Practice of billing Medicare to fix droopy lids raises eyebrows
The public health insurance program typically does not cover cosmetic surgery, but for cases in which a patient’s sagging eyelids significantly hinder their vision, it does pay to have them lifted. In recent years, though, a rapid rise in the number of so-called functional eyelid lifts, or blepharoplasty, has led some to question whether Medicare is letting procedures that are really cosmetic slip through the cracks – at a cost of millions of dollars.
Plastic surgeons say there are a number of legitimate reasons for the spike, including a tendency among the elderly to seek fixes for real medical issues they might have quietly suffered through even a decade ago. But surgeons also acknowledge an increased awareness of the surgery fueled by reality television, word-of-mouth referrals and advertising that promises a more youthful appearance. And doctors concede they face increased pressure from patients to perform eyelid lifts, even when they do not meet Medicare’s requirement that peripheral vision actually be impaired.
John LiVecchi, a Florida plastic surgeon, who has had an eyelid lift himself, disputes that patients are flocking to the procedure primarily with vanity in mind. Patients with droopy eyelids often don’t realize how much the droopy skin is narrowing their field of vision, he said. LiVecchi said he jokes with his patients that he doesn’t want them driving in his neighborhood until after the surgery. “It’s safer for society,” he said.
The benefits of functional eyelid surgery for some patients are documented. A 2011 study published in the journal Ophthalmology, for example, found that the surgery provided “significant improvement in vision, peripheral vision, and quality of life activities.”
Published June 2013
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