I Have Had a Droopy Eyelid for a Few Months. I Have Researched and I Think It's Ptosis? (photo)

Would my insurance cover surgery? I have blue cross ppo Anthem I live in California.

Doctor Answers 5

Ptosis surgery

Based on the photo alone, it seems likely that the right side would be covered, and the left side would not. But an in person examination is necessary to see if you are compensating with your eyebrows, and to do a formal visual field to assess the possible vision compromise.

I would recommend an ASOPRS trained oculoplastics surgeon. You can find one close to you using the link I've provided for you below.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Ptosis surgery and insurance coverage

thank you for the question

this is a very general statement and first things first you need to be evaluated by an ophthalmologist. That being said, you do appear to have ptosis possibly bilaterally and worse on the right than the left. The right side may be covered but the left side may not. Insurance carriers are very strict about this. Even if insurance covers your right I and your surgeon offers to operate on your left eye at the same time that no additional charge that is considered fraud and could be very problematic for yourself and your surgeon. However, all you really need to do is be evaluated and in order to determine whether or not insurance will cover it you'll have to have visual field testing and good photographs and a thorough note from your doctor.

Best of luck

Chase Lay, MD

double board certified facial plastic surgeon

eyelid surgery specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

I Have Had a Droopy Eyelid for a Few Months. I Have Researched and I Think It's Ptosis?

It depends on the heath plan you have in exact restrictions and coverages allowed. Best to see an eye doctor for a visual fields examination. Than address a letter of predetermination to your healthy carrier. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Droopy Eyelid treatment should involve both eyelids

Based on the photos you have droopy eyelid or ptosis ( pronounced TOE-SIS). It is more noticeable on one side, but the other side will be affected as well. Function of both eyelids are controlled by a central location in the brain by a mechanism called ( adaptive gain control) , in a manner similar the control of a two horses carriage by a set of reins. Personally, I believe in fixing both eyelids. In Australia, insurance cover is less of a problem than in the US ( at least for the time being, it will change in the future).

Naveen Somia, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 74 reviews

Ptosis surgery covered by insurance?

You do appear to have upper lid ptosis. It may or may not be bad enough for insurance to cover it.  The answer requires a few tests, including a visual field test to check how much the ptosis is obstructing the vision. See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 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.