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Medicare and other insurances will cover upper eyelid ptosis repair and blepharoplasty if certain criterion are met. First, the margin of the upper lid needs to be a certain distance away from the center of the pupil, usually less than 2mm. Second, visual field testing must demonstrate significant visual field restriction due to the drooping lids. Finally, some insurance companies will also want to see photographs. An experienced oculoplastic surgeon should be able to tell you whether your insurance will cover the procedure prior to having it done.
Unless it's for health reasons, insurance doesn't usually cover eyelid surgery since it's considered cosmetic.
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. Often times, MediCare will not cover. Detailed description of your complaints, testing, examination, and photographs will be requred. The other issue is that MediCare will not preauthorize, and if they do not cover, the entire costs will be placed on you. 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!
Droopy upper eyelid correction surgery may be covered by insurance provided that documentation of impairment of visual fields can be obtained. Find the plastic surgeon with best credentials who performs these surgeries every day.
There are two conditions that may possibly be covered: 1. Eyelid ptosis [droopy upper eyelid] 2. Excess upper eyelid skin [dermatochalasis] that hangs over lashes into line of sight. You would need photos and visual fields done by an Ophthalmologists to confirm these findings. Your best bet would be to see an Oculoplastics surgeon that does this kind of evaluation and surgery day in and day out.
