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

Question

I have a tiny lump on my left eyelid that I wanted removed. However, I have wanted to improve my eyelids for some time. Would this be covered by insurance?

Stephen Weber MD, FACS · Answer

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

Jerome Edelstein, MD · Answer

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

Lewis Albert Andres, MD · Answer

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!

Jeffrey J. Roth, MD, FACS · Answer

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.

Mehryar (Ray) Taban, MD, FACS · Answer

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.

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

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Answer: Eyelid surgery insurance coverage.

Answer: Eyelid surgery insurance coverage.

Answer: Eyelid lesion

Answer: Eyelid lesion

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

Answers (9)

Answer: Eyelid surgery insurance coverage.

Answer: Eyelid surgery insurance coverage.

Answer: Eyelid lesion

Answer: Eyelid lesion

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.