Will insurance pay for eyelid surgery?

For the past year or so my eyelids have gotten droopier and I find my self tilting my head backward a lot because my upper eyelids seem to obstruct my visibility when driving or just watching tv I'm 48

Doctor Answers (11)

Blepharoplasty: Who Pays?

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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!


Orlando Plastic Surgeon
5.0 out of 5 stars 3 reviews

Eyelids

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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.

John Strausser, MD
Sarasota Plastic Surgeon
5.0 out of 5 stars 2 reviews

Need field of vision study

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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.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

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Droopy eyelids at age 48

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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

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 58 reviews

Will insurance pay for eyelid surgery?

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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.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 26 reviews

Will insurance pay for eyelid surgery?

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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. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Insurance Coverage For Eyelid Surgery

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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.  

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

Will insurance pay for eyelid surgery #blepharoplasty?

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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

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 43 reviews

Insurance and eyelid surgery.

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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.    

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
4.5 out of 5 stars 8 reviews

Insurance might pay for upper eyelid surgery in exceptional cases.

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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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 10 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.