ptosis repair and blepharoplasty if certain criterion are met. First, the margin of the upper lid needs to be a certain distance away from the center of the pupil, usually less than 2mm. Second, visual field testing must demonstrate significant visual field restriction due to the drooping lids. Finally, some insurance companies will also want to see photographs. An experienced oculoplastic surgeon should be able to...
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Droopy Upper Eyelids Covered by Insurance
Droopy upper eyelid correction surgery may be covered by insurance provided that documentation of impairment of visual fields can be obtained. Find the plastic surgeon with best credentials who performs these surgeries every day.
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Medicare often covers eyelid surgery
All insurance carriers including Medicare have guidelines on when they will cover eyelid surgery. You have to show that it affects the vision in some way. Your doctor will make measurements of your eyelid position and test your peripheral vision. They will also take photographs from several angles. These are all used to determine if you qualify.
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It depends on the degree of visual obstruction
There are two conditions that may possibly be covered:
1. Eyelid ptosis [droopy upper eyelid]
2. Excess upper eyelid skin [dermatochalasis] that hangs over lashes into line of sight.
You would need photos and visual fields done by an Ophthalmologists to confirm these findings.
Your best bet would be to see an Oculoplastics surgeon that does this kind of evaluation and surgery day in and day out.
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Insurance coverage of droopy eyelids
In general insurance is covering less and less of non urgent conditions. At least in Chicago there has been a trend away from coverage. Your chances are the best if the droop of your upper lids is a true ptosis. This means that the margin of the eyelid sits low relative to the pupil when you look straight ahead. If the problem is just loose overhanging skin, coverage is less likely. If you want to try for coverage, it will be necessary for you to undergo visual...
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Medicare payment for blepharoptosis
In NY, I have found that Medicare will not automatically cover this procedure. Field of vision studies can easily be faked and this procedure is on the "hit list". They will cover unilateral ptosis repair as the result of stroke, myasthenia gravis, multiple sclerosis, etc.--all conditions that you don't want to have. I have had one bilateral upper lid bleph covered where the upper lid skin literally hung over and obstructed vision. Generally, since Medicare will not preauthorize...
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Will insurance pay for my eyelid surgery?
Dear Charlie
The answer is often times yes. Medicare is actually pretty good about paying for upper eyelid surgery with her before excess skin that is causing visual field loss or true upper eyelid ptosis. In fact there are some lower eyelid conditions that require surgery that Medicare will pay for. Essentially you need to start your evaluation and consultation series with an ophthalmologist who will determine whether or not there is sufficient laxity or ptosis or what have...
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My Eyelids Are Closing Because of Droopy Upper Lids and I Was Wondering if Medicare Will Pay Surgery?
Medicare will typically cover an upper blepharoplasty if your drooping eyelids interfere with your vision. This requires photos and functional visual field testing to confirm that the eyelid skin interferes with vision. Often, the skin must be hanging over your eyelashes to reach the point that medicare or private insurance will authorize the procedure. I hope this information is helpful.
Stephen Weber, M.D., F.A.C.S.
Lone Tree Facial Plastic Surgeon
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Does insurance pay for droopy eyelid surgery?
If the upper eyelid droopiness (ptosis) is significant enough, then medicare or other insurance may cover it. The significant part is determined by a few tests (visual field test, photos, etc) and examination. See an oculoplastic surgeon for evaluation.
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When Insurance Pays for "Cosmetic" Surgery
The only cosmetic procedure that may be covered by medical insurance or Medicare is upper eyelid surgery. In these special cases, the upper eyelid skin is so heavy that it hangs onto the eyelashes and obstructs the peripheral vision. You will be required preoperatively to prove you have this type of visual defect. Your surgeon will request that you see an eye doctor and have a test done called "visual fields." This test checks your peripheral vision. It must be performed twice: with your...
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