Is Eyelid Surgery covered by insurance?

In what cases can eyelid surgery be covered by most insurance companies?

Doctor Answers 3

Insurance Coverage for Eyelid Surgery

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Generally speaking, insurance only covers an eyelid surgery that is deemed medically necessary. If the droopiness of your eyelids is impairing your vision or is otherwise affecting the functionality of your eyes, it is possible that your insurance may cover all or some of the cost of your blepharoplasty procedure. If you are seeking surgery for cosmetic or aesthetic reasons, on the other hand, it is likely that insurance will not cover any portion your surgery.

Is eyelid surgery covered by insurance?

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Eyelid surgery may be covered by insurance if there is an issue that affects the function of the eyelids or affects vision.  One of the most common procedures that may be covered by insurance would be upper eyelid surgery when the droopy skin impairs the field of vision. An eye exam is needed to determine if there is a visual field defect due to the upper eyelids.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

When is Eyelid Surgery covered by insurance

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Simple answer to your question is yes. However, for "functional" or "medical" reasons and not for cosmetic reasons. Upper eyelid surgery is covered when peripheral or upper visual fields are affected. They can also be covered if contributing to a watery eye, however, certain criteria need to be satisfied. I published a paper describing this indication of "upper eyelid wick syndrome" (see in any search engine).
Lower eyelids are covered when contributing to either watery eyes or dry eyes, either by significant laxity or retraction. Lastly, both upper and lower eyelids are covered for the indication of medical conditions such as thyroid eye disease, facial palsy etc but again, this is for the rehabilitation to restore eyelid functions such as normal eyelid closure (even blink) and symptoms and signs of watery eye, dry eye, corneal exposure etc People with artificial eyes often are covered in order to allow correct fitting of an artifical eye.

Raman Malhotra, MB ChB FRCOphth
London Oculoplastic Surgeon

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