I'm sorry to hear that your
drooping eyelids are causing you trouble. Blepharoplasty is one of a handful of
traditionally "cosmetic" procedures that is sometimes eligible for
insurance coverage. For the most accurate answer, check with your individual insurance
provider. Coverage tends to vary from
plan to plan. In some cases, you may need to be evaluated by an eye doctor or
your general practitioner in order to prove that your sagging eyelids are to
blame for your visual disturbances. Good luck!
This isn't a question for the doctors.
Insurance companies each have their own criteria. Some will tell you what their criteria are, some won't.
At the very least an insurance company will require pre-operative visual field testing, in both taped (with the lids held up with tape) and un-taped modes, and pictures.
Your best bet is to ask your physician to submit a request for prior approval to your insurance company with the above mentioned history, pictures and testing results. Some insurers will authorize the procedure, some will say that they don't give prior authorizations - only post-operative decisions.
CAUTION: I have seen situations wherein an insurance company "approved" the surgery, and then refused payment !!!
My best advice is - always be prepared to pay for your procedure and be happily surprised when your insurance sends you reimbursement.
Thanks for your question, photos would be helpful for evaluation purposes. Some insurance companies will cover an upper eyelid blepharoplasty if your have > 25% obstruction of the superior field of vision. You must get a field of vision study performed by your optomitrist or ophthalmologist.
Without a photograph it's impossible to tell what the presenting issues may be. Ptosis is usually covered under medical insurance. Dermatochalasis, or natural hooding of the upper lids with the aging process can be covered, but it has to be significantly obstructing the visual fields. Medical necessity must be documented at time of examination and consultation. A visual field obstruction test is also required, along with photographs which were all submitted to the patient's medical insurance for preauthorization by your medical insurance. For many examples of eyelid surgery, please see the link below
Visual field test are needed to determine if insurance will help with your surgery. It is doubtful, unless you have severe "ptosis." Contact your insurance company to discuss your benefits.
If you have true "ptosis" than see eye doctor for a visual fields examination. If you "fail" this test than call your health insurance provider to see if they offer coverage for operative repair of this.
Insurance will cover upper eyelid blepharoplasty IF there is enough excess skin that the upper pupil is being covered and/or the excess skin is folded over the upper eyelid margin. Visual field testing by an eye doctor is usually required to show that there is visual loss from the excess skin and that it improves with taping (raising) of the upper eyelid tissues. Detailed measurements of the eyelid positions have to be submitted along with photos showing the excess skin. Medical reasons for an upper blepharoplasty include problems with visual activities such as problems while reading, driving, computer use etc due to the overhanging skin.
Is some cases and with some insurances, upper eyelid surgery can be covered. Typically, the eyelid tissue needs to be hanging over the eye lashes to meet criteria. A formal visual field test and an examination are required. During the visual test, you are asked to identify a series of dots on a screen. The eyebrow is then taped to lift the eyelid skin and the test repeated. If the vision is bad enough in the first stage and significantly improved in the second stage, you might qualify. This decision falls entirely to your insurer rather than the physician examining you. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
Some insurances will cover an upper eyelid surgery. You will need to have the lids sufficiently low that the lid margin touches or is below the upper edge of the pupil. You will also need a visual field test to show that there is enough loss of the visual field to be causing visual problems. You should see an oculoplastic surgeon since they can do all of this testing for you. Not all surgeons accept insurance due to the low reimbursement and battles that are needed to get paid.
Most insurance companies do not cover upper eyelid surgery. If the insurance company does they generally require that there be a visual field disturbance. Your plastic surgeon can sort this out for you.