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Is Eye Lid Surgery Covered by Any Kind of Medical Insurance?

I have a tiny lump on my left eyelid that I wanted removed. However, I have wanted to improve my eyelids for some time. Would this be covered by insurance?

Doctor Answers (8)

Is eyelid surgery covered by any kind of medical insurance?

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Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Eyelid surgery for cosmetic reasons is not covered, however a detailed examination, testing, and photographs would be required for the instance of functional deficits.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Eyelid surgery insurance coverage.

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The lesion my be covered.  If you have droopy upper lids, this may sometimes be covered if the lids are blocking your vision. For that, most insurance companies will require a visual confrontation test to determine just how much of your visual field is blocked by your upper lids. Different insurance companies may have different criteria. No, you can't "cheat" the test. The test is typically done in an ophthalmologist's office.  Each patient and insurance company is different.  Seek an experienced surgeon and ask about your particular case.

Jeffrey Roth, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 7 reviews

Removal of a suspicious eyelid lesion is usually covered by insurance but this does not include a blepharoplasty

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Removal of a suspicious eyelid lesion is usually covered by insurance but this does not include a blepharoplasty. If your upper eyelids are so droopy that they affect your vision, then an upper blepharoplasty is occasionally covered by insurance if you have objective testing data that shows an improvement in your vision when your eyelids are taped up and out of the way. Unfortuantely, if you want a cosmetic upper eyelid procedure performed to improve your appearance you will need to pay the cosmetic fee to have it performed. The typical cost is about $3000-4000.

Thank you for your question.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

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Eyelid lesion

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Removal of eyelid lesions can be covered by insurance if 1) they are cancerous, 2) suspicious for cancerous lesion, 3) irritating the eye.  Only a proper personal examination can determine that.  Consult an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

Insurance coverage of eyelid surgery

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Excision of an eyelid lesion may be covered by insurance. However, cosmetic surgery is not covered and the indications for establishing that a blepharoplasty is medically necessary are extremely strict. Currently, in NY, visual field studies are given very little weight because they can be manipulated and insurers will consider only unilateral corrections based on underlying conditions such as Bell's palsy, multiple sclerosis, stroke, and other conditions that you'd certainly not want to have!

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 12 reviews

Insurance coverage of eyelid surgery

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The short answer is that the lump may be covered by the insurance but the cosmetic aspect (blepharoplasty) definitely would not unless it interfered with your vision.

Here is the long answer: It used to be that just about all "lumps and bumps" were covered by insurance as it was considered reconstructive rather than cosmetic surgery.  The defiintion of this distinction is pretty straight forward - Reconstructive surgery means improvement of a condition that goes from abnormal towards the normal, whereas "Cosmetic" refers to improvement of a normal condition. Unfortunately, this does make a lot of difference to many insurance companies today. Instead they are more interested in correction of functional problems. That is something that interferes with your vision, irritates the eye, causes recurrent infection or dry eyes, or is a cancer (malignancy),etc.  

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 47 reviews

Eyelid surgery and insurance coverage

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The lesion may be covered if it appears to be a malignant lesion, if it obscures your vision in some way, or if it is causing tearing or eye irritation.  As far as improving the appearance of the eyelids, the doctor would have to document that the eyelids were blocking the vision with a visual field exam, eyelid measurements and photos that back up these tests.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Sometimes

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It depends on the insurance. If there has been change in the lesion, then there is a possiblity that this could be a malignant skin lesion and insurance would cover it. If not, then some insurances may consider it cosmetic.

 

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.