Is Any Part of the Surgery Covered by Insurance?

I like many people of my age have excess skin in my eyelids and I have many small skin tags that need to be removed. Is any part of this surgery covered by insurance?

Doctor Answers 21

Insurance coverage

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

Insurance Coverage

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For patients in our practice who have symptomatic droopiness of their upper eyelids, our staff performs testing during their initial consultation to submit to their insurance. Frontal and side view photographs of the eyelids are taken as well as visual field testing, to document any obstruction of peripheral vision from the droopiness of the upper eyelids. After these tests are submitted to your insurance company, they will determine if you meet their predetermination status to qualify for sugery. Insurance companies typically take 2-4 weeks to complete this process. Removal of benign skin lesions, such as skin tags, may be covered, depending on the coverage of your particular insurance plan. Check with your insurance company as well as a physician in your area.

William P. Mack, MD, PA
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 46 reviews

Upper eyelid surgery and medical insurance coverage

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Insurance will only cover upper eyelid surgery when there is a severe amount of excess skin called dermatochalasis, which is a medical condition whereby the excess skin pushes down on the eyelashes creating a visual obstruction. Approximately 30% of the visual field needs to be obstructed before medical insurance will pay for a medically necessary blepharoplasty.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Insurance may cover eyelid surgery.

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Different insurances will give different benefit levels.  All insurances will require you to see an ophthalmologist and get a visual field test which would show that you have parts of your vision blocked by the excess skin.  This would be a" functional" as opposed to a "cosmetic" problem and many insurances would cover it.  The skin tags are a cosmetic problem but perhaps your surgeon could snip most off quickly at the time of your upper eyelid surgery.

Excess skin over the eyelids may be covered by insurance

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Excess skin over the eyelids may be covered by insurance if it is interfering with vision. Peripheral vision is documented by visual field within 30 degrees of fixation. Skin tags are usually not covered unless they’re causing a functual irritation or a lesion that needs to be biopsied.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

Eyelid surgery may be covered by insurance...

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If you have droopy or sagging eyelids that interfere with your vision, then there may be a possibility insurance will cover it. Insurance will only cover upper lid surgery if there is a documented visual field impairment. Otherwise the procedure is considered cosmetic and would not be covered. I would recommend making an appointment with an ophthalmologist for a visual field exam to see if you qualify for your surgery to be covered

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 reviews

Insurance may cover an upper blepharoplasty

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Hi Ogden,

Insurance may indeed cover a portion of your upper blepharoplasty; however, this requires that you are seen by an ophthalmologist and have your visual fields tested to determine if you meet criteria to qualify.  Most plastic surgeons will have you sign a waiver stating that you are responsible for paying what insurance doesn't or won't pay.

Regarding the skin tags, these should also be evaluated by your plastic surgeon (or dermatologist).  If these are concerning for potential cancer, removal of the skin tags may be covered.  However, for those tags that are clearly not cancer and are just being removed for cosmetic purposes, insurance would not cover the costs.

Good Luck!

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 50 reviews

Insurance can sometimes cover upper eyelid surgery (blepharoplasty)

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If you have excess skin of the upper eyelids that is interfering with your vision, an upper blepharoplasty can help your symptoms.  This can be both functional (which could be covered by insurance) as well as cosmetic.  You may have to consult with an ophthalmologist to document that you have visual field deficits, and therefore, need the surgery for "functional" reasons. Please ask your health insurance carrier for their specific requirements

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

Yes insurance may pay for upper eyelid surgery

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Excess skin of the upper eyelids can cause loss of peripheral visual field.  This is dangerous while driving a car.  Most insurance companies will pay for correction or upper blepharoplasty.  To see if your insurance company will pay usually requires a letter from your board certified plastic surgeon, a copy of a peripheral field vision test, and photographs.  The peripheral field visual test can be done by your optometrist.

Randy Proffitt, MD
Mobile Plastic Surgeon

Eyelid surgery - insurance

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Insurance will cover upper eyelid surgery (but not lower) if you see an eye doctor and get visual field testing that shows that the extra skin is impairing your vision.  Each insurance is different in how picky they are but they'll usually cover this surgery.  The skin tags are unlikely to be covered.  However, the medical biller at the plastic surgeon's office you go to will help you through this process with your insurance.

Dr. Cat Begovic M.D.

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.