Will Medicare Cover my Surgery for Droopy Eyelid? (photo)

Question

I had glaucoma surgery 5 years ago. Since than my eyelid been droopy and it getting worst. I have a dr appt in Sept so I want to know if I should ask my eye dr about it. How much would it cost for repair in one eye if it isn't cover? I'm 30 from Houston and kidney transplant patient. I been dealing with it for years and makeup can't seem hide it no more. Thanks in advance for input

Vincent N. Zubowicz, MD · Answer

From your description in the picture it seems likely that Medicare will cover correction of your ptotic right eye.

Mehryar (Ray) Taban, MD, FACS · Answer

You do have significant right upper eyelid ptosis. Medicare may cover it, depending on how much it obstructs your vision, which is determined by a visual field test. If insurance doesn't cover it, the cost varies $2000-4000. See an oculoplastic surgeon for evaluation.

Kenneth D. Steinsapir, MD · Answer

I recommend asking your glaucoma specialist for a referral to an oculoplastic surgeon.  That way the oculoplastic surgeon will be fully informed regarding your glaucoma status and medical issues.

Curtis Wong, MD · Answer

suggests it will be covered through Medicare. You do need a visual field exam to document your peripheral vision loss and photos that show your lid encroaching on the pupil. If you don't meet the criteria this year, you will in short time. Find a local surgeon who can help you navigate the process of getting this covered as a medically necessary procedure.

Jeffrey Zwiren, MD · Answer

The correction of unilateral upper eyelid ptosis can be a difficult problem. Consultaton with an experienced occuloplastic or plastic surgeon is indicated. Insurance coverage can be determined at the time of your consultation.

Stephen Weber MD, FACS · Answer

The short answer is yes. However, as with all insurances, this depends upon exactly what policy you have and what is considered a covered benefit. It is a great idea to have your ptosis evaluated to determine the exact cause of this problem. It can be repaired under local anesthesia or IV sedation. If someone recommends a simple blepharoplasty, move on to the surgeon that recommends a ptosis repair. They are not the same. An oculoplastic surgeon is typically the most experienced at dealing with this type of issue. Stephen Weber MD, FACS

Mario J. Imola, MD, DDS · Answer

Ptosis (eyelid droop) repair is typically covered by medical insurance.  Oculoplastic surgeons are in general the most qualified specialists to surgically correct ptosis.

Will Medicare Cover my Surgery for Droopy Eyelid? (photo)

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