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.

If hooding of the upper eyelids interfere with your vision, your health insurance company may cover blepharoplasty surgery for the upper eyelids only. Most health insurance companies exclude coverage for cosmetic surgical operations such as the lower eyelid blepharoplasty or any complications that might occur from the surgery. Most insurance plans exclude coverage from secondary or revisionary surgery.

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