What Are the Requirements to Have Insurance Cover Blepharoplasty?

Insurance companies often will cover upper lid surgery if the patient has skin resting on the eyelashes and improvement in the visual field examination when the upper lid is taped.  The results of the visual field exam plus photographs are sent to the insurance reviewer ahead of time to determine coverage. 

Great question! It is certainly possible to have insurance cover a portion of your upper eyelid surgery based on the degree of visual field obstruction. The exact guidelines will depend on your insurance company, but generally speaking you will need formal visual field testing with an Ophthalmologist/Optometrist office to obtain objective measurements. This will include testing your visual field with your eyelids taped and untaped (simulating to some extent what surgery would accomplish). There must be a significant enough difference between these two scenarios to meet approval. Additionally, your surgeon will need to specifically document, both in their note and with photos, the degree of fullness of the upper eyelid. Once all of the information is obtained this is submitted to your insurance company who will determine if this is approved.
Hope this helps!Kyle Kimura, MDFacial Plastic and Reconstructive Surgery

Upper eyelid blepharoplasty needs to be determined to be medically necessary by the insurance provider, and each provider may have its own requirements, but they generally include:
Documented photographs of the eyelid abnormality Documentation of visual field obstruction, with improvement after the eyelids are tapedDocumented clinical exam and recommendation by a physician
If it is covered, you'll still be responsible for meeting your deductible and co-pays, based on your coverage.

Sometimes upper blepharoplasty surgery will be covered by insurance if the insurance  company deems that the excess skin laxity is hindering your field of vision.  Often they will require a visual fields test be done.  

In most cases, the excess skin must be fairly severe on the upper lids for insurance carriers to cover surgical correction. The required documentation almost always includes photographs demonstrating the skin hanging over the margin of the lid, visual field testing, and a patient complaint (such as difficulty with vision in certain directions or activities). All of these apply to the upper lid. Insurance does not typically cover lower eyelid blepharoplasty as this is considered cosmetic.
Be sure to see an expert.
All the best,

Typically, most health insurers require about a 30 to 35 deficit in the upper visual fields to confirm coverage. That means that you need to see better with your peripheral vision and upward gaze with a 35% improvement as if your eyelids were taped upward. We send our patients to have visual field testing by their eye specialist and if there is documentation of the visual field deficits, it is likely the insurance will approve your condition as medically necessary. This is not a guarantee and does vary from insurer to insurer.