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

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..

Doctor Answers (8)

Insurance Coverage for Blepharoplasty

+2

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 Surgeon who performs a large number of insurance/ medicare Blepharoplasties in order to enhance your ability to have this procedure covered.


Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Insurance for upper blepharoplasty

+2
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 your look. Dr Cat Begovic

Catherine Huang-Begovic, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 5 reviews

Unfortunately Insurance will not cover your blepharoplasty

+2

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
5.0 out of 5 stars 161 reviews

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Bleph by insurance

+2

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 surgeons.  You could call the nearest University Hospital to find out about the program.  Good luck!

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Insurance coverage for Blepharoplasty

+2

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 plastic surgeon to have a thorough evaluation.

Good Luck.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 703 reviews

Insurance for upper lid blepharoplasty

+2
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. In the past five years, only two of my eyelid patients were granted authorization and both were stroke victims.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Insurance coverage for upper blepharoplasty, possible?

+1

To get the procedure paid by insurance, most insurance companies will require a visual confrontation test to determine just how much of your visual field is blocked by your upper lids. Different insurance companies may have different criteria. No, you can't "cheat" the test. The test is typically done in an ophthalmologist's office.

Jeffrey Roth, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 7 reviews

Insurance Coverage for Blepharoplasty

+1

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 upper lid skin is affecting the patient's activities of daily living.

In my professional opinion, your insurance company will deem your excess upper lid skin to be cosmetic in nature, and will not cover your surgery.  However, you can seek an opinion from an oculoplastic surgeon in your area.  You can find one at asoprs.org.

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.