Excess upper eyelid skin runs in both sides of my family, and most have impaired vision by their late 50s. At 37, my upper eyelids hang over my lashes; the excess skin is about 1/2" when pinched with no apparent fat, just skin sagging over lashes. I'm used to it, but there is definitely an upper black line in my vision where the lids are pressing down, and I can "see" my lashes at all times.
What are the usual requirements to gain insurance approval with a good PPO? Is this even possible, or is it always considered cosmetic?
Hi eye,
See an ophthalmologist and have a visual field test. If the test is positive, have your surgeon submit a pre-authorization request to your insurance company. Even if you are pre-authorized, it does not guarantee that the insurance co will fully re-imburse you for your procedure. Good luck, and watch out for low hanging objects to avoid bumping your head on those objects being blocked out by your heavy eye lids.
Dr. P
In most cases, insurance does not cover eyelid surgery. Removal of simple excess skin and fat from the upper and lower eyelids is considered "cosmetic" in most cases, where the goal is primarily improvement of appearance.
In select cases, where the upper eyelid skin hangs so far over the upper eyelid lash margin that this extra "hood" of skin actually blocks the peripheral vision, upper eyelid surgery should be a covered benefit of your insurance plan. In these cases, the upper eyelid surgery is performed for functional improvement, and therefore is "reconstructive" and not cosmetic in nature. It is important that your surgeon properly documents the medical necessity of the planned procedure with your insurance carrier before the procedure is done. Most commonly, this involves sending you to an optometrist or ophthalmologist to have computerized visual field testing, which documents the degree to which your hanging upper eyelids obscure the peripheral vision. The test is then repeated with your excess upper eyelid skin temporarily taped up in a higher (non-obstructing) position to show the improvement of your peripheral vision that should be expected following blepharoplasty for the upper eyelids.
Drooping of the brow and forehead may also contribute to the visual field obstruction, and your plastic surgeon should evaluate whether brow lift (in addition to, or in place of, upper blepharoplasty) is the proper treatment option for you.
Although most insurance carriers will make every effort to deny benefits even for legitimate functional surgery such as this, proper documentation and diagnostic studies will tip the balance in your favor, and your insurance carrier should cover at least a portion of the cost of the operation.
There is an objective test, typically done in an ophthalmologists' office that confirms whether eyelid skin is responsible for blocking vision. The test involves evaluating each eye seperately. You sit looking into a box with one eye covered. There are brief flashes of light and with each flash you are asked to push a button. If you can't see the flashes in the upper field of your vision, and the opthalmologist concurs that this is from excess skin , then the test may be considered positive.
If there is a functional blockage of vision, either from excesss eyled skin, and or significant descent of the brow and eyelid skin, which is confirmed by the visual filed test, then many insurance carries will consider surgical management as "medically necessary".
Contact the doctor
