What are the requirements to have insurance cover blepharoplasty?

Excess upper eyelid skin runs in both sides of my family, and most have impaired vision by their late 50s. At 37, my upper eyelids hang over my lashes; the excess skin is about 1/2" when pinched with no apparent fat, just skin sagging over lashes. I'm used to it, but there is definitely an upper black line in my vision where the lids are pressing down, and I can "see" my lashes at all times.

What are the usual requirements to gain insurance approval with a good PPO? Is this even possible, or is it always considered cosmetic?

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6 answers to “What are the requirements to have...”

A: if vision is impaired by excess eyelid skin, then yes, procedure 15823

By Jonathan Hoenig, MD - Beverly Hills Oculoplastic surgeon

If the excess eyelid skin is pushing down your eyelids and your vision is impaired, then insurance may help cover the costs. The definitive test required by the insurance companies is the visual field exam - taped and untaped. You'll look at some flashing lights and push a button when you see the light. Then... more

A: Insurance coverage for Blepharoplasty

By Otto Joseph Placik, MD - Chicago Plastic Surgeon

Insurance coverage generally does not pay for cosmetic procedures. They will, however, contemplate paying for reconstructive or functional surgery. That having been said, each company determines the parameters by which they establish medically necessary blepharoplasty using reconstructive and functional... more

A: Use of a White Cane with Red at the TIp Helps

By Michael A. Persky, MD - Los Angeles Facial Plastic Surgeon

Hi eye, See an ophthalmologist and have a visual field test. If the test is positive, have your surgeon submit a pre-authorization request to your insurance company. Even if you are pre-authorized, it does not guarantee that the insurance co will fully re-imburse you for your procedure. Good... more

A: A "visual field test" confirms whether excess eyelid skin blocks vision

By John E. Gross, MD - Los Angeles Plastic Surgeon

There is an objective test, typically done in an ophthalmologists' office that confirms whether eyelid skin is responsible for blocking vision. The test involves evaluating each eye seperately. You sit looking into a box with one eye covered. There are brief flashes of light and with each... more

A: The Visual Field Test tells all

By Richard P. Rand, MD - Seattle Plastic Surgeon

It would be very unusual at your age to have an insurable amount of visual field obstruction, but not impossible. The Visual Field Tests are simple tests that have to be done by an ophthalmologist, not by a plastic surgeon. If you have an ophthalmologist, they can arrange for you to have it done and then... more

A: Field Test

By Athleo Louis Cambre, MD - Los Angeles Plastic Surgeon

In most cases, insurance does not cover eyelid surgery. Removal of simple excess skin and fat from the upper and lower eyelids is considered "cosmetic" in most cases, where the goal is primarily improvement of appearance. In select cases, where the upper eyelid skin hangs so far over the upper... more