Insurance coverage for Blepharoplasty

Insurance coverage generally does not pay for cosmetic procedures. They will, however, contemplate paying for reconstructive or functional surgery.

That having been said, each company determines the parameters by which they establish medically necessary blepharoplasty using reconstructive and functional criteria.

These are not consistent among insurance companies and no standard have been established.

Generally, the indications for medically necessary blepharoplasty include blepharoptosis, blepharochalasis or dermatochalasis. Other conditions include congenital (from birth), traumatic (from injury), or oncologic (from cancer) indications.

1. One of the most common conditions involves excess upper eyelid skin which hangs down and obstructs vision. This is documented using the visual field testing referred to in the other physicians responses.
2. Another condition called blepharoptosis is easily confused with above but is due to the upper eyelid (not the skin) covering the pupil. People confuse this with a tired or droopy eye look. It is usually associated with muscle problems that require repair. This can be documented with a photograph.
3. Blepharoptosis can be present at birth or develop over time and effect one eye or both.
4. Injuries to the eye may result in scars or abnormal conditions that require repair.
5. Removal of skin cancers can also precipitate the need for reconstructive procedures.