Does Insurance Ever Pay for Brow Lift...Medicare?

A brow lift isn’t usually covered by insurance. However, your brow lift or an eyelid lift (blepharoplasty) may be covered because of how your vision is being affected. To determine validity, you would require your doctor or surgeon to recommend the procedure as a treatment to correct your vision problem.

I recommend you undergo a visual field test.  If lifting your brow clears your visual field and improves your sight, then Medicare may cover a brow lift.  If this does not, then they will not cover a brow lift.  The second diffuctly will be finding a doctor who will accept Medicare payment for a brow lift.

Best Wishes,

Gary Horndeski, M.D.

Insurance coverage for browlifts, endoscopic, coronal, hairline


it is rare but can happen

medicare and other insurance may pay as little as 10-20%of doctors fee

this is why many doctors will not accept insurance even when covered

you must be examined by an opthamologist to show that it is a functional problem

With all due respect to the experts weighing in on this subject, as  Oculoplastics surgeons, we deal with the issue of brow ptosis more than any other subspecialty. This includes both cosmetic brow ptosis AND visually significant brow ptosis [within 20 degrees of central fixation].

And while COMPREHENSIVE ophthalmologists may not have the breadth of training to perform the various techniques of browlifting, OCULOPLASTIC SURGEONS have 2 additional years of training in facial plastic and reconstructive surgery, mostly focusing on periocular area, and  are extremely well trained in this area. We perform endoscopic, pretrichial, coronal, direct, and midforehead lifts, depending on the patients anatomy and hairline, for both cosmetic AND visually significant brow ptosis.

Though getting a browlift approved by insurance [or fitting the Medicare criteria] is more difficult, it can be and is often done successfully by Oculoplastics surgeons, who can not only perform the testing required, but have the judgement and skill to address the problem surgically.

One thing you should be aware of is that the different techniques of browlifting can take significant more time and effort on the surgeons part than others, and some techniques are more effective for visually significant brow ptosis than others.

For example, although an endoscopic browlift provides the most cosmetically appealing incisions, it does not provide an aggressive enough lift to improve a brow droop that is TRULY causing visual compromise.

Also, a pretrichial browlift takes significantly more time and effort for the surgeon, and many surgeons do not feel that the re-imbursement from medicare or insurance is adequate for that time/effort/skill required, and may only offer a "direct" browlift [incision made directly above the eyebrows], which provides the most effect lift in terms of improving the visual field, but has the most obvious incision site.

So if you really feel that you have a visually significant brow ptosis [and in all honesty, most patients do not] your best option is a consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.

Good luck

 

Medicare and other insurances usually do not pay for a browlift because generally an eyelid lift will correct the visual field problem. However, cosmetically speaking, a brow lift may do a better job, but insurance only pays for for a procedure if it is "medically necessary". They will pay for the cheaper procedure which is the blepharopasty (upper eyelid lift).

It is very unlikely that one could really justify all of the medical criteria necessary for a brow lift with medicare. 

The short answer is most probably NOT. Now the longer and more thorough answer.

Medicare is NOT "Medical Insurance" in the sense companies like BlueCross BlueShield and others are. With other companies, you must see a surgeon who accepted their terms (aka "a participating provider") who after examining you would submit a written request to the insurance company (including supporting exams and photographs) asking for them to authorize the surgery BEFORE performing it. Then after a rigmarole of 4-10 weeks the surgeon would be told if the surgery was authorized or not ("precertified"). Since a browlift is considered a cosmetic operation in most cases, it is rarely approved.

How does this apply to Medicare in 2012? Medicare NEVER knowingly pays for Cosmetic Surgery. Nor does it precertify any operations making it hard to know BEFORE going to the OR that the surgeon, anesthesiologist and facility will be compensated.

Regardless if you wear a Blue or Red T-shirt, both parties agree that if we do not take steps now to save it, our Medicare projected to go bankrupt in less than 10 years. HHC / Medicare is a HUGE department in which Billions more are spent on wheelchairs and bedside commodes, for examples, than on surgeons' reimbursement. Nonetheless, our Government is telling us that "cutting back of waste and curruption" will correct things. Unfortunately, every president since Jimmy Carter tried doing so without much success. While stopping corruption IS important radically slashing doctors' reimbursement and refusing to pay for operations has resulted in MANY surgeons declining to operate on Medicare patients especially if they THINK the operation will not be paid. Worse yet, if the operation if followed by an official HHS fraud and abuse investigation of the surgeon.

Most conscientious surgeons regret this situation and cringe every time we see a know-nothing politician grabbing a microphone to comment on health care. If these bastards shared the SAME insurance plan as us, Medicare would have been fixed overnight.

It is always difficult or impossible to determine, prior to surgery, if Medicare will cover a procedure such as a brow lift.  You will first need to have an examination determining that the brows are the primary problem and as documentation you will need to have a field of vision study.  

This procedure is very frequently covered by insurance.  Even though Medicare does not pre-authorize the procedure, the standards are quite clear so it is generally easy for your surgeon to determine coverage.  The process starts with an appointment to determine the functional problems associated with a depressed brow.  These include forehead fatigue, visual problems, chronic headache, etc.  Photos will generally be taken and you will be referred to an ophthalmologist for visual field testing.  This will determine what percentage of your vision is being blocked.  Once this information is obtained, your surgeon will know whether your procedure is medically necessary.

A few words of advice.  Start with a plastic surgeon rather than an eye doctor.  They are better trained to perform brow lifts.  If the surgeon you choose determines that you would not be covered by insurance without visual field testing, find another plastic surgeon.  Reimbursement is significantly greater when a brow lift is performed as a cosmetic procedure.  Doctors of questionable ethics will try and convince you that it is cosmetic without testing.  Finally, even though it may be an insurance based surgery, make sure that your plastic surgeon has an aesthetic eye.  After rhinoplasty, brow lift is one of the most difficult surgeries to do well.  To give you a sense of what qualifies for insurance and end results, look at the photos in my RealSelf album.  Both of these were insurance based procedures.

Rarely would brow lift be covered by medicare and they never preauthorize any procedures. In the past we have had patients see their ophthalmologist to get a test called visual field. They measure your peripheral vision first with your brows in their natural position and then repeat the test with the brows raised. If there is significant improvement with raised brows there is the possibility of insurance coverage. You would probably need to find someone first who accepts medicare, then pay for the surgery in advance as is done routinely for elective cosmetic surgery, then the medical records are submitted to your carrier and they may reimburse you. I have seen this work for some carriers. I have never had the occasion to submit it to medicare specifically.