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I Am 57, Have a Complex About my Eyes and Need an Upper Bleph. Is This Something Insurance Can Cover? (photo)

asked 7 months ago by santerry
Latest answer by Stephen Prendiville, MD
Question viewed 311 times
Tags: candidate, insurance

but am on unemployment, have been a single parent since my son was 5 and can't afford to do it unless it is considered medical. How can I go about this..

7 answers to I Am 57, Have a Complex About my Eyes and Need an Upper Bleph. Is This Something Insurance Can Cover? (photo)

+1

Insurance Coverage for Blepharoplasty

Based on the pictures provided, I think it is unlikely that insurance will cover an upper eyelid Blepharoplasty. As others have stated, medical necessity for upper eyelid Blepharoplasty requires a subjective problem seeing related to excess upper eyelid skin, visual field testing which confirms a peripheral visual filed defect (performed by an Ophthalmologist), and a physical exam which confirms excess upper eyelid skin. I would recommend that you see an Occuloplastic... more
Stephen Prendiville, MD

Fort Myers Facial Plastic Surgeon

www.drprendiville.com

+1

Insurance for upper blepharoplasty

Thank you for your photos. In my experience, insurance companies are strict about their criteria on what they will cover. I usually have my patients go to one of my opthomology colleagues to get visual field testing to document visual field impairment that insurance companies usually require. Regardless, I'd recommend you see a plastic surgeon for a consultation to go over what you specifically wish to improve. There may be some other less invasive procedures you could do to rejuvenate... more
Catherine Huang-Begovic, MD

Beverly Hills Facial Plastic Surgeon
+1

Unfortunately Insurance will not cover your blepharoplasty

I am sorry you dislike your eyelids, but without a truw medical indication (which is extremely rare), insurance will not cover this cosmetic procedure.
Matthew Schulman, MD

New York Plastic Surgeon
+1

Bleph by insurance

Dear Santerry, I doubt insurance will cover your surgery but there is another option. You would need to meet several criteria and just looking at your photos I doubbt you would qualify. You might consider being a "clinic " patient at the residency training center near you. You would bbe operated upon by plastic surgeons in training under the direct supervision of board certified plastic surggeons like myself who assist in the training of future plastic... more
Steven Schuster, MD

Boca Raton Plastic Surgeon
+1

Insurance Coverage for Blepharoplasty

Santerry, Insurance companies have very strict criteria for coverage of blepharoplasty. These include: 1) Photos showing the excess upper lid skin encroaching upon the visual axis (in my experience, the insurance companies evaluate this criterion first and foremost). 2) Visual field testing showing both loss of visual field due to the excess upper lid skin and improvement in the field of vision with the upper lid skin taped up. 3) Documentation of symptoms of how the... more
Michael McCracken, MD

Boulder Oculoplastic Surgeon
+1

Insurance coverage for Blepharoplasty

Thank you for your photos and question. In my experience, insurance companies are very strict on what they will cover in regards to eyelid surgery. It has to be medically indicated and a significantly reduced visual field result is usually required from an Ophthalmologist (they want to see that the droopy eyelid is affecting your vision). From your photos, it doesn't look like the eyelid is affecting your vision but you may want to visit with a board certified... more
Tom J. Pousti, MD

San Diego Plastic Surgeon
+1

Insurance for upper lid blepharoplasty

Insurance restricts payment for upper lid blepharoplasty to medically conducted ptosis based on Bell's palsy, multiple sclerosis, stroke, or ptosis of such magnitude that the field of vision is radically impaired. So much fraud occurred with respect to this operation that they now express marked skepticism at field of vision studies. Generally, the insurance companies give more serious consideration to a unilateral ptosis and require extensive documentation of the underlying condition. ... more
Robert L. Kraft, MD

New York Plastic Surgeon

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