Opthalmologist Stated I Needed 4-way Lid Surgery but Medicare Denied?

Have constant eye infections. Recently Opthalmologist told me I need surgery on upper/lower lids as they're turning inward causing constant irritation. Medicines ineffective. Have small ''bump" in corner under lid filled with white? Was told could scratch eye & affect vision. Vision Field test supported DX. Am seeing small bright spots in dark & floaters. Could this be permanent? Am on SSD, said Medicare denied. Why? Must I use optic surgeon vs plastic surgeon? I want to see!!

Doctor Answers 4

Opthalmologist Stated I Needed 4-way Lid Surgery but Medicare Denied?

It sounds like you have a lot of issues going on that an Oculoplastic Surgeon can help you with.  In terms of the Medicare coverage, your physician should know the guidelines.  Cosmetic surgery is not covered by Medicare but reconstructive surgery is.

Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Opthalmologist Stated I Needed 4-way Lid Surgery but Medicare Denied

Sorry for the issues medically and economic. But you should seek MORE opinions and ask foer a review of your predetermination of surgical benefits. I'm confuse why your first surgeon did not? From MIAMI Dr. Darryl J. Blinski, 305 598 0091

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

You need an Oculoplastic Surgeon!

Dear Tampa, 

       Without examining you myself, it is very difficult to ascertain what is going on exactly.  You may have a condition call Entropion, where the eyelid rolls in and the eyelashes rub and scratch the eye.  Medicines do not help and unfortunately surgery would be the only solution.  This is definitely a medical problem that i would expect to be covered by insurance, and generally performed by an oculoplastic surgeon like myself, rather than a general plastic surgeon.  Depending on your examination, you may also qualify for upper eyelid surgery as well if it obstructs your peripheral vision.  As far as your floaters and bright spots, you should have a full dilated eye exam to ensure you don't have any problems with your retinas.  My practice is in Largo and I'd be happy to consult with you if you like.  Good luck.

Jasmine Mohadjer, MD
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Generally this would be something that will be covered by medicare.

This type of care is specialized.  You will benefit from the care of an oculoplastic surgeon.  It is important that whoever provides this care is able to carefully examine the eyelid and the eye surface.  The only surgeons who have the necessary microscope, called a slit lamp, are ophthalmologists or oculoplastic surgeons who are board certified ophthalmologists fellowship trained in oculoplastic surgery.  General plastic surgeons do not have this essential piece of equipment in their offices making it difficult to diagnoses and assess the care of these types of eyelid problems.  

Medicare does not require a prior authorization so it is difficult to understand why you were denied coverage for this service.  If the ophthalmologist you saw advised you that it was not a covered service, you should find another provider.  ASOPRS, the American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a website: ASOPRS.org that has a geographic listing for specialists which will help you find someone in your area.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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