Cosmetic Surgery Tips

Is eyelid lift covered by insurance

Have your ears pinned back. One of the most common problems with people’s ear is that they stick out from the head. This may make them look good, but unfortunately it can also cause hearing loss when there is a gap between the ears. For some people, their ears stick out permanently because their bones are thicker than other. Most children and young adolescents though experience excessive growth in their ears which causes them to stick out in different angles later on in life as they age.

You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on Is eyelid lift covered by insurance, criteria that insurance companies use to determine if blepharoplasty or upper eyelid surgery is “visually significant”, and therefore will be covered?. Read on to learn more. We at cosmeticsurgerytips have all the information that you need about Eyelid Lift Surgery: Procedure and Care. Read on to learn more.

Is eyelid lift covered by insurance

Blepharoplasty is a surgical technique that can dramatically eliminate the signs of aging and improve a tired or upset appearance by removing the excess skin, fat and tissue that cause droopy, baggy eyelids. It is one of the most popular aesthetic procedures performed in the United States, and has a tremendous impact on the overall appearance of the face. Several factors contribute to an appearance of aging around the eyelids, including loss of skin elasticity, years of sun exposure, downward pull of gravity, heredity, and thinning of tissue. These factors lead to a condition called dermatochalasis, or excess skin, wrinkles, fat and tissue around the eyelids. Though dermatochalasis is often associated with aging, some patients may develop this condition earlier in life.

Blepharoplasty surgery is not only performed for cosmetic purposes to enhance appearance, but it can also improve visual function. Blepharoplasty is performed for reconstructive purposes to correct visual impairment caused by excess skin that hangs down to obscure vision. Ptosis or eyelid droop can also occur in conjunction with excess upper eyelid skin. Ptosis occurs when the upper eyelid droops from lack of normal eyelid support. Children with ptosis can be a serious condition as a drooping eyelid from a poorly developed eyelid muscle can interfere with visual development. The majority of patients develop ptosis due to aging changes, which includes stretching or detachment of the eyelid muscle responsible for elevating the upper eyelids. Dermatochalasis can cause a “secondary” ptosis, with excess skin or tissue resting on the upper eyelid causing the eyelid to droop. Ptosis is also associated with trauma, prior ocular surgery, conditions such as thyroid disease, blepharospasm, nerve palsies or progressive neuromuscular conditions such as myasthenia gravis.

Patients may complain of visual obstruction superiorly, fatigue with reading, or brow ache from lifting the forehead muscles to compensate for the heavy, drooping eyelids. In these instances, blepharoplasty or ptosis surgery is considered medically necessary and is usually covered by insurance. Patients undergo evaluation by the surgeon, photographs and a visual field test to demonstrate the degree of visual field defect before surgery. Insurance and Medicare approval for functional eyelid surgery can vary, and continues to evolve with healthcare changes. When blepharoplasty of the upper or lower eyelids is performed to improve one’s appearance in the absence of any signs or symptoms of functional abnormalities, the procedure is considered cosmetic and therefore not a covered service by Medicare or private insurance carriers.

Surgeons who perform blepharoplasty and ptosis surgery must have an excellent knowledge of the anatomy of the eyelids and the face as well as an appreciation of the aesthetic and functional goals of each patient. Though traditional techniques of blepharoplasty should be known, the surgeon must customize the approach that best suits each individual patient. Facial rejuvenation is an evolving art and science, and new better techniques are continually developing.

criteria that insurance companies use to determine if blepharoplasty or upper eyelid surgery is “visually significant”, and therefore will be covered?

In general, insurance companies will cover blepharoplasty or ptosis repair if the eyelids cause a “visually significant” obstruction of the upper visual field that “affects activities of daily living”. To put it another way, if the upper lids block enough of your vision to significantly affect your life, then blepharoplasty or ptosis repair is considered medically necessary and may be covered by insurance.

1) Physician notes. These notes must clearly document the position of the lids, a decreased visual field, and a patient complaint about the upper lids interfering with certain activities (driving, reading, etc). The lid position should be measured using standard oculoplastic measurement techniques showing the lid or excess skin comes within less than 2 millimeters of the pupil (also called an MDR1 less than 2mm).

2) External ophthalmic photography. Basically these are high resolution photos of the eyelids and eyes. For criteria to be met, the eyelids or extra eyelid skin must clearly been seen to fall within less than 2 millimeters of the center of the pupil. Clear frontal and side photos are required.

3) Visual Fields. A visual field test is a noninvasive way to evaluate peripheral vision. This test is usually performed at an ophthalmology office. The field of vision is tested both with the eyelids in their natural position and with them held up (usually with tape). The difference between the taped and untapped visual field determines whether or not insurance will cover upper eyelid surgery. The visual field must improve by a certain percentage or certain number of degrees depending on the insurance carrier.

Occasionally there are other indications that insurance companies will accept to cover upper eyelid surgery. Reconstruction after thyroid eye disease, children born with ptosis (congenital ptosis), and chronic dermatitis due to skin rubbing on the eyelashes are a few of these indications.

Once an oculoplastic surgeon has all the information necessary, they will evaluate it and determine whether or not they feel upper eyelid surgery is medically necessary.

If the answer is yes, then the next step is to submit all notes and testing to the insurance company. The carrier will then either “pre-authorize” or deny the claim. A pre-authorization means that the insurance company agrees that eyelid surgery is medically necessary and they plan on covering the blepharoplasty or ptosis repair. Although a pre-authorization is very reassuring, they are not a 100% guarantee of coverage. Occasionally insurance carriers will do a second review of the case after the surgery has been performed. It is unusual, but occasional the carrier may deny the original pre-authorization and consider the surgery cosmetic. An appeal can be submitted if this occurs, however, if the claim is again denied then payment is usually the patient’s responsibility.

Medicare works a bit differently. Medicare does not pre-authorize anything (any procedure- not just eyelid surgery). Medicare does, however, have clearly defined criteria that most oculoplastic surgeons know in detail. Based on the exam and testing, it can be determined if Medicare would typically cover a patient’s eyelid surgery. While most oculoplastic surgeons are correct in their coverage assessment, since Medicare will not pre-authorize surgery, a form called an “ABN” is usually completed and signed by the patient. The ABN typically states that while the surgeon believes Medicare will cover the blepharoplasty or ptosis repair, the patient is responsible for the payment if the claim is denied. Again, most oculoplastic surgeons will be able to give a fairly accurate assessment of whether Medicare or an insurance company will cover blepharoplasty or eyelid surgery.

Eyelid Lift Surgery: Procedure and Care

The medical term for an eyelid lift is blepharoplasty. The procedure surgically removes excess fat, muscle and skin from the upper and lower eyelids to redefine the shape of the eye.

While an eyelid lift cannot alter dark circles or fine lines and wrinkles around the eye (“crow’s feet”), it can address age-related drooping or puffy eyelids and create a more refreshed, youthful appearance. An eyelid lift can also correct drooping eyelids that are interfering with vision.

Eyelid surgery can take place in the surgeon’s office-based surgical facility, an outpatient surgery center or in a hospital.

The surgeon will ensure you are comfortable during the procedure by using anesthesia. A general anesthesia puts you in a deep sleep for the surgery. Local anesthesia numbs the area of surgery so the person feels no pain. Sedative medications allow the patient to remain awake but relaxed.

The procedure itself takes several hours. Immediately afterward, the surgeon may apply tiny sterile bandages to the area. The eyes may not need to be covered, but the surgeon may use an ointment to prevent the area from drying.

Afterward, the person may notice that the eyelids feel tight or sore. The eyes may feel sticky, dry or itchy for a week or more. Bruising and swelling are normal, and cold compresses can help, along with prescribed pain medications and in some cases, eye drops.

The surgeon may recommend that the person elevate his or her head while sleeping or lying down to enhance healing and relieve discomfort.

It is extremely important to follow the surgeon’s postsurgery instructions carefully, especially:

  • Avoiding certain activities and environments
  • Alerting your surgery team immediately in the event of any problem or unexpected change
  • Keeping follow-up appointments

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