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Helping Denver patients understand when Medicare will cover their Eyelid Lift

One of the most common questions I get from patients is "will my insurance cover my eyelid procedure". There are several criteria that insurance companies in Denver including Medicare use to analyze or see if eyelid surgery is necessary for a patient.

First off, is the patient having any problems from the drooping eyelid (i.e having symptoms). These symptoms include the eyelids blocking vision and needing to lifting the eyelids to see. When the eyelid is drooping the pupil will commonly be blocked and a patients superior visual field will be obstructed. Patients may notice trouble with TV, reading or other activities. They may feel their eyebrows are aching from lifting them as compensation. Insurance companies want to make sure that patients are actually having a problem visually from their eyelids. Complaints such as "I don't like the way my eyelid looks" or "People tell me I look tired" reflect a cosmetic problem not a functional one. Cosmetic problems are treated by cosmetic procedures and insurance and medicare especially in Denver does not pay for them.

Second, a visual field test is performed to confirm the patient's complaints. This is a test when the superior visual field is tested to see if the vision is being blocked. Afterwards, the test is repeated with the eyelid taped.

Third, photos are taken to see how much drooping is actually there. In the photo above, insurance or medicare would most likely cover the right upper eyelid but not the left upper eyelid. Insurance companies care in eyelid surgery or blepharoplasty about the distance between the pupil and the fold of skin. In the right eyelid (from the patient's perspective) that distance is 1 mm. In the left it is 2.5. Additionally, the skin in the right extends over the eyelashes and in the left it does not.

In summary blepharoplasty or eyelid surgery in denver is covered by insurance companies or medicare based on these strict guidelines. It does not mean that if you are having symptoms that the extra skin is not bothering you or causing a problem. It just means that your insurance company does not feel its bad enough for them to pay for it. In that case, you can pay for it as a cosmetic patient would or wait several years until it gets to a point where it bothers you. Most patients choose to pay for it.

The best way to really determine the problem with your eyelid is to have an eyelid specialist take a look at it and see if it is actually a problem. They can often tell you most likely if insurance would cover the procedure as well.

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