I need to remove excess skin on my upper eyelid. I have Medicaid. Will it cover it?

Question

In my family almost everyone has excess eyelid skin, now it's getting to the point where it bothers my vision. I have Medicaid, would it cover it?

William Portuese, MD · Answer

Removing excess skin on the upper eyelid is usually considered cosmetic in nature, and must be paid for by the patient. When there is severe excess skin significantly blocking vision, medical insurance may participate in the payment, if it is considered medically necessary. A thorough examination documenting the issue, photographs, and visual field obstruction test are all required along with pre-authorization with your medical insurance company to determine medical necessity. For many examples of eyelid surgery, please see the link and the video below

Curtis Wong, MD · Answer

with Medicaid... requires that you get a visual field exam to document visual field loss and then a surgeon that participates with Medicaid.  Or you can search around for a surgeon that would do it for a reasonable cash fee (as it only takes an hour or less under local).  In my practice, we have an 'on-call' special where we contact you 2-3 days prior and offer the procedure for $1150 (all inclusive) and if you can take advantage of that, you win and I fill an empty spot and win too.  See if any surgeons around you will offer something similar in concept as fees vary wildly across the USA.

Shoib Myint, DO, FAOCO · Answer

Hello China0810,It will depend on documentation. There are certain parameters insurance companies look for to see if it is medical necessity. You will need vision, visual field test and other documentations which will need to be reviewed by the surgeon first. Suggestion is to seek out an expert oculoplastic surgeon to have this discussion.Cheers

I need to remove excess skin on my upper eyelid. I have Medicaid. Will it cover it?

Answers (3)

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