My Eyelids Are Closing Because of Droopy Upper Lids and I Was Wondering if Medicare Will Pay Surgery?
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Doctor Answers 14
Blepharoplasty: Covered by Insurance?
My eyelids are closing becue of droopy upper lids and I was wondering if MediCare will pay surgery?
Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!
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Will insurance cover upper eyelid surgery?
Medicare and other insurances will cover upper eyelid ptosis repair and blepharoplasty if certain criterion are met. First, the margin of the upper lid needs to be a certain distance away from the center of the pupil, usually less than 2mm. Second, visual field testing must demonstrate significant visual field restriction due to the drooping lids. Finally, some insurance companies will also want to see photographs. An experienced oculoplastic surgeon should be able to tell you whether your insurance will cover the procedure prior to having it done.
Droopy Upper Eyelids Covered by Insurance
Droopy upper eyelid correction surgery may be covered by insurance provided that documentation of impairment of visual fields can be obtained. Find the plastic surgeon with best credentials who performs these surgeries every day.
Medicare often covers eyelid surgery
All insurance carriers including Medicare have guidelines on when they will cover eyelid surgery. You have to show that it affects the vision in some way. Your doctor will make measurements of your eyelid position and test your peripheral vision. They will also take photographs from several angles. These are all used to determine if you qualify.
It depends on the degree of visual obstruction
There are two conditions that may possibly be covered:
1. Eyelid ptosis [droopy upper eyelid]
2. Excess upper eyelid skin [dermatochalasis] that hangs over lashes into line of sight.
You would need photos and visual fields done by an Ophthalmologists to confirm these findings.
Your best bet would be to see an Oculoplastics surgeon that does this kind of evaluation and surgery day in and day out.
Insurance coverage of droopy eyelids
In general insurance is covering less and less of non urgent conditions. At least in Chicago there has been a trend away from coverage. Your chances are the best if the droop of your upper lids is a true ptosis. This means that the margin of the eyelid sits low relative to the pupil when you look straight ahead. If the problem is just loose overhanging skin, coverage is less likely. If you want to try for coverage, it will be necessary for you to undergo visual field testing submit photos. Even then it is far from a sure thing.
Medicare payment for blepharoptosis
Will insurance pay for my eyelid surgery?
The answer is often times yes. Medicare is actually pretty good about paying for upper eyelid surgery with her before excess skin that is causing visual field loss or true upper eyelid ptosis. In fact there are some lower eyelid conditions that require surgery that Medicare will pay for. Essentially you need to start your evaluation and consultation series with an ophthalmologist who will determine whether or not there is sufficient laxity or ptosis or what have you to justify surgery for functional purposes. Overall the surgery should should be pretty smooth and your recovery should be about 1 to 2 weeks.
I hope that was helpful
Chase Lay, MD
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.