I like many people of my age have excess skin in my eyelids and I have many small skin tags that need to be removed. Is any part of this surgery covered by insurance?
Is Any Part of the Surgery Covered by Insurance?
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Upper eyelid surgery and medical insurance coverage
Insurance will only cover upper eyelid surgery when there is a severe amount of excess skin called dermatochalasis, which is a medical condition whereby the excess skin pushes down on the eyelashes creating a visual obstruction. Approximately 30% of the visual field needs to be obstructed before medical insurance will pay for a medically necessary blepharoplasty.
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Insurance may cover eyelid surgery.
Different insurances will give different benefit levels. All insurances will require you to see an ophthalmologist and get a visual field test which would show that you have parts of your vision blocked by the excess skin. This would be a" functional" as opposed to a "cosmetic" problem and many insurances would cover it. The skin tags are a cosmetic problem but perhaps your surgeon could snip most off quickly at the time of your upper eyelid surgery.
Excess skin over the eyelids may be covered by insurance
Excess skin over the eyelids may be covered by insurance if it is interfering with vision. Peripheral vision is documented by visual field within 30 degrees of fixation. Skin tags are usually not covered unless they’re causing a functual irritation or a lesion that needs to be biopsied.
Eyelid surgery may be covered by insurance...
If you have droopy or sagging eyelids that interfere with your vision, then there may be a possibility insurance will cover it. Insurance will only cover upper lid surgery if there is a documented visual field impairment. Otherwise the procedure is considered cosmetic and would not be covered. I would recommend making an appointment with an ophthalmologist for a visual field exam to see if you qualify for your surgery to be covered
Insurance may cover an upper blepharoplasty
Insurance may indeed cover a portion of your upper blepharoplasty; however, this requires that you are seen by an ophthalmologist and have your visual fields tested to determine if you meet criteria to qualify. Most plastic surgeons will have you sign a waiver stating that you are responsible for paying what insurance doesn't or won't pay.
Regarding the skin tags, these should also be evaluated by your plastic surgeon (or dermatologist). If these are concerning for potential cancer, removal of the skin tags may be covered. However, for those tags that are clearly not cancer and are just being removed for cosmetic purposes, insurance would not cover the costs.
Insurance can sometimes cover upper eyelid surgery (blepharoplasty)
If you have excess skin of the upper eyelids that is interfering with your vision, an upper blepharoplasty can help your symptoms. This can be both functional (which could be covered by insurance) as well as cosmetic. You may have to consult with an ophthalmologist to document that you have visual field deficits, and therefore, need the surgery for "functional" reasons. Please ask your health insurance carrier for their specific requirements
Yes insurance may pay for upper eyelid surgery
Excess skin of the upper eyelids can cause loss of peripheral visual field. This is dangerous while driving a car. Most insurance companies will pay for correction or upper blepharoplasty. To see if your insurance company will pay usually requires a letter from your board certified plastic surgeon, a copy of a peripheral field vision test, and photographs. The peripheral field visual test can be done by your optometrist.
Eyelid surgery - insurance
Insurance will cover upper eyelid surgery (but not lower) if you see an eye doctor and get visual field testing that shows that the extra skin is impairing your vision. Each insurance is different in how picky they are but they'll usually cover this surgery. The skin tags are unlikely to be covered. However, the medical biller at the plastic surgeon's office you go to will help you through this process with your insurance.
Dr. Cat Begovic M.D.