Eyelid Surgery: Q&A
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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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24 Doctor Answers |
Asked by
eyeking
in san diego, ca
+4
A "visual field test" confirms whether excess eyelid skin blocks vision
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 flash you are asked to push a button. If you can't see the flashes in the upper field of your vision, and the opthalmologist concurs that this is from excess skin , then the test may be considered...
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+3
If vision is impaired by excess eyelid skin, then yes, procedure 15823
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 you'll repeat the test after having your eyelids taped up. The computer records how many you saw and how many you missed. It also keeps track of false positives and negatives, so it...
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+3
The Visual Field Test tells all
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 you can see if you are insurable. Expect major resistance from your carrier, however, as they will likely be skeptical of your "medical necessity" for an upper blepharoplasty...
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+3
Field Test
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 eyelid lash margin that this extra "hood" of skin actually blocks the peripheral vision, upper eyelid surgery should be a covered benefit of your insurance plan. In these cases,...
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Los Angeles Plastic Surgeon
+2
Insurance coverage of blepharoplasty
Most insurance companies will cover blepharoplasty if 3 requirements are met.
1. Documented photo of eyelid droop or dermatochlasia (excess skin above the eyelid)
2. Documented clinical exam by a physician
3. Improvement in superior visual field test with tape compared to without. (Basically you have to see better to make it a non cosmetic case)
Insurance companies never cover the lower eyelid blepharoplasty
+1
Insurance Coverage for Upper Eyelid Lift
The only way that insurance will cover an upper eyelid lift is if it can be demonstrated that your vision is compromised. This requires formal evaluation by an ophthalomologist and the test is called a "visual field test."
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When Redundant Upper Eyelid Skin Obstructs Vision, it's More than a Cosmetic Issue and Usually is Covered by Insurance
When redundant upper eyelid skin results in obstruction of vision, it’s more then a cosmetic issue. Patients often have excess skin which obstructs vision superiorly and laterally. Under these circumstances excess upper eyelid skin can actually cause significant functional problems. For instance, this can create problems when driving a motor vehicle and this can be potentially dangerous. When this happens insurance carriers will occasionally view upper lid...
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Insurance sometimes covers blepharoplasty for drooping upper eyelids
There are usually 4 main things that are necessary for insurance to help cover upper blepharoplasty:
Patient's symptoms of blocked visual field from the upper lids
Physical findings noted on the surgeon's examination (upper lid skin crowding the lashes or overhanging the margin
Visual field testing showing the blockage of peripheral vision
Photos of the excess skin
That said, different insurance companies vary in their coverage policies. Also,...
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+1
Test to determine insurance coverage for droopy upper lids.
Most insurance companies will require a visual confrontation test to determine just how much of your visual field is blocked by your upper lids. Different insurance companies may have different criteria. No, you can't "cheat" the test. The test is typically done in an ophthalmologist's office.
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Coverage rules vary from company to company
You need your surgeon to take photographs, and you need visual field testing (done by an ophthalmologist) for your insurance company to consider covering upper eyelid lifts. Coverage rules vary from company to company, but generally you must have skin hanging over the ends of your eyelashes and blocking your vision. Good luck!
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What Are the Requirements to Have Insurance Cover Blepharoplasty
Most insurance companies require a field of vision test that shows lack of total vision caused by heavy upper eyelids. The insurance companies will not cover the lower eyelids.
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Blepharoplasty Insurance Requirements
While there are variations in the requirements among the insurance plans, the standard basis is a functional complaint and a supporting visual field test.
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Insurance for blepharoplasty
Visual field deficit is necessary for insurances to cover the blepharoplasty. I send my patients to an ophthalmologist to have the visual field testing since they are the most qualified.
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What Are the Requirements to Have Insurance Cover Blepharoplasty?
In order to have insurance cover upper eyelid Blepharoplasty (insurance companies will not cover lower eyelid Blepharoplasty), you have to have two objective criteria: a visual field test which shows evidence of peripheral visual field obstruction, and you have to have lateral hooding (dermatochalasis). As described by Dr. Rand, insurance companies put up an incredible fight to prevent coverage for this type of procedure, often submitting pre-approvals that are later subject to...
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+1
How to get insurance to cover upper blepharoplasty
You need the following:
1. Pictures documenting excess upper eyelid skin and possible brow ptosis (drroping)
2. An ophthamological exam
3. A visual fields test from your ophthamologist
4. A physical exam from your plastic surgeon documenting the excess skin +/- brow ptosis with the surgical plan of action
Then you start calling your insurance company and bug them!
+1
How to get insurance to cover a blepharoplasty.
Insurance will cover an upper eyelid blepharoplasty (upper eyelid surgery) if it can be documented. First I would suggest photographs of the conditions both frontal and lateral views.
Second: Insurance companies do not trust physicians and require another physician especially an ophthalmologist to have performed a visual field on the patient. Armed with this, you should not have any trouble having them reimburse you for upper eyelid surgery...
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Insurance and blepharoplasty
There are several criteria that must be fufilled for insurance companies to cover blepharoplasties. It is the most common procedure I do so I have some experience with this:
1. Excess upper eyelid skin that is blocking the vision: Your excess eyelid skin must be blocking your vision. This must be confirmed with a photograph that shows this. Also, skin should be over the lashes atleast and usually dropping down near the pupil. The photograph is key because insurance companies need to...
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+1
Insurance coverage and Blepharoplasty
Sometimes insurance companies will cover upper lid blepharoplasty. Each insurance company will have different criteria for coverage. If the excess skin hangs over the lids and blocks the superior vision insurance may cover it. Your doctor will need to do a visual field test to determine if there is a superior visual field defect. The insurance company may also require photos of the lids.
Englewood Oculoplastic Surgeon
+1
Insurance almost never covers eyelid surgery any more even if there is a functional problem.
Upper lid eyelid surgery to correct a visual field disturbance is becoming much harder to get insurance to pay for. Many policies specifically exclude eyelid operations. Your broker should be able to tell you if you have even a chance for coverage.
+1
Insurance vs Cosmetic eyelid surgery
Cosmetic eyelid surgery, called blepharoplasty, is a surgical procedure to improve the appearance of the upper eyelids, lower eyelids, or both, and give a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert. Insurance related cases are approved by an opthamologist with a field of vision test to assure you qualify for coverage.
+1
Documented 25 % block of visual fields is required for insurance to cover blepharoplasty
Insurance will cover an upper blepharoplasty if there is documented disturbance of your vision.
In my state, a documented 25% cut in the visual field is required. The visual field is a test which is done by an ophthamologist.
Typically, a copy of the report of the visual field and photographs of your eyes are sent to the insurance company for approval.
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Insurance coverage for Blepharoplasty
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 criteria.
These are not consistent among insurance companies and no standard have been established.
Generally, the indications for medically necessary blepharoplasty include blepharoptosis,...
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Use of a White Cane with Red at the TIp Helps
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 luck, and watch out for low hanging objects to avoid bumping your head on those objects being blocked out by your heavy eye lids.
Dr. P
+1
Insurance coverage
Insurance will not cover any procedure they deem as cosmetic. They will cover for eyelid reconstruction following cancer resection or trauma. Insurance companies (Even PPOs etc) are very adept at denying any procedure they view as cosmetic.
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