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My Eyelids Are Closing Because of Droopy Upper Lids and I Was Wondering if Medicare Will Pay Surgery?

Doctor Answers (11)

Will insurance cover upper eyelid surgery?

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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 tell you whether your insurance will cover the procedure prior to having it done.

Springfield Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

Droopy Upper Eyelids Covered by Insurance

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   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.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 149 reviews

Medicare often covers eyelid surgery

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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.  

Web reference: http://utahoc.com/droopy-eyelids-ptosis/

Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

It depends on the degree of visual obstruction

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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.

Web reference: http://seattleface.com/html/dr_amadi.php

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 19 reviews

Insurance coverage of droopy eyelids

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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 field testing submit photos.  Even then it is far from a sure thing.

Chicago Plastic Surgeon
5.0 out of 5 stars 7 reviews

Medicare payment for blepharoptosis

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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 procedures, patients have to sign the waiver, pay for the surgery and then keep their fingers crossed. I would not accept assignment and assume that it would be covered.
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Will insurance pay for my eyelid surgery?

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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 you to justify surgery for functional purposes. Overall the surgery should should be pretty smooth and your recovery should be about 1 to 2 weeks.

 

I hope that was helpful

 

Chase Lay, MD

Web reference: http://chaselaymd.com/Ptosis.php

Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

My Eyelids Are Closing Because of Droopy Upper Lids and I Was Wondering if Medicare Will Pay Surgery?

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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 MD, FACS

Web reference: http://weberfacialplasticsurgery.com/blepharoplasty/

Denver Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Does insurance pay for droopy eyelid surgery?

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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.

Web reference: http://www.tabanmd.com/ptosis-droopy-upper-eyelid

Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

When Insurance Pays for "Cosmetic" Surgery

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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 eyelids taped up (to remove the skin from your field of vision) and untaped. The test done with the lids taped can show if you see better with the extra skin removed. Your surgeon will be required to submit the visual field testing as well as photographs for the insurance company to decide if they will cover the procedure. Years ago, doctors could send the information BEFORE surgery and get a preoperative approval for covering the surgery. The companies won't do that anymore, so you do take a little chance that they will not cover the surgery after it has been performed. In that case, you would be liable for the cost of the procedure. Discuss these issues with your surgeon preoperatively and he or she can probably advise you on the chances of the surgery being covered based on the severity of your visual field deficit.

Web reference: http://facialplasticsurgerymd.com

Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.