Do you think Medicare will pay to fix my drooping eyelid? (photo)

Question

The drooping eyelid is on my weaker eye and has continued to drop over the years.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon to discuss financing and insurance options.
Best wishes,

Curtis Wong, MD · Answer

is the edge is already over the pupil and has to be obscuring your vision on that side.  Get a visual field exam (and don't cheat and try to open your eyes up wide - you want to fail) and your doctor can refer you to someone to repair this for you.  Your brows are also very low and you could benefit from a browlift if you were accepting of the risks, scarring, and costs as this would be a cosmetic procedure.

J. Timothy Heffernan, MD · Answer

Thank you for your question. Insurance companies want to see how much your drooping eyelids are affecting your vision before they decide if a blepharoplasty would be medically necessary. I would recommend scheduling a Visual Field test along with consultation with an oculoplastic surgeon to discuss your individual needs. Best of luck, Dr. Heffernan

Anup Patel, MD, MBA, FACS · Answer

I recommend you schedule a consultation with an experienced plastic surgeon to assess your condition. Depending on the reason of your eyelid drooping (ptosis) it may or may not be something that could be approved by insurance.

Myriam Loyo, MD · Answer

Hi there, thank you for sharing your photo and question. It looks like you have eyelid ptosis and that is usually covered by your medical insurance. Although most of the time the eyelid drops due to aging, sometimes there is an underlying condition. It is important that you have an evaluation by a doctor. My recommendation is that you seek a consultation with an oculoplastic surgeon in your area. Hope this helps! Good luck

Joel M. Stewart, Jr., MD · Answer

In short yes, but it is more complicated than that.
From your photo it looks as though you also have some degree of ptosis which results from disruption of the muscle that raises the eyelid. Of course, an exam is necessary to determine this. However, a blepharoplasty may only be part of what you need to correct your upper lids.
Best of luck.

Joseph L. Hill Jr., MD · Answer

Thank you for your question.  Your droopy eyelid is likely the result of a weakened eyelid muscle that helps lift your eyelid.  My suspicion is that if this eyelid muscle were to be tightened, your stronger left eyelid would then droop.  I would recommend bilateral upper eyelid lift with tightening of the internal eyelid muscle elevator.  Medicare is tricky in that you cannot pre approve surgeries.  A visual field test will be required to show a deficit in your gaze due to your droopy eyelid along with pictures.  These will then be submitted to Medicare along with your surgical claim.  Medicare will then decide whether they will cover your claim after your surgery has been completed.  We typically have patients sign a waiver stating that if Medicare does not cover the claim, the patient is responsible for the bill.  That is why Medicare claims are tricky.  My suspicion is that a visual field test will show a deficit and your surgery will be covered; however, no one can truly predict how Medicare will act.

Do you think Medicare will pay to fix my drooping eyelid? (photo)

Answers (7)

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