At What Point Does Insurance Generally Pay for Eyelid Ptosis Repair?

Dear in Concord

I would advise that you get a referral to the oculoplastic surgeon at Kiaser to be assessed.  Kaiser surgeons have total discretion regarding when they operate, they are not bound by a fixed rule.  They will not perform cosmetic surgery unless you self pay but the line between medically necessary and cosmetic for this type of issue is not set in stone.  Good luck.

For your situation, you may be able to get it covered because your vision is impaired. Please ask your insurance provider directly.

Hello there! Thanks for your question! Ptosis repair is a treatment that varies in coverage from one insurance company to another. The best thing that you can do at this point is get an assessment first from a Kaiser Insurance oculoplastic surgeon and ask them directly. This way, you will get an idea about the coverage. If you do not want to undergo assessment yet, you may want to initially ask regarding the what criteria is for coverage of ptosis repair. If you finally decide to get assessed, you may want to bring up that the ptosis repair is more for improving vision impairment compared to cosmetic. You can also ask for a test on the visual field to support this claim. You have to keep in mind though that if the visual field deficit is not assessing to be vision impairing, it may not be covered by your insurance company.