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When is Blepharoplasty Medically Necessary?

asked 2 years ago by Dan H.
Latest answer by Kris M. Reddy, MD, FACS
Question viewed 4,429 times
Tags: age 55-64, eyelids, male, insurance

When is blepharoplasty considered to be medically necessary? The skin on my upper eyelids hangs down over my eyelashes. It tends to push my eyelashes into my eyes and makes it hard for me to use my computer without tilting my head back. My eyes also get tired and my vision blurs towards the end of the day. I would like to get this fixed, but I am not sure if insurance typically covers this sort of thing. When I talk to my insurance company about this, is there anything in particular that I should mention?

16 answers to When is Blepharoplasty Medically Necessary?

Blepharoplasty Medically Necessary

While insurance companies and plans have a different set of requirements if there is a functional complaint and a supporting visual field test.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon

www.drkrisreddy.com

Medically necessary blepharoplasty requires documented blockage of the visual field

Most insurers require that you have a formal visual field exam performed in an ophthamology office which demonstrates a 25 % blockage of the visual field for an upper blepharoplasty to be covered. Typically, these reports need to be filed with the insurer before coverage is permitted. There are other more subtle complaints that may be covered but require confirmation by an ophthamologist.

Brooke R. Seckel, MD
Boston Plastic Surgeon

www.drseckel.com

Blepharoplasty medically necessary when visual field is obstructed

The skin on the upper lids usually has to hang over and cover the eyelashes and cause a visual obstruction. Most commercial insurance carriers require approximately 30% of the visual field to be obstructed prior to paying for this procedure. An ophthalmologist needs to perform a visual field obstruction test, and this is usually submitted with pictures of the patient and chart notes from the surgeon. Preauthorization is then obtained prior to moving forward with the medically necessary... more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Blepharoplasty may be covered by insurance

Blepharoplasty may be covered by insurance when the excess skin of the under eyelid interferes with vision. This needs to be verified by an eye exam called a "visual field test". This can be performed by an Ophthalmologist or Optometrist, and typically, documents a deficit in the upper or outer field of vision. Most insurance companies require this test before providing coverage if included in your benefits. Some insurance companies also require photographs for documentation.... more

Steven L. Ringler, MD
Grand Rapids Plastic Surgeon

www.stevenringlermd.com

Visual fields are the key

Dan, An evaluation by your local board certified ophthalmologist for visual field testing and a general eye exam will determine medical necessity for your blepharoplasty. More importantly, it will identify whether you have an underlying medical condition that may be causing your symptoms. "Tired eyes and blurred vision" at the end of the day may be the signs of certain medical conditions (e.g. hypothyroidism, multiple sclerosis) that will not be helped by a blepharoplasty. Good... more

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

Have a visual field test performed by your ophthalmologist to be sure

Usually I tell patients that one cosmetic surgery that can be covered by insurance is upper eyelid surgery, or "blepharoplasty." When excess skin of the upper lids interferes with vision, it is considered "medically necessary." Make an appointment to see your ophthalmologist (not optometrist) and have a visual field test performed, with the upper lids taped up and untaped (this is very important). If there is a loss of vision from the overhanging lids that improves when... more

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon

Blepharoplasty covered by insurance

If you have excess upper eyelid skin which hangs down over your eyelashes and interferes with your vision, then you likely have a condition that would be covered by insurance. Typically, the insurance companies need to see photos and proof of your visual field deficit (obstructed vision) by an ophthalomologist examination prior to approving your surgery. Depending on the type of insurance you have, this procedure would be considered reconstructive, and not cosmetic, therefore being... more

William Bruno, MD
Beverly Hills Plastic Surgeon

Medical necessity for Blepharoplasty very much depends on your insurance coverage

Dear Dan No doubt you have a functional issue with the upper eyelids. Will your insurance company cover the services needed to correct this situation. This depends on the insurance coverage you have. I would advise you to seek care in your area from a fellowship trained oculoplastic surgeon in your area who accepts your health insurance. These are board certified ophthalmologist who have gone on to do a two year fellowship in eyelid and facial plastic surgery. They have the necessary... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Medically necessary blepharoplasty

Dear Dan, I am going to answer your question but first allow me to show you how the English language and common sense are battered by insurance companies. Surgical cases can be classified as either ELECTIVE (you and I choose when to have the operation) or EMERGENT (you have to have the operation or you will die ; IE gunshot wound to the chest etc). It goes without saying that emergent cases are ALL medically necessary. The class of ELECTIVE surgical cases can be further subdivided into... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Medically Necessary Blepharoplasty

If the extra skin in your upper eyelids is interfering with your vision, then it would be considered medically necessary. To get approved, you have to see an ophthalmologist and undergo peripheral visual field testing. If that confirms that your field of vision is restricted due to the extra skin, then insurance is likely to approve it. Regards

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon

You may consider it medically necessesary but....

You may consider it medically necessesary but.... most insurance companies consider it cosmetic. True ptosis -- where there is a problem with y our eyelid muscles is considered a medical problem - but extra skin is cosmetic.

William B. Rosenblatt, MD
New York Plastic Surgeon

Medically necessary blepharoplasty

In general, insurance companies are looking for medical consequences of excess skin or sagging of the brows. This can mean skin irritation or dermatitis from the excess skin folds, limitation of vision usually demonstrated by visual field deficits, particularly in the upper outer visual fields that can be documented by a visual field test, and evidence that the lids are hanging over hte pupil as evidenced by photographs.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Correction of drooping upper eyelids are occasionally paid by insurance

Actual ptosis of the upper eyelids is a medical condition that is correctible by surgery. Occasionally, excess skin of the lids combined with drooping of the eyebrows requires correction of both problems to improve upper visual field deficits. Of course, there will be improvement in appearance as a result of the surgical correction, but the main reason for operating is to improve vision in the upper fields. Therefore, it is my opinion that the procedures should be considered... more

Jack A. Friedland, MD
Phoenix Plastic Surgeon

Droopy eye lids (ptosis) & visual field limitation

Your insurance could cover one of two medical condition related to your upper eye lids: 1-Excessive upper lid skin obstructing the superior visual field. You might need a special rest to confirm this finding for insurance approval. 2-Droopiness of the upper lid (eye lid Ptosis). Caused by a variety of factors but mainly acquired weakness in the muscle/tendon mechanism. Insurance approval will require a clinical exam from your plastic surgeon and authorization letter. All the best! more

Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon

Upper blepharoplasty or brow lift for medical condition

Dan H. Yes, plastic surgery of the upper eyelid (blepharoplasty) can be performed for medical conditions where the excess skin of the eyelid and/or brow obstructs the visual field. Blepharoplasty is not all cosmetic. The eyelid itself may be droopy or ptotic too. Severe eyebrow descent, in addition to the upper eyelid descent, may affect visual field. Patients typically have to tilt their head or strain to lift the eyelids and eyebrow for routine vision. Some may develop chronic headaches... more