Is Eye Lid Surgery Covered by Any Kind of Medical Insurance?

Removal of a suspicious eyelid lesion is usually covered by insurance but this does not include a blepharoplasty. If your upper eyelids are so droopy that they affect your vision, then an upper blepharoplasty is occasionally covered by insurance if you have objective testing data that shows an improvement in your vision when your eyelids are taped up and out of the way. Unfortuantely, if you want a cosmetic upper eyelid procedure performed to improve your appearance you will need to pay the cosmetic fee to have it performed. The typical cost is about $3000-4000.
Thank you for your question.Stephen Weber MD, FACS

Unless it's for health reasons, insurance doesn't usually cover eyelid surgery since it's considered cosmetic.  

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.  Eyelid surgery for cosmetic reasons is not covered, however a detailed examination, testing, and photographs would be required for the instance of functional deficits.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!

The lesion my be covered.  If you have droopy upper lids, this may sometimes be covered if the lids are blocking your vision. For that, 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.  Each patient and insurance company is different.  Seek an experienced surgeon and ask about your particular case.

Removal of eyelid lesions can be covered by insurance if 1) they are cancerous, 2) suspicious for cancerous lesion, 3) irritating the eye.  Only a proper personal examination can determine that.  Consult an oculoplastic surgeon.

The short answer is that the lump may be covered by the insurance but the cosmetic aspect (blepharoplasty) definitely would not unless it interfered with your vision.

Here is the long answer: It used to be that just about all "lumps and bumps" were covered by insurance as it was considered reconstructive rather than cosmetic surgery.  The defiintion of this distinction is pretty straight forward - Reconstructive surgery means improvement of a condition that goes from abnormal towards the normal, whereas "Cosmetic" refers to improvement of a normal condition. Unfortunately, this does make a lot of difference to many insurance companies today. Instead they are more interested in correction of functional problems. That is something that interferes with your vision, irritates the eye, causes recurrent infection or dry eyes, or is a cancer (malignancy),etc.  

It depends on the insurance. If there has been change in the lesion, then there is a possiblity that this could be a malignant skin lesion and insurance would cover it. If not, then some insurances may consider it cosmetic.

 

Excision of an eyelid lesion may be covered by insurance. However, cosmetic surgery is not covered and the indications for establishing that a blepharoplasty is medically necessary are extremely strict. Currently, in NY, visual field studies are given very little weight because they can be manipulated and insurers will consider only unilateral corrections based on underlying conditions such as Bell's palsy, multiple sclerosis, stroke, and other conditions that you'd certainly not want to have!

The lesion may be covered if it appears to be a malignant lesion, if it obscures your vision in some way, or if it is causing tearing or eye irritation.  As far as improving the appearance of the eyelids, the doctor would have to document that the eyelids were blocking the vision with a visual field exam, eyelid measurements and photos that back up these tests.