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Will my Insurance Pay for Blepharoplasty?

insurance covers for eyelid surgery?

Asked 39 months ago by caitie in cincinnati, oh

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Insurance paying for upper eyelid surgery

There are three criteria that medicare has established and all three need to be documented before your insurance company considers covering the cost of upper eyelid surgery. 1. Documentation of superior visual field loss: This test is performed with each eyelid taped up to prove improvements in the superior visual field after surgery. 2. Documentation of ptosis (eyelid droop) OR dermatochlasia by your surgeon 3. Frontal and side view photographs documenting the presence of ptosis or... more

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Kami K. Parsa, MD

Los Angeles Oculoplastic Surgeon

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... more

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Adam J. Cohen, MD

Chicago Oculoplastic Surgeon

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.

Gregory Turowski, MD, PhD

Chicago Plastic Surgeon

ASPS

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

Los Angeles Plastic Surgeon

Depends on visual field obstruction

Typically, blepharoplasties are considered cosmetic surgery and are not paid for by medical insurance. However, if there is approximately 30% of visual field obstruction of the entire field of view, some insurance companies may consider paying for this as a functional problem. Always be prepared to pay for this surgery in case your insurance denies the claim.

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William Portuese, MD

Seattle Facial Plastic Surgeon

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... more

David Shafer, MD

New York Plastic Surgeon

ASPS

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... more

Athleo Louis Cambre, MD

Los Angeles Plastic Surgeon

ASAPS ASPS

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

ASPS

Insurance for eyelid surgery

Upper eyelid surgery (blepharoplasty) may be covered by insurance if it can be proven to be causing visual field impairment. This must be documented by an ophthalmologist (eye doctor) and then submitted to your carrier. However, this procedure is typically denied by most insurance carriers as they deem eyelid surgery to be cosmetic.

Etai Funk, MD

Houston Facial Plastic Surgeon

Will my Insurance Pay for Blepharoplasty?

Upper eyelid Blepharoplasty is covered by insurance if you can document decreased vision because of the excess eyelid skin. The surgeon needs to document this with photos and visual fields. Often preauthorization from the insurance company is necessary. If there is no visual loss, insurances will not pay.

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Sam Goldberger, MD

Beverly Hills Oculoplastic Surgeon

Will insurance cover eyelid surgery

Upper blepharoplasty (eyelid surgery) may be covered by your insurance if your surgeon can document that the excess skin is interfering with your vision and therefore deemed medically necessary. Often times this will require a consultation with an ophthalmologist to determine the extent of the visual impairment caused by the excess upper eyelid skin. This also varies depending on the type of insurance plan you currently have. Lower eyelid surgery is generally not covered by... more

William Bruno, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Insurance only covers what they consider "medically necessary"

In some cases, UPPER eyelid surgery may be covered. You would have to check with your carrier to see what their criteria for coverage are, then take that list to your surgeon to see if you could possibly meet those criteria. Lower eyelid surgery (lower blepharoplasty) is not ever covered by insurance.

Carmen Kavali, MD

Atlanta Plastic Surgeon

ASPS

Insurance will occasionally cover upper eyelid surgery.

Upper eyelid surgery is occasionally covered by insurance but it is getting harder and harder to get those cases approved. A visual field study that shows some impairment is usually required. Photos are sent with the request.

Vincent N. Zubowicz, MD

Atlanta Plastic Surgeon

ASAPS ASPS

Insurance Coverage for Eyelid Surgery

I assume your question has more to do with the upper eyelid and how it relates to problems with vision. In some cases, health insurance companies will provide coverage for a blepharoplasty if the upper eyelid skin is so redundant that it obstructs your peripheral vision. It does require a thorough examination by a surgical specialist and objective documentation that lifting the eyelid skin will correct the visual field loss to a significant degree. Standardized photographs of your eyes... more

John M. Hilinski, MD

San Diego Facial Plastic Surgeon

Blepharoplasty is covered if you meet criteria, depending on insurance company

Visually obstructive eyelid problems are absolutely included in most insurance companies' benefits. An ophthalmology or oculoplastic surgeon has equipment in the office to measure the amount of visual obstruction from the eyelid problem. Based on the patient's complaint, the visual field loss from the eyelids, and the photographic documentation, these upper eyelid procedures are frequently approved by Medicare and private insurance companies. If you are trying to have your eyelids... more

Evan Black, MD

Detroit Oculoplastic Surgeon

Not very often will insurance pay for Blepharoplasty

In most cases, the simple answer is no. In the case of vision blockage due to ptosis or excess skin, there are very specific vision tests that insurance companies will demand as well as photo documentation before approving such a surgery. There are times a procedure can be approved because of medical necessity. That said, if it is approved, the insurance company will have an amount that they deem normal for the procedure and the area it is performed in. Often times, in a private cosmetic... more

Amiya Prasad, MD

New York Oculoplastic Surgeon

Insurance applies only if it is medically necessary

There is no insurance coverage for Blepharoplasty surgery unless it affects the field of vision; even then it may not be covered. If not, it is considered cosmetic and elective surgery.

David R. Stephens, MD

Seattle Plastic Surgeon

ASPS

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,... more

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

Cosmetic Blepharoplasty is not covered

If your upper eyelids cover your visual fields in a demonstrable way then insurance should cover it. However, you will need to go to an ophthalmologist to have visual field testing and these test do not lie. Lower eyelids may sag and cause eyelid dryness and this may be covered, but once again you will need to see a second opinion or jump through hoops in order to get this covered as well. Good luck.