If my vision is impaired due to eyelid sagging, can is be covered by medicare? (photos)

I notice my eyelids make it difficult for me to see normally..and makes me force my eyes open like a deer in headlights..

Doctor Answers 9

Eyelid laxity and vision impairment

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Hello,Thank you for your pictures and questions.  It is possible to utilize your insurance if there is visual impairment, but it requires going to see an ophthalmologist to check your vision and your visual fields.  If these tests are positive for visual field loss, there is a good chance your insurance would cover the procedure or part of the procedure.  Best of luck!

San Jose Facial Plastic Surgeon
5.0 out of 5 stars 1 review

If my vision is impaired due to eyelid sagging, can is be covered by medicare?

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Although Medicare will usually not commit to approving and guarantying payment, if your lateral vision is impaired and documented by an ophthalmologist, a plastic surgeon will usually be paid by Medicare for the surgery.

Fred Suess, MD (retired)
San Francisco Plastic Surgeon

Obscured visual fields

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will qualify you for a covered blepharoplasty but your photos need to document the skin hanging over the pupil and yours is questionable at this time.  Best to invest in a consultation with a Medicare provider to get more information.  If you wish to pay out of pocket, costs can range from $999 through $1700, when done in the office under local.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Insurance coverage for upper eyelid surgery

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  Patients must have significant and severe visual obstruction documented on examination, photographs and visual field obstruction tests to qualify for any insurance to cover for upper eyelid surgery for functional purposes. Always be prepared to pay for the surgery  yourself in case medical insurance denies the procedure

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Droopy lid surgery paid by Medicare?

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Medicare does not behave like commercial health insurance. PPO insurance will make their own determination for coverage using exam notes, photos and results of visual field tests. Medicare does not provide pre-authorization for surgery so we document the findings, do the surgery then bill Medicare. Usually they pay us but we cannot guarantee that. If they don't we will bill you. If they do then you or your supplemental insurance will be responsible for the remaining 20%.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 42 reviews

Twenty years ago, no question, health insurance would cover this.

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The criteria for what is and is not considered medically necessary very much depends on who is providing your health insurance.  Many health insurance programs would regard your issue as cosmetic.  See an oculoplastic surgeon who participates with your health insurance.  They will know the details of your program and what is covered.  

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

If my vision is impaired due to eyelid sagging, can is be covered by medicare?

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Yes, if you can prove loss of visual field due to heavy and excess eyelid skin, insurance usually covers the surgery. It requires a visual field exam. BTW, the skin does not affect visual accuity, it is nothing more than a block, like the bill of a baseball hat. So do not expect eyelid surgery to improve your vision, just to widen your visual field, ie peripheral vision.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Blepharoplasty: insurance coverage

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Blepharoplasty (upper eyelid surgery) has the potential to be covered by insurance if there is a functional issue.
It requires an examination by your eye doctor to show your field of vision now and your field of vision after taping or other means of lifting the skin on your eyelid. 
This may mean you need to meet with an eyelid surgeon (oculoplastic surgeon) or a plastic surgeon and an ophthalmologist (eye doctor), depending on the available providers in your area. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Medically necessary Blepharoplasty

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You need an evaluation by an eye surgeon.If he can determine that the operation is medically necessary your insurance may help cover the costs. Best wishes.

Fernando Colon, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 17 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.