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!

Insurance doesn’t cover eyelid surgery cost performed for aesthetic reasons. If the surgery is performed to correct vision or an eye deformity, the surgery may be partially reimbursed.  Your physician will refer for a peripheral field test to determine if there is a visual problem.

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.

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

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance.  Typically this is a cosmetic procedure.  Detailed description of your functional deficit, examination, testing, and photographs will be required in the rare instance of visual issues.  Only upper lids would be covered for this reason.  Lower eyelids are usually not a covered benefit for this reason.  Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

Insurance covering blepharoplastyIt is very challenging to prove to an insurance company that
removing the excess skin from the upper eyelid is truly a medically necessary
procedure.In most cases, it is purely
cosmetic and due to aging. In order for an insurance company to cover it, you
should see on ophthalmologist and have a visual field exam done.I believe more than 25% or 30% must be
blocked in order for them to consider it.This being said, most are not covered and really should not be billed
through insurance as removal of excess skin of the upper eyelid is not a
medically necessary procedure in most cases.

The majority of blepharoplasties are viewed as cosmetic by insurance companies.  Rarely, insurance carriers will cover the expense of an isolated upper eyelid blepharoplasty.  Under these circumstances the insurance company will declare that the procedure is medically necessary.
Before this can occur, the insurance carrier requires that certain criteria are met.  These include medical documentation of symptoms and physical findings associated with visual field obstruction.  In addition, they require formal visual field studies performed by an ophthalmologist or optometrist.  These studies must confirm the presence of significant visual field obstruction.
Once these studies are complete, a prior authorization letter is sent to the third party payer.  This should include the visual field studies and any other pertinent information.  If the insurance companies criteria are met, then occasionally they will cover the expense of blepharoplasty surgery.