Will my Insurance Pay for Blepharoplasty?

If hooding of the upper eyelids interfere with your vision, your health insurance company may cover blepharoplasty surgery for the upper eyelids only. Most health insurance companies exclude coverage for cosmetic surgical operations such as the lower eyelid blepharoplasty or any complications that might occur from the surgery. Most insurance plans exclude coverage from secondary or revisionary surgery.

You will have to check with your carrier to get an answer to this question, but generally insurance does not cover plastic surgery unless it is performed for medical reasons. In the case of blepharoplasty, some patients experience such significant drooping of their upper eyelid that it actually impairs their vision. As mentioned by my colleagues above, an optometrist would need to evaluate your case and you may need to provide additional proof of medical need to your insurer before you can be cleared. I hope this helps.

Your insurance would pay for upper lid surgery if you have visual field defects on examination all documented causing problems for you.

This is a wonderful question if you are interested in a blepharoplasty procedure. For an upper eyelid blepharoplasty there is a chance your insurance would cover this procedure. Your Optometrist may order a visual field test. This test helps show dysfunction in central and peripheral vision. A visual field test can then be submitted to your insurance for a possible approval. If you had any interest in a lower lid blepharoplasty this is consider a cosmetic procedure and your insurance unfortunately would not cover this procedure. Best of luck!

Thank you for your questions.  This is a very common question the patient's have.  In general insurance may cover blepharoplasty if it is related to functional concern and visual field obstruction.  Unfortunately he functional blepharoplasty is very much different than a cosmetic blepharoplasty.  He functional blepharoplasty involve simply removing excess skin to open up the femoral division.  It does lose discussed with the appearance of the upper eyelid and restore a youthful appearance.  There is many intricacies related to a cosmetic blepharoplasty that insurance does not pay for.  These include removing or repositioning fat pockets,  restoring the contour of the brow, restoring the contour of the natural crease. I would proceed with caution if your expectations are to look younger after a functional blepharoplasty...this is often not the case but your visual fields has significantly improved.  his appearance is her primary concern, a cosmetic blepharoplasty is most likely in your best interest.  Unfortunately this is oftentimes an out-of-pocket expense.  Best of luck in your decision-making, Dr. Pacella

Insurance will usually cover upper lid blepharoplasty for skin excess that causes visual field cuts.  Every insurance company has their own guidelines, but a rule of thumb is that you will need to see an optometrist or ophthalmologist to perform visual field tests with and without your upper eyelids taped to determine if there is vision change secondary to the excess upper eyelid skin.  Insurance will then usually cover skin excision.  For cosmetic blepharoplasty, skin and often fat is addressed to rejuvenate the eyes.  Insurance does not generally cover typical lower lid blepharoplasty.