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Will my Insurance Pay for Blepharoplasty?

insurance covers for eyelid surgery?

Doctor Answers (30)

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

+3

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


Boston Plastic Surgeon
4.5 out of 5 stars 31 reviews

BLEPHAROPLASTY AND INSURANCE

+3

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 12 reviews

Insurance can pay for Blepharoplasty in certain cases

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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
4.5 out of 5 stars 25 reviews

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Functional blepharoplasty be covered by insurance

+2

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 47 reviews

Depends on visual field obstruction

+2
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 56 reviews

Blepharoplasty is usually not covered.

+2

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 57 reviews

Visual Field Test

+2

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

Decrease in visual field may justify upper blepharoplasty

+2

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 7 reviews

Will my insurance pay for blepharoplasty?

+1
Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Typically this is a cosmetic procedure.  Detailed description of your functional deficit, examination, testing, and photographs will be required in the rare instance of visual issues.  Only upper lids would be covered for this reason.  Lower eyelids are usually not a covered benefit for this reason. 

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Insurance covering blepharoplasty

+1
Insurance covering blepharoplasty
It is very challenging to prove to an insurance company that removing the excess skin from the upper eyelid is truly a medically necessary procedure.In most cases, it is purely cosmetic and due to aging. In order for an insurance company to cover it, you should see on ophthalmologist and have a visual field exam done.I believe more than 25% or 30% must be blocked in order for them to consider it.This being said, most are not covered and really should not be billed through insurance as removal of excess skin of the upper eyelid is not a medically necessary procedure in most cases.

Christopher T. Maloney Jr., MD
Tucson 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.