Will Medicare pay for a ptosis revision or another redo of what wasn't done right the first time?

Question

Medicare approved ptosis surgery in May 2018, both eyes. after 2 mos. left eye still not open and even with right eye now have excess skin hanging, but I can see a lot better. Had revision, he opened up the corner of left eye more, smoothed out stitch lines. STILL looks bad. Left eye not equal to right eye and now have hanging skin on both lids. Not satisfied and not sure if I want to let him redo it again. Will Medicare cover a second opinion and another surgery to correct his failure?

Joseph Walrath, MD · Answer

Hi there,
It seems to me unlikely that insurance will cover revision surgery in your case, based on your description, because it sounds like you have had significant visual benefit from the ptosis repair that you had.  Your complaints at this point are based on appearance.
It is often hard to separate what is cosmetic and what is functional / medical in upper eyelid surgery.  It sounds to me like you have had good surgery, which has met the stated goal of improving your vision.
I personally treat every upper lid case like a cosmetic case, because I'm a sucker for doing free revisions.  If you do a free revision on a Medicare case, the case is basically a financial loss due to low federal reimbursement levels.  Therefore, I can't really tolerate avoidable revisions.  Nevertheless, revisions (usually minor) DO happen, and I do them without hesitation, so as to do my best to make patients happy with the care they have received.  I am willing to bet that your surgeon would do the same.

Best,
JDW

Jasmine Mohadjer, MD · Answer

If you are still having visual problems, and loss of peripheral vision, then Medicare will likely cover the exam.  However, if your concern is mostly about what the eyelids look like, then that would be considered a cosmetic consult and would not be covered by insurance.  I would recommend you seek the advice of an oculoplastic surgeon and bring all your previous notes and operative reports with you so the new doctor will have all the information to give you a good second opinion.  Unfortunately sometimes with a droopy eyelid, the muscle can be so degenerated that it does not lift up very well with traditional eyelid surgery. However, there are some other alternatives that an eyelid surgeon can discuss with you if needed.Good luck

Will Medicare pay for a ptosis revision or another redo of what wasn't done right the first time?

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Will Medicare pay for a ptosis revision or another redo of what wasn't done right the first time?

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Recommended reading

Everything you need to know about Ptosis Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.