EYE LIFTS - FINE LINE BETWEEN COSMETIC AND THERAPEUTIC

May 31, 2013
By GILLIAN MOHNEY
via GOOD MORNING AMERICA
More than 200,000 eyelid lifts were performed in the U.S. last year. (Media for Medical/UIG/Getty Images)
Drooping eyelids may seem like an inevitable effect of getting older, but sagging eyelids not only age a person’s face, they can impair peripheral vision too.

Removing the excess skin through surgery can both improve vision and result in a more youthful appearance, but determining whether the procedure is cosmetic or medically necessary has become a point of controversy, especially since Medicare is increasingly picking up the tab………

Many private health insurance plans in Orange County will cover the cost of upper eyelid blepharoplasty or upper eyelid lift surgery. In addition, if you have Medicare coverage, you can qualify for coverage of the cost of surgery. If you have upper eyelid skin that is resting on, or hanging over your lashes, surgery may be covered by insurance. Dr. Joseph can perform and examination and specialized testing to determine if you qualify.

….. Eyelid lifts, called blepharoplasties, are done when the upper eyelid, which usually hangs about 2mm above the pupil, starts to sag. It can be removed for cosmetic reasons or because it starts to block a person’s peripheral vision.

According to the Center of Public Integrity, Medicare pays $574 to $640 per eye. Dr. Michael Migliori, president of the American Society of Ophthalmic Plastic and Reconstructive Surgery, estimates that the cost of a blepharoplasty is often about four to five times that rate, although he cautions that’s only an estimate.

According to the American Society of Plastic Surgeons, the average surgeon’s fee for the operation was $2,972 in 2012.

Dr. Mami Iwamoto, a Boston-based ophthalmologist who performed a blepharoplasty on Boston Mayor Tom Menino last year, said she has to say no to some patients who think they need a functional blepharoplasty – one that would improve their vision – but who don’t meet the medical criteria.

“We’re the final word on it,” said Iwamoto. ” She said she’ll tell them, “‘It’s not medically necessary.’ In their hearts they know that.”

There are no national Medicare criteria for what determines a functional blepharoplasty. Different Medicare contractors that cover different regions of the country have their own criteria, although Migliori said that the criteria were fairly uniform across the country.

For Medicare to cover the surgery, according to Migliori and the Centers for Medicare and Medicaid Services, a doctor must perform two vision tests, which measure the degrees to which a person can see peripherally from the horizon. The surgery would have to theoretically improve a patient’s peripheral vision by a specific number of degrees to be approved. The number of degrees depends on what is required by the individual Medicare contractor.

Other private insurance companies often use the same criteria as Medicare to determine if an eye lift is necessary, according to Migliori. United Health Group, one of the largest private U.S. health insurance carriers, uses the Medicare guidelines to determine if a blepharoplasty is medically necessary or if it is cosmetic.

According to Migliori, a photo of the patient also has to be included to show that he or she has sagging eyelids, and the patient must report additional symptoms, such as headaches from straining their eyebrows or injuries from running into things they can’t see. Migliori said one common early sign was difficulty reading.

EYE LIFTS - FINE LINE BETWEEN COSMETIC AND THERAPEUTIC

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