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It is possible that your insurance will cover this procedure. You will need a formal visual field test, an evaluation by an eyelid surgeon as well as high quality photos of your eyelids. This will allow your surgeon to determine whether you are having vision issues due to the extra skin in your eyelids and your insurance company to determine whether surgery will be a covered benefit. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon
Loose skin of the upper eyelid can cause vision issues. You will need a visual field test to determine to what degree this extra skin is disturbing your vision. Your optometrist can perform this. Take the results of this test to a plastic surgeon or a facial plastic surgeon during your consultation. The office will submit your exam and the test results to see if YOUR insurance will cover the procedure
Just because they recommend surgery, it does not mean you need surgery and it certainly does not mean that your health insurance will pay for it. Particularly in questionable situations (i.e. just beginning to interfere with vision) it is most likely going to be considered a cosmetic issue. I recommend actually consulting an oculoplastic surgeon in your areas and leaning what they recommend.
When excess skin on the upper lids is significantly blocking a large percentage of the visual fields, a medical insurance company may cover it. Medical necessity has to be documented at the time of consultation and examination. This involves submitting pictures of the eyelids, examination/consultation reports, and visual field obstruction test which document the interference of vision. Once medical necessity has been met, preauthorization is performed with the medical insurance company prior to the surgery itself. It is also best to check with your Medical insurance handbook for inclusions and exclusions.
It is possible that your insurance may cover this procedure, but each insurance plan has specific criteria that must be met first. This could involve submitting visual field test results, photographs, doctors' notes, and even having a peer to peer phone conference between the insurance company and your physician. The best thing to do would be to go through your surgeon's office....they usually have been through this process numerous times before.