Pre-op Eyelid Surgery

Am I a candidate...


Functional vs. Cosmetic

One of the most common questions we encounter is "Will insurance cover my procedure?" The answer is maybe. An upper blepharoplasty, the removal of excess skin and fat from the upper eyelids, is often covered if:

  1. The excess skin causes the patient a problem.
  2. The skin hangs over the eyelid and interferes with vision.
  3. Photographs show the excess skin is present.

Most insurers require (and will pay for) patients to undergo the tests needed to answer these questions. We are required to submit all this data to the insurer. The insurer makes the determination if the procedure will be covered or if it is cosmetic. How the insurer decides this varies from one company to the next. In general they look at:

  1. The medical record to show there is a documented problem
  2. The visual field tests for a significant obstruction which resolves when the excess skin is taped out of the way
  3. The photographs to determine if the excess skin jives with the visual fields and patient complaints
If the records show these 3 things, most insurers will approve the surgery.

How long is the approval process?

We deal with all the local insurers and the answer to this is, it depends. Some insurers will return a determination within days. Of the national providers we deal with, we have found that some insurers, such as Blue Cross of Illinois and Blue Cross of Rhode Island, will rarely provide an authorization. People with these plans are nearly always cosmetic.

Medicare instructs the surgeon to do the tests and if the surgeon thinks you meet the Medicare published guidelines, go ahead and do the surgery. Medicare will decide, after it is done, if they will pay for the surgery. We will let you know based on our experience how likely it is that Medicare will pay for your surgery. Medicare patients who are well within the guidleines have no fear, the surgery will be covered. But those who are borderline will need to sign an ABN (Advance Beneficiary Notice) which states Medicare may not pay for the procedure - it might be cosmetic. This ABN is a Medicare requirement. Even its name sounds like something from the government!

Patients with Medicare Managed Care Plans go through the pre-authorization process just like non-Medicare patients. We know before the surgery what is covered and what is not.

The OR Experience

Whatever works for you...

Part of the OR team is anesthesia. They are your friend. They administer the sedation before we get started so you are not aware when the local injections are given. These medicines provide a brief but deep relaxation. This is why you are not allowed to eat for eight hours before surgery. There will be an oxygen cannula in your nose, but there is no breathing tube. It is not that kind of surgery. During the procedure you are arousable and if you are anxious, your anesthesia friend is by your side. Ask and you shall receive what you need. One of the reason my patients do so well is that they know to communicate with us, even if they are sedated, if there is any anxiety. Anxiety raises the blood pressure, promotes bruising and stretches out the healing time. The OR should be an anxiety free zone, and for these procedures it is. You get whatever you need as long as it is safe. And because of that, half the patients leave the OR without a bruise. This is delicate surgery on delicate tissue. The OR experience should be boring, predictable and uneventful. It is amusing when a patient is so relaxed, often singing to the music or telling stories. We don't mind. Eyelid surgery is different than other surgeries, particularly those in the eyeball itself. We find this reassuring that all is well with the patient. And no one ever says anything they would not say normally. There is no "truth serum", just "happy juice".

Read about the Post-op Experience
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