Do I qualify for insurance based drooping eyelid surgery? (Photo)

Upper eyelid surgery (and sometimes a browlift) can be covered by insurance if very specific criteria are met. In decades past these procedures were paid for by insurance much more frequently, but as healthcare and insurance have changed the insurance carriers have become much more strict on the criteria.You need to keep a few things in mind to see if you meet the acceptable criteria:- examination with a facial plastic surgeon, oculoplastic surgeon, or general plastic surgeon.Diagnosis is the first step.  Your surgeon will also need to rule out other issues such as ptosis, etc.  Then you can review the surgical options and likely outcomes. - submit medical records.These can be from your office visit with your surgeon.  Any functional impairment and day to day complaints should be clearly documented in the medical record.- photographs will need to be taken during your visit with your surgeon.Often insurance companies want a series of photographs and then those same views with tape lifting the eyelid skin or drooping brow showing an improvement in any visual impairment after lifting the redundant skin out of the way.  Most insurance companies will not approve upper blepharoplasty unless the eyelid skin is so redundant that it is resting on (or over) the eyelashes.- examination by an ophthalmologistA good overall eye exam is necessary and must also include visual field testing taped and untaped.  A good rule of thumb is that patients who qualify for insurance coverage for blepharoplasty usually show a 30% or greater improvement in visual fields when the tape is in place.  Remember that every insurance plan is different.  I have dealt with some that are very clear and quick in their answers and some that are painful to deal with every step of the way.  As others have said, an upper eyelid lift is something that can often be performed easily and very safely in an office setting under local anesthesia, perhaps with some light oral sedation if needed to relax you.  This can help to cut out operating room and anesthesia costs.  You might find that once you consider deductibles and out of pocket costs with insurance that paying for a blepharoplasty without insurance is not quite as expensive as you might have guessed.

 In order to bill a medical insurance for drooping and hooded upper eyelids, medical necessity must be documented and met prior to the surgery for insurance to cover it. Preauthorization is obtained prior to the surgery. Visual field obstruction test, photographs, and clinical chart notes are all required in order to submit  it to an insurance company. Always be prepared to pay for the surgery  yourself, in case it denied by  your medical insurance.