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Will my Insurance Pay for Blepharoplasty?

insurance covers for eyelid surgery?

Doctor Answers 38

Insurance Payment for Blepharoplasty Requires Decrease in Vision Proven by Visual Fields

Most Bleparoplasties that are done are not covered by Medical Insurance. Insurance companies have strict criteria that must be met for Insurance to cover a Blepharoplasty.

To meet these criteria you must have a Visual Field Exam done usually by an Optometrist.

That exam tests your ability to see around you. If the Visual Field Test shows that 25% of your upper Visual Field is cut or lost by the overhanging Upper Eyelid Skin then your Blepharoplasty may be covered

Insurance can pay for Blepharoplasty in certain cases

If hooding of the upper eyelids interfere with your vision, your health insurance company may cover blepharoplasty surgery for the upper eyelids only. Most health insurance companies exclude coverage for cosmetic surgical operations such as the lower eyelid blepharoplasty or any complications that might occur from the surgery. Most insurance plans exclude coverage from secondary or revisionary surgery.

BLEPHAROPLASTY AND INSURANCE

In some instances insurance will cover the fee for upper eyelid blepharoplasty. The reasons include:

1- Significant interference with vision or obstruction of the superior or lateral (outer) visual fields; insurance companies and Medicare will usually require visual field testing to document a minimum of 12 degrees or 30 percent loss of upper field of vision.

2-Difficulty reading due to superior visual field loss.

3- Looking through the eyelashes or seeing the upper eyelid skin.

Insurance companies other than Medicare will require the visual fields and photographs be submitted for review and pre-approval prior to surgery.

Lower eyelid blepharoplasty is never covered by insurance- this is a purely cosmetic and not a functional (medically indicated) procedure.
 

Adam J. Cohen, MD
Skokie Oculoplastic Surgeon
3.5 out of 5 stars 13 reviews

Functional blepharoplasty be covered by insurance

Third party payers will not pay for a cosmetic blepharoplasty. However, some patients may exhibit visual field obstruction documented by a visual field test in the upper eyelids.  These patients may qualify for a functional blepharoplasty to relieve the obstruction.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 61 reviews

Depends on visual field obstruction

To obtain insurance coverage for an upper blepharoplasty there are several items that are submitted to insurance to document medical necessity. These are visual field obstruction test( taped and untaped), photographs of the eyelids and your surgeon's chart notes. If there is approximately 25-30% of visual field obstruction of the entire field of view, some insurance companies may consider paying for this as a functional problem and consider it medical necessity.  Patient's are still required to pay the co-pays and deductibles according to their insurance plan, even if it's covered under insurance. Always be prepared to pay for this surgery in case your insurance denies the claim. Lower blepharoplasty  is considered cosmetic. for many examples of eyelid surgery, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 67 reviews

Blepharoplasty is usually not covered.

Caitie,

That is a good question and one that almost every patient asks. However, the insurance companies are very strict when it comes to covering procedures which may seem "cosmetic" in nature. Your best hope of getting it covered by insurance is to have a visual field test by an ophthalmologist. However, the test will have to show significant visual obstruction of your vision by your redundant upper lid skin for the insurance company to consider covering the procedure. Then, even if they do cover it, you would need to find a plastic surgeon who takes your insurance. Since, the insurance companies usually only pay pennies on the dollar, most plastic surgeons do not take insurance.

I hope this is helpful.

David Shafer, MD
Shafer Plastic Surgery, NYC

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 63 reviews

Visual Field Test

Insurance coverage for Blepharoplasty is limited to those patients whose excess upper eyelid skin or sagging brow causes a measurable impairment of their peripheral vision. This condition must be documented by Visual Field testing, which evaluates the degree of obstruction caused by the hanging upper eyelid or sagging brow. One measurement is done with the eyelids in the "normal" position, and a second measurement is done with the eyelids taped or held open. If there is measurable improvement, insurance may cover the procedure, but there are generally no guarantees.

Athleo Louis Cambre, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Decrease in visual field may justify upper blepharoplasty

If the upper eye lid covers the pupil, there is infection due to excess folds of skin, or an eye doctor can demonstrate decrease in visual field due to heaviness of the upper lid, insurance may cover various surgeries on the upper lid depending if the problem is excess skin, weak or detached levator muscle, or ptosis of the brow causing visual field deficit. If your visual field is normal and you have no dermatological condition, blepharoplasty will not be covered.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 9 reviews

Does insurance cover blepharoplasty?

Thank you for your questions.  This is a very common question the patient's have.  In general insurance may cover blepharoplasty if it is related to functional concern and visual field obstruction.  Unfortunately he functional blepharoplasty is very much different than a cosmetic blepharoplasty.  He functional blepharoplasty involve simply removing excess skin to open up the femoral division.  It does lose discussed with the appearance of the upper eyelid and restore a youthful appearance.  There is many intricacies related to a cosmetic blepharoplasty that insurance does not pay for.  These include removing or repositioning fat pockets,  restoring the contour of the brow, restoring the contour of the natural crease. I would proceed with caution if your expectations are to look younger after a functional blepharoplasty...this is often not the case but your visual fields has significantly improved.  his appearance is her primary concern, a cosmetic blepharoplasty is most likely in your best interest.  Unfortunately this is oftentimes an out-of-pocket expense.  Best of luck in your decision-making, Dr. Pacella

Insurance and blepharoplasty

Insurance will usually cover upper lid blepharoplasty for skin excess that causes visual field cuts.  Every insurance company has their own guidelines, but a rule of thumb is that you will need to see an optometrist or ophthalmologist to perform visual field tests with and without your upper eyelids taped to determine if there is vision change secondary to the excess upper eyelid skin.  Insurance will then usually cover skin excision.  For cosmetic blepharoplasty, skin and often fat is addressed to rejuvenate the eyes.  Insurance does not generally cover typical lower lid blepharoplasty.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 9 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.