In most cases, the simple answer is no. In the case of vision blockage due to ptosis or excess skin, there are very specific vision tests that insurance companies will demand as well as photo documentation before approving such a surgery. There are times a procedure can be approved because of medical necessity. That said, if it is approved, the insurance company will have an amount that they deem normal for the procedure and the area it is performed in. Often times, in a private cosmetic practice, that covered amount is a fraction of the actual cost of surgery. Insurance companies rarely account for the specialty involved in these surgeries.

My advice would be to deal with your insurance company first. Get approval from them.  Submit it all your i's dotted and t's crossed and then knock on wood and cross your fingers that the claim will process.

Caitie,

That is a good question and one that almost every patient asks. However, the insurance companies are very strict when it comes to covering procedures which may seem "cosmetic" in nature. Your best hope of getting it covered by insurance is to have a visual field test by an ophthalmologist. However, the test will have to show significant visual obstruction of your vision by your redundant upper lid skin for the insurance company to consider covering the procedure. Then, even if they do cover it, you would need to find a plastic surgeon who takes your insurance. Since, the insurance companies usually only pay pennies on the dollar, most plastic surgeons do not take insurance.

I hope this is helpful.

David Shafer, MD
Shafer Plastic Surgery, NYC

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If your upper eyelids cover your visual fields in a demonstrable way then insurance should cover it. However, you will need to go to an ophthalmologist to have visual field testing and these test do not lie.

Lower eyelids may sag and cause eyelid dryness and this may be covered, but once again you will need to see a second opinion or jump through hoops in order to get this covered as well.

Good luck.

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